Assessment of prostate cancer patients knowledge regarding managing side effects of chemotherapy
Abstract
Chemotherapy remains an important method for treating advance and metastatic prostate cancer. Chemotherapy has many side effects. Patients should have adequate knowledge to manage these side effects. The study aims to assess prostate cancer patients’ knowledge regarding management side effects of chemotherapy. A Quantitative study using cross-sectional design approach was conducted to assess level of knowledge for patients with prostate cancer regarding management side effects of chemotherapy. The study conducted from the period of 15th March 2024 up to 1st March 2025. A non-probability (purposive sampling) was used to select the study. The sample of the study consist of 50 patients diagnosed with prostate cancer receiving chemotherapeutic agents. A self-administration constructive questionnaire concerning knowledge of patients about managing side effects of chemotherapy was used in the current study. The findings of the study demonstrate that the most of age group of patients were between (66-71 years), not read & write, self-employee, not engaging in self-learning. Cancer duration for most patients were from 1-3 years, the duration of receiving chemotherapy for most patients were less than 1 year, Taxotere was the antineoplastic agents used for most cancer patients. Most patients were not having chronic diseases and with no family history. The study concluded that the level of knowledge was high percentage of patients had fair and poor knowledge about managing the side effects of chemotherapy.
Keywords: Prostate cancer, Knowledge, Side effects, Chemotherapy
Introduction
The study aimed to assess knowledge of the patients regarding management side effects of chemotherapy. As well as To find out the relationships among Patients’ knowledge and their demographic and clinical In the 1990s, chemotherapy's involvement in metastatic prostate cancer became prominent. Recent advancements during the past decade have significantly influenced the modern management of this condition [1]. Chemotherapy can be used to manage cancer patients to palliate symptoms of cancer by shrinking the tumor [2]. According to Sagt and colleagues study, most cancer patient experiencing side effects of chemotherapy as well as social and psychological aspects [3, 4]. The chemotherapies frequently employed for metastatic prostate cancer treatment are the taxane drugs docetaxel and cabazitaxel, which reversibly bind to microtubulin to inhibit microtubule depolymerisation, thereby obstructing cell division and facilitating cell death [5]. The deficiency of knowledge regarding chemotherapy treatment and the management of associated adverse effects may lead to higher hospital admissions, increased morbidity, and diminished quality of life for cancer survivors. Conversely, enhanced understanding of chemotherapy side effects can improve self-care practices for managing these effects, thereby contributing to an improved quality of life [6]. Cancer patients require information to recognize the side effects associated with chemotherapy and the appropriate actions to mitigate them. The provision of adequate pre-chemotherapy information, encompassing side effects and self-care strategies, has been shown to mitigate specific treatment-related concerns and improve physical and psychosocial outcomes [7]. Research involving cancer patients indicated that the side effects of chemotherapy and their management were prioritized among the necessary information. A Lei and colleagues indicated that the management and prevention of possible side effects were identified as the most significant treatment-related informational needs, alongside the rationale for treatment and its efficacy against cancer. There exists a persistent disparity between the actual needs of patients and the information supplied by healthcare professionals [8]. Patient and their family participate in self-management for their diseases or adverse effects of treatment, therefore should be well educated about engaging in self-management strategies [9].
