Chemotherapy Induced Dermatological Adverse Reactions and its Effect on Quality of Life for older Women with Breast Cancer
EmanShokryAbd Allah1, ShimaaAbo Khalil abd el-rafea2, Naeima Mohamed Elsayed
1Professor and Head of Gerontological Nursing Department, Faculty of Nursing, Zagazig University, Egypt, Email: [email protected]
2Instructor of Gerontological Nursing, Faculty of Nursing, Zagazig University, Egypt
3Assistant professor of obstetrics and gynecological Nursing, Faculty of Nursing, Zagazig University, Egypt, Email: [email protected]
Corresponding Author: ShimaaAbo Khalil AbdEl-Rafea, Email:
Abstract
Study’s purpose: to assess chemotherapy induced dermatological adverse reactions and its effect on quality of life for older women with breast cancer.Methodology: a descriptivestudy conducted at X University Hospitalswas used. Study sample was selected purposively which composed of 100 older women. Demographic characteristics for older women, Dermatological adverse reactions measured by X version of the common terminology criteria for adverse events. Skindex-29 measures the effects of skin reactions on quality of life.
Major results:revealed that 100% of older women were at risk of dermatological adverse reactions and 55% their skin symptoms had extremely sever effect on total quality of life.
Highly statistically significant relation between hair, head, nails and body side effectsandtheir total effect on quality of life Clinical implications: Conducting Dermatology-educational programs for older women with breast cancer receiving chemotherapy to pay attention to healthy skin and how to overcome dermatological side effects.
Keywords: Dermatological adverse reactions, older women, breast cancer, chemotherapy, quality of life
Introduction
Populations around the world are ageing at a faster pace than in the past and this demographic transition will have an impact on almost all aspects of society. By 2030 the world is likely to have 1 billion older, accounting for 13 percent of the total population. While today’s proportions of older people typically are highest in more developed countries, the most rapid increases in older populations are occurring in the less developed world (United Nations, 2019). Egypt's elderly people account 6 .5million (3.5 million males and 3 million females) according to the (Central Agency for Public Mobilization and Statistics ''CAPMAS'' 2019).
Breast cancer is a disease of the older women. Carcinoma of the breast is the most prevalent cancer among Egyptian women and hence, it has particularly marked familial, societal and economic consequences (Punglia et al., 2018). Chemotherapy and new protocols in oncology have led to an increasing survival rate in women affected by breast cancer. However, this increased use has been accompanied by a growth in the incidence of cutaneous side effects and a worsening of women’s quality of life. The dermatological syndromes most often associated with these therapeutic targets are as follows: Alopecia, scalp pain, xerosis (Dry skin), hyper pigmentation, hand-foot syndrome, pruritus, hypersensitivity reactions, nail changes and nail discoloration. They are rarely fatal but may result in significant morbidity, cosmetic disfigurement and psychological distress (Berthelot et al., 2010).Quality of life is a dynamic and multidimensional measure that includes the diagnostic effects, the impact and progression of disease treatment on normal daily activities and the rehabilitation of breast cancer women (Al Zahrani et al., 2019).Currently in oncology quality of life is considered to
be an indicator for assessing the quality of care and its management. Psychological, physical and social well-being is subjectively measured by the quality of life and provides insight into daily life during breast cancer treatment (Zaid et al., 2017).Dermatological toxicities occur while older women with breast cancer are being treated with targeted therapies (chemotherapy).Their onset may cause dose reductions and/or delays in administering the prescribed therapy which can affect patient survival (Curry et al., 2019). This toxicity has a significant impact on patients’ quality of life and can affect their personal, social and workplace relationships. As a result, early diagnosis of these side effects is important and therapeutic steps to reduce severity and duration must be taken as soon as possible. A multidisciplinary assessment by a medical oncologist, dermatologist and oncology nurse is also needed to care for these women (Haanen et al., 2017).Once the existence of cutaneous toxicity of grade two or above has been confirmed, the olderwomen should be referred to the dermatology department to commence specific treatment to improve the symptoms. Follow- up should take place. In the event of deterioration, the patient should be admitted to hospital (Walko et al., 2018) .Appropriate management of skin toxicity associated with chemotherapy is therefore necessary for suitable drug administration and to improve quality of life and clinical outcomes. Preventive measures are important such as using suitable footwear (padded and exerting no pressure) podiatric care, good hygiene, applying emollient creams and avoiding contact with anything hot (Lee et al., 2018).