Materials and Methods
A Quantitative study using cross-sectional design was conducted to assess level of knowledge for patients with prostate cancer regarding management side effects of chemotherapy. The study conducted in the Kirkuk oncology & hematology center from the period of 15th March 2024 up to 1st March 2025. A non-probability (purposive sampling) was used to select the study. The sample of the study consist of 50 patients diagnosed with prostate cancer receiving chemotherapeutic agents. Overall prostate cancer patients visiting Kirkuk oncology & hematology center were approximately 100 patients. Due to tiredness, older patients, not receiving chemotherapy, some patients excluded from the study. A self-administration questionnaire concerning knowledge of patients about managing side effects of chemotherapy was used in the current study. It is composed of three parts: Part one: Socio-demographic data of the study sample, Part two: Clinical Data, Part three: patients’ knowledge regarding management side effects of chemotherapy. Validity done by presenting the questionnaire to 15 experts from nursing specialties [10-14]. Test-retest reliability is a measure of reliability obtained by administering the same test twice over a period of time to a group of individuals which determined by using Pearson Correlation Coefficient (0.75). The collection of data was taken approximately 20-25 minutes to complete the questionnaire. The data were collected and analyzed by using SPSS version 26. descriptive and inferential statistics was used as follow:
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(1) |
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(2) |
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(3) |
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(4) |
Results and Discussion
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Table 1. Distribution of Patients according to their Socio-demographic Characteristics |
||||
|
No. |
Characteristics |
f |
% |
|
|
1 |
Age (year) |
54 – 59 |
9 |
18 |
|
60 – 65 |
16 |
32 |
||
|
66 – 71 |
25 |
50 |
||
|
Total |
50 |
100 |
||
|
2 |
Level of education |
Not read & write |
11 |
22 |
|
Read & write |
9 |
18 |
||
|
Primary |
5 |
10 |
||
|
Intermediate |
7 |
14 |
||
|
Secondary |
5 |
10 |
||
|
Diploma |
6 |
12 |
||
|
Bachelor + |
7 |
14 |
||
|
Total |
50 |
100 |
||
|
3 |
Occupation |
Employee |
6 |
12 |
|
Self-employee |
25 |
50 |
||
|
Retired |
10 |
20 |
||
|
Jobless |
9 |
18 |
||
|
Total |
50 |
100 |
||
|
4 |
Self-learning |
No |
37 |
74 |
|
Yes |
13 |
26 |
||
|
Total |
50 |
100 |
||
|
5 |
Learning source |
None |
37 |
74 |
|
Scientific website |
2 |
4 |
||
|
Social network |
2 |
4 |
||
|
Doctor/nurse |
2 |
4 |
||
|
Book/magazine |
0 |
0 |
||
|
More than one |
7 |
14 |
||
|
Total |
50 |
100 |
||
No: Number, f: Frequency, %: Percentage
Table 1 displays the majority of patients fall within the 66–71 age range (50%). A notable percentage of patients have low educational level (22%). concerning occupational status, a significant proportion of patients (50%) are self-employed. The patients reported that they not engaging in self-learning (74%).
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Table 2. Distribution of Patients according to their Clinical Variables |
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|
No. |
Variables |
f |
% |
|
|
1 |
Cancer duration |
1 – 3 years |
34 |
68 |
|
4 – 6 years |
16 |
32 |
||
|
Total |
50 |
100 |
||
|
2 |
Duration of chemotherapy |
< 1 year |
21 |
42 |
|
1 – 2 year |
17 |
34 |
||
|
3 – 4 years |
11 |
22 |
||
|
5 < years |
1 |
2 |
||
|
Total |
50 |
100 |
||
|
3 |
Type of chemotherapy |
Taxotere |
29 |
58 |
|
Carboplastin |
6 |
12 |
||
|
Carbazitaxel |
8 |
16 |
||
|
Gemzar |
3 |
6 |
||
|
Doctaxel |
4 |
8 |
||
|
Total |
50 |
100 |
||
|
4 |
Chronic disease |
No |
29 |
58 |
|
Yes |
21 |
42 |
||
|
Total |
50 |
100 |
||
|
5 |
Type of disease |
None |
29 |
58 |
|
Hypertension |
7 |
14 |
||
|
Diabetes |
7 |
14 |
||
|
Other |
7 |
14 |
||
|
Total |
50 |
100 |
||
|
6 |
Family history of prostate ca |
No |
33 |
66 |
|
Yes |
17 |
34 |
||
|
Total |
50 |
100 |
||
No: Number, f: Frequency, %: Percentage.
Table 2 reveals that most of patients have been dealing with prostate cancer for 1–3 years (68%). The duration of chemotherapy refers that most patients have been undergoing chemotherapy for less than 1 year (42%). The most commonly used chemotherapy drug is Taxotere with (58%) of patients receiving this treatment. Regarding chronic disease, a majority of patients do not have chronic diseases (58%). Regarding family history of the patients, there were (34%) of the patients were family history of prostate cancer [15-18].