Literature review
A high proportion of dermatological side effects were reported in cross-sectional survey study carried out in Brazil byHu et al. (2014) demonstrated that 96% of olderwomen diagnosed with breast cancer were at high risk of dermatologic manifestations during receivingchemotherapy.Additionally,National cancer institute, (2020) at the national institute of health which reported that older women who undergo chemotherapy were at risk of dermatological adverse reactions which put them at increased risk for toxic changes in the hair, mucosa, nails, body and skin. Meanwhile, skin toxicity is a common side effect of chemotherapy that is experienced by 70%–100% of older women treated for early-stage breast cancer. Reactions occur within one to four weeks of treatment and range from erythema to dry or wet desquamation and ulceration may occur in more severe cases. Skin toxicity may affect women for a long time post-treatment. So, increased knowledge about patients experience will contribute to provide tailored patient care (Butcher& Williamson, 2018).However, adverse skin reactions to these therapies are sometimes so severe that they make significant disturbance to older women and the dose of anticancer agent should be adjusted at times, meaning that they can affect not only the patient's quality of life but also optimal anticancer treatment. Therefore, they must not be ignored and should be evaluated and managed (Lee et al., 2018).In the study setting, the dermatological adverse reactions and its effect on quality of life aretypically excluded during the course of chemotherapy.
Furthermore, studies that assess dermatological adverse reactions and its effect on quality of lifein our country are limited; hence this study was conducted to assess chemotherapy induced dermatological adverse reactions and its effect on quality of life for older women with breast cancer at XUniversity Hospitals.
Method
Study Design and Ethical Considerations
A descriptive design was used to achieve the aim of the study from beginning of May 2020 up to the end of October 2020; three days per week in the oncology day clinic at X University Hospitals. The study was approved by the Research Ethics Committee (REC) and the
Postgraduate Committee of the Faculty of Nursing at X University. Written consent was obtained from the patients after a description of the purpose of the study.
Sample
A purposive sample composed of 100older women aged 60 years or above, received at least one chemotherapy cycle with all stages of breast cancer and able to communicate was selected in the recruitment of this study.
Sample size calculation
The sample size was calculated by using the software Epi Info package.It was found to be 100 older women according to the expected prevalence of dermatological adverse reactions on quality of life is 34.1% (Hackbut, 2008) and number of elderly women with breast cancer who admitted to the oncology outpatient clinic in one year during 2019 which were 2400.
Tool of data collection
Three tools were used to collect necessary data.Tool I: An interview questionnairethat was developed by the researchers based on the literature review.It consisted of three parts;Part one used to assess the demographic characteristics which included age, gender, residence, marital status, educational level, previous working, current working, monthly income and the source of income and living condition.
Tool II: Skindex-29 health related quality of life (HRQOL) instrument (Chern et al., 1996).
This tool was designed to measure the effects of skin reactions on patients' lives and adopted by (Chern et al., 1996).This dermatology-specific questionnaire composed of 29 items measures the effects on three domains of HRQOL: Symptoms, emotions and functioning.
Each item asks the patient the degree to which they have been bothered by a specific aspect of their skin condition in the week before administration of the instrument. The patient answers each question by indicating a number from 1 (never bothered) to 5 (always bothered).The items checked from never to always bother were scored from 1 to 5 respectively and the total score was ranged between 1-145. The scores of items of each category and the total scale were summed-up and the total divided by the number of items giving a mean score. This score were converted into percent score as ≥ 3 = very little effect on quality of life,4 –10 = Mild effect on quality of life, 11–25 = Moderate effect on quality of life, 26–49 = Severe effect on quality of life and< 50 = Extremely severe effect on quality of life.In the current study, it’sCronbach α was 0.780.
Tool III:Common Terminology Criteria for Adverse Events [CTCAE](National Cancer Institute’s; 2017).
This tool was adopted by (National Cancer Institute’s; 2017) which includes 40 questions related to skin and subcutaneous tissue disorder that had five grades for each adverse events as (alopecia, dry skin, eczema, palmer-planter erythro-dysesthesia syndrome (PPE) and nail changes). Grade refers to the severity of the adverse events (AE). The CTCAE displays grades 1 through 5 with unique clinical descriptions of severity for each adverse reaction. The sum of the questions can provide the following grades: Grade 1: Asymptomatic or mild symptoms; clinical or diagnostic observations only; intervention not indicated, Grade 2:
Minimal, local or noninvasive intervention indicated; limiting age appropriate instrumental activities of daily living (ADL),Grade 3: Medically significant but not immediately life- threatening; hospitalization or prolongation of hospitalization indicated; disabling; limiting self-care activities of daily living (ADL), Grade 4: Life-threatening consequences; urgent intervention indicated and Grade 5 (Death): Related to adverse events.The researchers read all questions of the tools to the patients and record their answers. The tool was presented to a panel of three experts in the field of community& obstetrics and gynecological (one professor
of community, one assistant professor of community and one professor of obstetrics and gynecological health nursing) for face and content validation. They assessed the tool for clarify, relevance, comprehensiveness and applicability. The tool was modified according to their comments and suggestions.
Statistical analysis
The statistical analysis of data was done by using the computer software of Microsoft Excel Program and Statistical Package for Social Science (SPSS) version 22. Data were presented using descriptive statistics in the form of frequencies and percentage for categorical data, the arithmetic mean (X) and standard deviation (SD) for quantitative data. Qualitative variables were compared using chi square test (X) 2, P-value to test association between two variables and R- test to the correlation between the study variables. Degrees of significance of results were considered as follows: P-value > 0.05 Not significant-value ≤ 0.05 Significant and P- value ≤ 0.01 Highly Significant.
Results
The study findings revealed that, there were statistically significant relations between their total effect on quality of life and their age (P =.041), residence (p= .331) and marital status (p= 0.44). It is clear that the higher percentages of extremely sever effect on their quality of life were aged 60 years and over, belonged to rural areas, married, illiterate and had insufficient income. Meanwhile, educational level (p= .952) and monthly income were highly statistically significant related to total effect on quality of life of the older woman at P = .034.(Table 1).Concerning dermatological adverse reactions, the most common side effects experienced by the studied older women were hair texture abnormal&alopecia (90% ―grade 1‖&84% ―grade 2‖), nail changes & nail discoloration (90% ―grade1‖ &90% ―grade 1‖), fat atrophy & hyperhidrosis (81%―grade 2‖ &74% ―grade 2‖), skin hyper pigmentation& Dry skin ''xerosis'' (80 %―grade 2‖ &72% ―grade 2‖) and urticaria& palmer- planter erythrodysthesia syndrome (69% ―grade 2‖&47% ―grade 2‖). It indicates statistically highly positive correlation between hair, nails side, body, skin side effects and quality of life of the studied patients at p- value (<0.01)(Table 2).The study also demonstrates that there were highly statistically significant relations between hair and head side effects as (alopecia, hair color changes, hair texture abnormal and scalp pain) and their total effect on quality of life at (P= < 0.01). Additionally, there was highly statistically significant relation between Elderly’s nails side effects as (nail changes, nail discoloration, nail loss and nail ridging) and their total effect on quality of life at (P= < 0.01). Moreover, there was statistically significant relation between Elderly’s body side effects as (hyperhidrosis, hirsutism and hypertrichosis) and their total effect on quality of life at (P= < 0.05). While, there was no statistically significant relation between Elderly’s body side effects as (body odor, fat atrophy and hyperhidrosis) and their total effect on quality of life at (P= > 0.05).Table3 reveals that, there washighly statistically significant relation between skin side effects as (dry skin, pain of skin, skin hyper pigmentation, telangiectases, hyperkeratosis, urticaria, pruritus nd photosensitivity) and their total effect on quality of life at (P= < 0.01). Also,there was statistically significant relation between Elderly’s skin side effects as (Palmar-plantar erythro-dysesthesia syndrome, skin hypopigmentation, rash acneiform and rash maculopapular) and their total effect on quality of life at (P= < 0.01).Table 4expounds that the age (p=.047),marital status (p=.039), monthly income (p=.021), suffering from chronic diseases (p=.034), Duration of breast cancer diagnosis (p=.041), cancer stage at diagnosis (p=.003), Stages of breast cancer at diagnosis(p=.031),Time since receiving chemotherapy(p=.029), and number of chemotherapy cycles (p=.045).However, there was significant statistical positive effect from monthly income, timing of cancer diagnosis on total effect on quality of life at (p = <0.05).
While, there was significant statistical negative effect from age, marital status, history of
chronic diseases, stage at diagnosis of breast cancer, time since receiving chemotherapy and previous chemotherapy history on total effect on quality of life at (p = <0.05).