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Table 3. Assessment of Patients’ Knowledge about Management Side Effect of Chemotherapy. |
|||||
|
No |
Knowledge about Gastrointestinal system items |
Scale |
F(%) |
M |
Ass. |
|
1 |
Anti-emetic medication given before chemotherapy |
Incorrect |
42(84) |
.16 |
Poor |
|
Correct |
8(16) |
||||
|
2 |
Before chemotherapy, I should eat Light meal |
Incorrect |
29(58) |
.42 |
Fair |
|
Correct |
21(42) |
||||
|
3 |
Before chemotherapy, I should drink Plenty of liquid |
Incorrect |
16(32) |
.68 |
Good |
|
Correct |
34(68) |
||||
|
4 |
It is preferred to divide meal daily small six times |
Incorrect |
37(74) |
.26 |
Poor |
|
Correct |
13(26) |
||||
|
5 |
When diarrhea occurred, patients stop eat fibers |
Incorrect |
33(66) |
.34 |
Fair |
|
Correct |
17(34) |
||||
|
6 |
The boiled rice and clear broth beverages preferred during diarrhea |
Incorrect |
34(68) |
.32 |
Poor |
|
Correct |
16(32) |
||||
|
7 |
Constipation can be managed with fiber diet |
Incorrect |
34(68) |
.32 |
Poor |
|
Correct |
16(32) |
||||
|
8 |
In constipation, patients drink plenty of fluid |
Incorrect |
17(34) |
.66 |
Fair |
|
Correct |
33(66) |
||||
|
List |
Knowledge about Blood items |
Scale |
F(%) |
M |
Ass. |
|
1 |
To minimize fatigue, patients should sleep 8-10 hours |
Incorrect |
34(68) |
.32 |
Poor |
|
Correct |
16(32) |
||||
|
2 |
Commonly fatigue caused by decreased blood cells |
Incorrect |
36(72) |
.28 |
Poor |
|
Correct |
14(28) |
||||
|
3 |
Regular exercise preferred when feeling tired |
Incorrect |
19(38) |
.62 |
Fair |
|
Correct |
31(62) |
||||
|
4 |
Plenty of fruits can help Reduce fatigue |
Incorrect |
36(72) |
.28 |
Poor |
|
Correct |
14(28) |
||||
|
5 |
Use electric razor to prevent easy bleeding |
Incorrect |
19(38) |
.62 |
Fair |
|
Correct |
31(62) |
||||
|
List |
Knowledge about Nervous system items |
Scale |
F(%) |
M |
Ass. |
|
1 |
Checking water temperature, I use my elbow |
Incorrect |
38(76) |
.24 |
Poor |
|
Correct |
12(24) |
||||
|
2 |
To prevent bleeding and wounds, I take care when using knives |
Incorrect |
20(40) |
.60 |
Fair |
|
Correct |
30(60) |
||||
|
3 |
Improving balance, strength, and weakness, by exercise |
Incorrect |
36(72) |
.28 |
Poor |
|
Correct |
14(28) |
||||
|
4 |
Improving peripheral neuropathy, I consume food rich in vitamins |
Incorrect |
42(84) |
.16 |
Poor |
|
Correct |
8(16) |
||||
|
5 |
The common site of nerves that affected by chemotherapy is peripheral nerve |
Incorrect |
32(64) |
.36 |
Fair |
|
Correct |
18(36) |
||||
|
List |
Knowledge about Urinary system items |
Scale |
F(%) |
M |
Ass. |
|
1 |
Most common urinary problem after chemotherapy is hematuria |
Incorrect |
34(68) |
.32 |
Poor |
|
Correct |
16(32) |
||||
|
2 |
To decrease urinary problems after chemotherapy, I drink 8–10 glass of water |
Incorrect |
24(48) |
.52 |
Fair |
|
Correct |
26(52) |
||||
|
3 |
To remove toxins from urinary tract, I drink water |
Incorrect |
28(56) |
.44 |
Fair |
|
Correct |
22(44) |
||||
|
4 |
Holding larger volume of urine in bladder help to decrease urinary urgency |
Incorrect |
36(72) |
.28 |
Poor |
|
Correct |
14(28) |
||||
|
5 |
Avoiding coffee beverage that irritate the bladder |
Incorrect |
34(68) |
.32 |
Poor |
|
Correct |
16(32) |
||||
|
List |
Knowledge about Immune system items |
Scale |
F(%) |
M |
Ass. |
|
1 |
After chemotherapy, immunity decreased due to decreased WBCs |
Incorrect |
35(70) |
.30 |
Poor |
|
Correct |
15()30 |
||||
|
2 |
Whole grains can provide essential nutrients to support immune function |
Incorrect |
24(48) |
.52 |
Fair |
|
Correct |
26(52) |
||||
|
3 |
I perform good hand washing before and after meal |
Incorrect |
42(84) |
.16 |
Poor |
|
Correct |
8(16) |
||||
|
4 |
To prevent infection, I avoid crowded places |
Incorrect |
40(80) |
.20 |
Poor |
|
Correct |
10(20) |
||||
|
5 |
I monitor fever, the most sings and symptom of infection |
Incorrect |
32(64) |
.36 |
Fair |
|
Correct |
18(36) |
||||
|
List |
Knowledge about integumentary system items |
Scale |
f (%) |
M |
Ass. |
|
1 |
I believe alopecia occurred after chemotherapy temporary |
Incorrect |
21(42) |
.58 |
Fair |
|
Correct |
29(58) |
||||
|
2 |
Re-grow of hair after completing chemotherapy treatment occur within 4-12 months |
Incorrect |
37(74) |
.26 |
Poor |
|
Correct |
13(26) |
||||
|
3 |
Scalp sensitive after chemotherapy, it's important to protect from sun by using hat |
Incorrect |
43(86) |
.14 |
Poor |
|
Correct |
7(14) |
||||
|
4 |
Consuming Omega-3 fatty acid nutrients are essential for promoting hair growth |
Incorrect |
29(58) |
.42 |
Fair |
|
Correct |
21(42) |
||||
|
5 |
I Comb my hair gently using large comb |
Incorrect |
21(42) |
.58 |
Fair |
|
Correct |
29(58) |
||||
|
6 |
Chemotherapy can make my skin more sensitive to the sun, so I use sunscreen |
Incorrect |
36(72) |
.28 |
Poor |
|
Correct |
14(28) |
||||
Ass: Assessment, M: Mean, (Poor= 0-0.33, Fair= 0.34-0.66, Good= 0.67-1)
Table 3 exhibit the patients’ knowledge regarding management side effects of chemotherapy were poor and fair knowledge in all section of knowledge scale.