Discussion
Based on the current study findings, all of older women were at risk of dermatological adverse reactions.Such a finding may be the result of ageing, cancer or chemotherapy side effects that cause a variety of symptoms that interfere with one's quality of life. This is further supported by the study findings as the highly reported side effects were alopecia, nail changes, hyper pigmentation, dry skin, and hand foot syndrome. Also,the lowest educational achievement category was related to a higher risk of cancer especially breast cancer in women. Such result might be due to a low level of knowledge regarding ways of breast cancer prevention and healthy lifestyle such as healthy diet, exercises, and how to perform breast self-examination.This is in congruence with National cancer institute, (2020) at the national institute of health which reported that elderly women who undergo chemotherapy were at risk of dermatological adverse reactions which put them at increased risk for toxic changes in the hair, mucosa, nails, body and skin. Furthermore, an internal malignancy such as breast cancer, as well as their treatment can often result in skin changes being with hair loss the most frequent followed by nail changes.In present study, the relation between demographic characteristic compared to the effect of dermatological adverse reactions on quality of life was statistically significant (P= < 0.05). Moreover, these data highlight that has marked positive impacts on quality of life. These findings have been similarly reported by Alzabaidey, (2017) showed that the highest percentages of affected elderly women were in the age group 60 years and over. The explanation of such relation is that advanced age is highly prone to skin adverse reactions. This might be due to high level of illiteracy, low socioeconomic conditions, and limited health care facilities in these areas, all of which negatively affection on their health and quality of life especially after receiving chemotherapy.Concerning relation between level of educationanddemographic characteristic compared to the effect of dermatological adverse reactions on quality of life, the results indicate that the level of education and residence of studied older women found that nearly less than half of the studied elderly women were illiterate and three- quarters belonged to rural areas. This result might be due parental focus or interest particularly in children's education has been low in the last century.Additionally, low education has been associated with the forgetting of medical information and more negative attitudes towards cancer.
Moreover, low socioeconomic status is also negatively correlated with health-related QOL among the breast cancer women. So, if having a better grasp of patient's backgrounds, the healthcare professionals are able to implement an effective strategy in managing chemotherapy-related side effects and providing important information.The current study revealed that dermatological adverse reactions were highly associated with insufficient income. Moreover, monthly income was a statistically significant independent predictor for dermatological adverse reactions. The explanation of such result is that the most of the studied older women were depending on their pension which is often very low compared to their requirements and drugs needed, therefore the financial burden of cancer increased.In the same context, Yip et al., (2015) carried out a study in Africa, which reported breast cancer mortality in countries with lower income is higher where women in low-income countries seek treatment in advanced stages of disease, when it has spread to other organs and care has a relief aspect in these people.Furthermore, poverty is considered a major contributing factor of occurrence of breast cancer as lower socioeconomic status is associated with less accessibility to healthcare services to detect breast cancer or even treat any skin adverse reactions. Additionally, such results might be due to that cancer and chemotherapy increase the financial burden on geriatric patients as many of them are defraying some of their
treatment expenses besides low economic status that already present.Concerning relation betweenthe grades of common toxicity criteria of chemotherapy compared to its effect on quality of life, the present study were illustrated that most of the studied older women were had grade one of hair texture abnormality and the majority had grade two of alopecia. This is considered the first dermatological manifestation from the use of antineoplastic drugs which appearing straight after the beginning of the treatment and occurs due to fragmentation and reduction in the diameter and depigmentation of the hair (Dinesh et al., 2017). Nail changes are also considered frequent that usually appear between four to eight weeks of treatment.
With regards to nails side effects among older women under the study showed that most of them were suffered from grade one of nail changes and nail discoloration.In the same line, studies conducted by Capriotti et al. (2019) in United States, who found that nail toxicity appears to be cumulative and related to the number of chemotherapy. These nail conditions are not only cosmetically undesirable and emotionally disturbing to women with cancer but may also be painful, limit manual activities and disrupt quality of life in nearly half of older women and occasionally lead to treatment interruption.As for the body side effects the present study found that nearly three-quarters were suffered from grade two of fat atrophy and hyperhidrosis. In confirmation of the forgoing results, Oncology Nursing Society, (2020) reported that the studied older women undergoing chemotherapy who have fat atrophy as gain weight during treatment, it may be due to changes in hormone levels or due to certain anti-cancer drugs that cause body to hold on to extra fluid and has ahigh impact on the quality of life.Regarding the side effects of skin itself, the present study showed that nearly three- quarters were had grade two of skin hyper pigmentation, dry of skin, pruritus, urticaria and pain of skin. Meanwhile, about half of them had grade three of palmer-planter erythro- dysesthesiasyndrome. Additionally, The current study reveals that, highly statistically significant relation between Elderly’s skin side effects as (dry skin, Palmar-plantar erythro- dysesthesia syndrome, pain of skin, skin hyper pigmentation, telangiectases, hyperkeratosis, urticaria, pruritus and photosensitivity) and their total effect on quality of life at (P= <
0.01).Similarly, Patel et al. (2016) who conducted a cross-sectional study found that almost three-quarter of the older Taiwanese women receiving chemotherapy had reticulate hyper pigmentation on her abdomen, back and extremities after receiving her initial treatment for metastatic breast cancer. The hyper pigmentation became darker with each subsequent administration of chemotherapy.This finding is consistent withstudy carried out by Komatsu et al. (2019) in United States found that almost half of older women receiving chemotherapy had Hand-foot syndrome (HFS), also referred to as palmar-plantar erythro-dysesthesia.This study clarified that there was significant statistical positive effect from monthly income, timing of cancer diagnosis on total effect on quality of life at (p = <0.05). While, there was significant statistical negative effect from age, marital status, history of chronic diseases, stage at diagnosis of breast cancer, time since receiving chemotherapy and previous chemotherapy history on total effect on quality of life at (p = <0.05).Considering chemotherapy cycles, the current study found that receiving ten or more chemotherapy cycles was highly associated with effect on quality of life. Furthermore, the number of chemotherapy cycles was a statistically significant independent predictor of the studied older women with breast cancer and their total effect on quality of life. Such result might be due to the repeated exposure to chemotherapy and recurrence of its adverse reactions in each cycle makes the patients more vulnerable to dermatological side effects and effect on quality of life. In the same line, Dehkordi et al. (2019) conducted a study in Iran stated that about two- thirds (66%) of the patients had strong correlation between quality of life and number of chemotherapy cycles.
Limitations of the Study
The limitation of the study was that the authors didn’t have any data about the dermatological adverse reactions of the studied older women with breast cancerbefore starting chemotherapy and its effect on quality of life. Purposive sampling technique could also be considered as a limitation.
Conclusion
All of the studied older women with breast cancer had dermatological adverse reactions due to chemotherapy. A high proportion of dermatological side effects were reported among older women as the most of them had grade one of hair texture abnormality and nail changes.
While, the majority had grade two of alopecia, Furthermore, nearly more than three-quarters of the studied older women had grade two of skin hyper pigmentation. Meanwhile, about half of them were suffered from grade three of palmer-planter erythro-dysesthesia syndrome and approximately half of the older women their skin symptoms had extremely sever effect on their quality of life. Eventually, there was a highly significant positive correlation between total dermatological adverse reactions of the studied older women with breast cancer who receiving chemotherapy and their total effect on quality of life.
Recommendation
Based on the results of this study, pre-treatment and clinical visual skin examination for older women with breast cancer and programs for early detection of dermatological adverse reactions due to receiving chemotherapy. There is a need for conducting dermatology- educational programs, strategies for prevention and management of dermatological adverse reactions to improve quality of life. So, in every oncology department a dermatology unit should be available to provide supportive guidelines for older women with dermatological problems resulting from chemotherapy. Future studies are needed to implement and measure the effect of dermatology education programs in improving skin condition and quality of life among elderly women with breast cancer receiving chemotherapy.
Declaration of Conflicting Interests
The Author(s) declare(s) that there is no conflict of interest.
Funding
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Table 1. Demographic Characteristics of the Studied Older Women with Breast Cancer and its relation totheir Total Effect on Quality of Life(N=100)
Items
Total effect on quality of life X2 P-
Value Mild(n=
6)
Moderate(n
=14)
Severe (n=25)
Extremely severe(n=5 5)
N % N % N % N %
Age (year)
60-<65 3 50 10 71.
4
14 56 31 56.4
12.16 .041*
65-<70 3 50 4 28.
6
11 44 21 38.2
≥70 0 0.
0
0 0.0 0 0.0 3 5.4
Residence Rural 3 50 12 85.
7
17 68 42 76.4 3.442 .331
Urban 3 50 2 14.