The current study aimed to assess prostate cancer patient knowledge concerning managing side effects of chemotherapy. It is important to the patients to be aware and overcome the undesirable effects of chemotherapy [6]. The study revealed that the majority of prostate cancer patients’ knowledge demonstrate poor and fair knowledge for overall domains regarding management side effects of chemotherapy). According to the study conducted by Majeed and Atiyah were revealed poor knowledge among participants regarding screening of prostate cancer and contributing factors [19].
The findings of the present study exhibit inadequate knowledge concerning management side effect of chemotherapy of gastrointestinal system especially in given anti-emetics before session of chemotherapy and dividing meals to six small meals. The results similar with Cope 2022 that indicates despite of advances in medication to prevent nausea and vomiting affect most patients undergoing chemotherapy [20]. Similar results conducted by Moghazy and others, which states the knowledge level inadequate before utilization of educational program [21]. Most patients display poor knowledge in relation to managing side effects of chemotherapy for blood items as in sleep for 8-10 hours to minimize fatigue and causes of fatigue [22-25]. The results of the study show insufficient knowledge for most patients regarding nervous system after administering chemotherapy mostly in checking temperature by using elbow and improve balance and strengthen with exercise, chemotherapy-induced peripheral neuropathy can be mitigated with self-care behaviors, Al-Fahham and Al-Jubouri indicate that Peripheral neuropathy can be relieved by foot massage, range of motion by educating the patient proper self-care [26] Regarding patients’ knowledge for managing side effects of chemotherapy for urinary system, the majority of patients exhibit inadequate knowledge especially in items of common urinary problems after chemotherapy is hematuria and decreasing urinary urgency with holding urine for long periods. the patients asked for immune system and demonstrate poor knowledge about chemotherapy side effects management, including in performing hand washing before and after meals and avoiding crowded places to prevent infection. also patients exhibit insufficient knowledge regarding managing side effects of chemotherapy for integumentary system as in items of regrow of hair within 4-12 months after completing session of chemotherapy and protect the sensitive scalp after chemotherapy by using hat. Several techniques the healthcare providers can be assumed to ease chemotherapy-induced side effects for patients with cancer [27]. Flayeh and Khuder study recommended printing guide and booklet to improve patients’ knowledge as well as participating patients in educational program [28].
|
Table 4. Relationships among Patients’ Knowledge and their Sociodemographic Variables in the Study sample |
||||
|
Variables |
Overall Knowledge |
|||
|
Mean |
SD |
Relationship |
||
|
Age (year) |
54 – 59 |
24.40 |
2.881 |
rs = .042 P-value= .841 Sig= N.S |
|
60 – 65 |
21.13 |
2.475 |
||
|
66 – 71 |
23.83 |
2.791 |
||
|
Total |
23.08 |
2.943 |
||
|
Level of education |
Not read & write |
22.00 |
1.095 |
rs = .390 P-value= .054 Sig= N.S |
|
Read & write |
21.50 |
5.000 |
||
|
Primary |
23.00 |
1.414 |
||
|
Intermediate |
26.33 |
4.619 |
||
|
Secondary |
21.00 |
1.414 |
||
|
Diploma |
24.25 |
1.893 |
||
|
Bachelor + |
23.75 |
1.258 |
||
|
Total |
23.08 |
2.943 |
||
|
Occupation |
Employee |
23.00 |
1.414 |
rs = .045 P-value= .831 Sig= N.S |
|
Self-employee |
23.07 |
3.668 |
||
|
Retired |
24.25 |
1.893 |
||
|
Jobless |
22.20 |
1.643 |
||
|
Total |
23.08 |
2.943 |
||
|
Learning source |
None |
22.78 |
3.282 |
rs = .278 P-value= .179 Sig= N.S |
|
Scientific website |
24.00 |
. |
||
|
Social network |
22.00 |
. |
||
|
Doctor/nurse |
24.50 |
.707 |
||
|
More than one |
24.00 |
2.646 |
||
|
Total |
23.08 |
2.943 |
||
rs: Spearman Correlation coefficient, r*: Biserial correlation coefficient, P: Probability, Sig: Significance, N.S: Not Significant, S: Significant, H.S: High Significant
Table 4 indicates that there is no significant relationship has reported among patients' overall knowledge scores in the study group and sociodemographic variables; age, level of education, occupation, and learning sources.