3
8 32 13 23.6 Marital
status
Single 0 0.
0
0 0.0 0 0.0 2 3.6
11.76 .044*
Married 6 10
0
12 85.
7
21 84 45 81.9 Divorced 0 0.
0
0 0.0 1 4 1 1.8
Widowed 0 0.
0
2 14.
3
3 12 7 12.7
Education al level
Illiterate 2 33 .3
8 57.
1
12 48 23 41.8
7.205 .952 Read
&write
1 16
.7
2 14.
3
1 4 8 14.5
Primary 0 0.
0
1 7.2 1 4 2 3.6
Preparator y
0 0.
0
0 0.0 2 8 4 7.3
Secondary 2 33 .3
3 21.
4
6 24 14 25.5 University 1 16
.7
0 0.0 3 12 4 7.3
Previous work
Working 3 50 2 14.
3
8 32 19 34.5 3.076 .380 Not
working
3 50 12 85.
7
17 68 36 65.5 Monthly
income
Not Sufficient
0 0.
0
0 0.0 11 44 16 29.1
13.16 .034*
Sufficient 3 50 14 100 14 56 39 70.9 Sufficient
& save
3 50 0 0.0 0 0.0 0 0.0
Responsib le for care
By her self 6 10 0
9 64.
3
16 64 37 67.3
10.21 .043*
Family members
0 0.
0
5 35.
7
9 36 18 32.7
*Significant at p ‹ 0.05.**Highly significant at p ‹ 0.
Table2. Relation between Elderly's women Hair, Nails and Body Side Effects and their Total Effect on Quality of Life (n=100)
Variables
No. Total effect on quality of life X2 P-
Value Mild Moderate Severe Extremely
severe
N % N % N % N %
Hair Side Effects
Alopecia Grade 1 16 6 37.5 8 50 2 12.5 0 0.0
26.34 .000**
Grade 2 84 0 0.0 6 7.1 23 27.4 55 65.5 Hair color
changes
Grade 1 82 6 7.3 10 12.2 21 25.6 45 54.9 33.24 .000**
Grade 2 18 0 0.0 4 22.2 4 22.2 10 55.6
Hair texture abnormal
Grade 1 90 6 6.7 14 15.6 25 27.8 45 50
27.56 .000**
Grade 2 8 0 0.0 0 0.0 0 0.0 8 100
Grade 3 2 0 0.0 0 0.0 0 0.0 2 100
Scalp pain Grade 1 6 6 100 0 0.0 0 0.0 0 0.0
25.38 .000**
Grade 2 67 0 0.0 14 20.9 23 34.3 30 44.8 Grade 3 27 0 0.0 0 0.0 2 7.4 25 92.6 Nails Side Effects
Nail changes Grade 1 90 6 6.7 14 15.6 25 27.8 45 50
31.27 .000**
Grade 2 6 0 0.0 0 0.0 0 0.0 6 100
Grade 3 4 0 0.0 0 0.0 0 0.0 4 100
Nail
discoloration
Grade 1 90 6 6.7 14 15.6 25 27.8 45 50
17.00 .000**
Grade 2 6 0 0.0 0 0.0 0 0.0 6 100
Grade 3 4 0 0.0 0 0.0 0 0.0 4 100
Nail loss Grade 1 14 0 0.0 4 28.6 4 28.6 6 42.9
34.14 .000**
Grade 2 3 0 0.0 0 0.0 0 0.0 8 100
Nail ridging Grade 1 40 6 6.7 14 15.6 15 37.5 5 12.5
29.31 .000**
Grade 2 8 0 0.0 0 0.0 0 0.0 8 100
Grade 3 2 0 0.0 0 0.0 0 0.0 2 100
Body Side Effects
Body odor Grade 1 3 0 0.0 0 0.0 2 66.7 1 33.3
5.361 .467
Grade 2 15 0 0.0 0 0.0 3 12
Fat atrophy Grade 1 6 0 0.0 1 16.7 2 33.3 3 50
6.954 .254 Grade 2 81 0 0.0 13 16 23 28.4 45 55.6
Hyperhidrosis Grade 1 12 0 0.0 2 16.7 3 25 7 58.3
7.114 .099 Grade 2 74 0 0.0 12 16.2 23 31.1 39 52.7
Hypohidrosis Grade 1 6 0 0.0 0 0.0 1 16.7 5 83.3
4.444 .032*
Grade 2 2 0 0.0 0 0.0 0 0.0 2 100
Hirsutism Grade 1 4 0 0.0 3 75 1 25 0 0.0 9.479 .024*
Grade 2 9 0 0.0 1 11.1 2 22.2 7 77.7
Hypertrichosis Grade 1 8 0 0.0 4 50 3 37.5 1 12.5 15.27 0.01*
Grade 2 15 0 0.0 2 13.3 3 20 10 66.7
*Significant at p ‹ 0.05. **Highly significant at p ‹ 0.01.
Table 3.Relation between Elderly’s women Skin Side Effects and Their Total Effect on Quality of Life (n=100).
Variables Grade
No. Total effect on quality of life X2 P-
Value Mild Moderate Severe Extremely
severe
N % N % N % N %
Dry skin Grade 1 11 3 27.3 1 9.1 0 0.0 7 63.6
21.58 .001**
Grade 2 72 3 4.2 9 12.5 25 34.7 35 48.6 Grade 3 17 0 0.0 4 23.5 0 0.0 13 76.5 Pain of
skin
Grade 1 15 1 6.7 5 33.3 0 0.0 9 60
24.28 .000**
Grade 2 67 2 3 8 11.9 25 37.3 32 47.8 Grade 3 18 3 16.7 1 5.6 0 0.0 14 77.8
Palmar- plantar erythrodys esthesia syndrome
Grade 1 4 0 0.0 2 50 2 50 0 0.0
13.53 .035*
Grade 2 46 0 0.0 2 4.3 8 17.4 36 78.3 Grade 3 49 0 0.0 9 18.4 15 30.6 25 51 Skin
hyperpigm entation
Grade 1 10 6 60 4 40 0 0.0 0 0.0 30.93 .000**
Grade 2 80 0 0.0 10 12.5 25 31.3 45 56.2 Skin
hypopigme ntation
Grade 1 2 0 0.0 1 50 1 50 0 0.0 12.30 .021*
Grade 2 8 0 0.0 0 0.0 2 25 6 75
Telangiect asia
Grade 1 10 0 0.0 8 80 2 20 0 0.0 25.30 .000**
Grade 2 54 0 0.0 6 11.1 23 42.6 25 46.3 Hyperkerat
osis
Grade 1 28 0 0.0 14 50 8 28.6 6 21.4 22.08 .001**
Grade 2 21 0 0.0 0 0.0 6 28.6 15 71.4
Urticaria Grade 1 14 2 14.3 2 14.3 8 57.1 2 14.3 30.32 .000**
Grade 2 69 0 0.0 0 0.0 19 27.5 50 72.5
Pruritus Grade 1 28 6 21.4 4 14.3 15 53.6 3 10.7 18.02 .001**
Grade 2 72 0 0.0 10 13.9 10 13.9 52 72.2 Rash
acneiform
Grade 1 8 0 0.0 0 0.0 4 50 4 50 10.21 .01*
Grade 2 5 0 0.0 0 0.0 0 0.0 5 100
Rash maculo- papular
Grade 1 10 0 0.0 0 0.0 5 50 5 50 8.261 .027*
Grade 2 19 0 0.0 0 0.0 5 26.3 14 73.7 Photosensi
tivity
Grade 1 40 2 5 6 15 12 30 20 50 14.36 .008**
Grade 2 31 0 0.0 0 0.0 6 19.4 25 80.6
*Significant at p ‹ 0.05. **Highly significant at p ‹ 0.01.
Table 4.Best Fitting Multiple Linear Regression Model for older Women with Breast Cancer on Quality of Life
Variables Unstandardized
Coefficients
Standardized Coefficients
T P. value
B Β
Age -.108 -.115 -1.042 .047*
Marital status -.177 -.187 -1.396 .039*
Monthly income .169 .182 1.705 .021*
Suffering from chronic diseases
-.268 -.287 1.388 .034*
Duration of breast cancer diagnosis
.161 .173 1.299 .041*
Stages of breast cancer at diagnosis
-.162 -.179 -1.345 .031*
Time since receiving chemotherapy
-.301 -.309 -1.558 .029*
Number of total Chemotherapy cycles
.131 .147 1.153 .045*
Previous chemotherapy history -.101 -.110 -1.006 .048*
ANOVA
Model Df. F P. value
Regression 9 6.314 .031*
** Dependent Variable: Total Effect on Quality of Life.
References
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