|
Table 5. Relationships among Patients’ Knowledge and their Clinical Variables in the Study samples |
||||
|
Variables |
Overall Knowledge |
|||
|
Mean |
SD |
Relationship |
||
|
Cancer duration |
1 – 3 years |
23.00 |
3.181 |
r*= .031 P-value= .882 Sig= N.S |
|
4 – 6 years |
23.29 |
2.430 |
||
|
Total |
23.08 |
2.943 |
||
|
Duration of chemotherapy |
< 1 year |
22.45 |
1.440 |
rs = .120 P-value= .567 Sig= N.S |
|
1 – 2 year |
23.86 |
4.880 |
||
|
3 – 4 years |
23.29 |
2.430 |
||
|
Total |
23.08 |
2.943 |
||
|
Type of chemotherapy |
Taxotere |
22.60 |
2.823 |
rs = .225 P-value= .279 Sig= N.S |
|
Carboplastin |
21.33 |
1.155 |
||
|
Carbazitaxel |
24.80 |
2.588 |
||
|
Gemzar |
25.00 |
5.657 |
||
|
Total |
23.08 |
2.943 |
||
|
Chronic disease |
None |
22.33 |
2.795 |
rs = .270 P-value= .192 Sig= N.S |
|
Hypertension |
24.67 |
4.041 |
||
|
Diabetes |
23.67 |
3.786 |
||
|
Both |
24.25 |
2.217 |
||
|
Total |
23.08 |
2.943 |
||
|
Family history of prostate ca |
No |
22.81 |
3.209 |
r*= 147 P-value= .484 Sig= N.S |
|
Yes |
23.56 |
2.506 |
||
|
Total |
23.08 |
2.943 |
||
rs: Spearman Correlation coefficient, r*: Biserial correlation coefficient, P: Probability, Sig: Significance, N.S: Not Significant, S: Significant, H.S: High Significant
Table 5 reveals that there is no significant relationship has reported among patients' overall knowledge scores in the study group and clinical variables; cancer duration, duration of chemotherapy, type of chemotherapy, chronic disease, and family history of prostate cancer.
The findings of the present study indicate that there is no significant relationship has reported among patients' overall knowledge scores in the study group and sociodemographic variables; age, level of education, occupation, marital status, residency, and learning sources. The results of the study were similar with the study conducted by Ibrahim and Bakey 2023 that indicated elderly having inadequate knowledge about hygiene and no relationship between persons’ knowledge with their sociodemographic data [29]. Another study indicates no significant between patient knowledge and sociodemographic dat [30]. The Table 5 reveals that there is no significant relationship has reported among patients' overall knowledge scores in the study group and clinical variables; cancer duration, prostate surgery, duration of chemotherapy, type of chemotherapy, chronic disease, and family history of prostate cancer. The results not parallel with the study of Odah and Hattab, that found significant association had been revealed between some sociodemographic data with knowledge of study participant [31, 32].
Conclusion
The patients’ knowledge concerning management side effects of chemotherapy were inadequate in both study and control group during pretest. there is no significant relationship has reported among patients' overall knowledge scores in the study and control group and sociodemographic variables; age, level of education, occupation, marital status, residency, and learning sources. Also there is no significant relationship has reported among patients' overall knowledge scores in the study and control group and clinical variables; cancer duration, prostate surgery, duration of chemotherapy, type of chemotherapy, chronic disease, and family history of prostate cancer.
Acknowledgments: None
Conflict of interest: None
Financial support: None
Ethics statement: Official approvals were obtained to conduct this study from the College of Nursing, and official permission was obtained from Kirkuk Health Directorate/ oncology Center to approve the research and collect data from patients. Patients were informed of the confidentiality of information and their consent was obtained.
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