We aimed to evaluate the short-term effects of community-based occupational therapy on health-related quality of life and engagement in meaningful activities among women with breast cancer. An open label randomized controlled trial study design was applied. The participants were members of various societies of women with cancer. In total, 22 women have participated in the study. Participants of the experimental group (
On the global scale, cancer causes one-seventh of all deaths. According to the most recent estimates, there have been over 14 million new cases of cancer and over 8 million deaths from cancer registered worldwide, and it is expected that, due to the increasing numbers and aging of the population, these numbers will increase to, accordingly, 21.7 million and 13 million by the year 2030 [
Breast cancer, defined by the National Cancer Institute as cancer forming in breast tissues, is the most common malignant tumor among women and in as many as 19 out of 21 regions it is the leading cause of death among women in both the developed and the developing countries [
Unfortunately, the completion of breast cancer treatment does not mean the end of the disease [
Today, it is the field of health-related quality of life that is being most actively developed in Lithuania as well as abroad [
The impact of the diagnosis and treatment of breast cancer differs depending on the patient, resulting in varying numbers and degrees of physical and psychological sequelae. The consequences may significantly impair a woman’s ability to participate in meaningful activities, including housework, return to work, and adequate performance of the main social roles and responsibilities. This, in turn, may negatively affect the economic status and disrupt interpersonal relations, thus further impairing the woman’s engagement in meaningful activities as well as her psychoemotional status and the quality of life. Despite the fact that the combined effect of breast cancer and its treatment may manifest themselves at any moment and last for a very long time, it is essential for the patients to resume their daily roles as soon as possible after the completion of the treatment and this is where the role of the occupational therapist is especially important [
The theory of occupational therapy states that human subsistence is a social process, and people need meaningful activity; its absence is a major threat to human health, and thus occupational therapists in their professional practice strive to achieve their patients’ maximum capacity to increase their ability to engage in activities that they see as important and meaningful [
When working in communities, occupational therapists have to be familiar with the characteristics of community-based activity in order to be able to pursue meaningful activities based on the community members’ priorities. Active participation in community activities, social support, and engagement in meaningful activities positively affect community members’ health and the quality of life [
No similar research was found and we were the first in Lithuania who made a study analyzing changes in health-related quality of life, engagement in meaningful activities, and its associations among breast cancer patients when applying occupational therapy in the field of community healthcare. We hope that the results of our study will be useful for occupational therapists working with breast cancer patients’ communities.
Consequently, all these reasons have affected the following aim of the study: to evaluate the short-term effects of community-based occupational therapy on health-related quality of life and engagement in meaningful activities among women with breast cancer.
This randomized controlled trial was conducted with the permission of the Bioethics Center of the Lithuanian University of Health Sciences (number BEC-SR(M)-186), the permission of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Group to use the quality of life questionnaire EORTC QLQ-C30 and its module EORTC QLQ-BR23 in the study, and the permission of the Associate Professor A. M. Eakman from Colorado State University to use the Engagement in Meaningful Activities Survey (EMAS) in the study. The study was performed during May–June 2016 in Kaunas city, with the mediation of the chairwomen of two societies of women who either had overcome their breast cancer or were still fighting it on the community level.
Eligible women were adult (≥18 years of age) and Lithuanian-speaking, with diagnosed breast cancer and functional status being ≤2b according to the ECOG
All the participants who met the inclusion criteria were in advance familiarized with the study, its aims, objectives, and methods, the confidentiality of the data, and the possibility of withdrawing from the study at any time and provided a written consent to participate in the study.
In total, 22 members of breast cancer patients’ societies met the inclusion criteria. All participants had been diagnosed with breast cancer (code C50 according to the ICD-10-AM). The participants were randomly distributed into two groups: the experimental group and the control group, following simple randomization procedure (computerized random numbers). The distribution of the participants was equal in both groups. The participants were also distributed into two groups based on the analyzed characteristics: age, employment status, the duration of the disease, the stage of the disease, the location of the tumor, metastases, and functional status according to the ECOG. Detailed characteristics of the participants are presented in Table
Participants’ characteristics.
Characteristic | Total | Experimental group | | Control group |
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Young or middle-aged (18–59 years) | 11 (50) | 6 (54.5) | 1 | 5 (45.5) |
Elderly or old (60–80 years) | 11 (50) | 5 (45.5) | 6 (54.5) | |
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Employed or a student | 9 (40.9) | 4 (36.4) | 1 | 5 (45.5) |
Unemployed, housewife, retired, or not working because of disability | 13 (59.1) | 7 (63.6) | 6 (54.5) | |
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<5 years | 11 (50) | 5 (45.5) | 1 | 6 (54.5) |
≥5 years | 11 (50) | 6 (54.5) | 5 (45.5) | |
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0, I, or II | 17 (77.3) | 10 (90.9) | 0.311 | 7 (63.6) |
III or IV | 5 (22.7) | 1 (9.1) | 4 (36.4) | |
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Left | 12 (54.5) | 6 (54.5) | 1 | 6 (54.5) |
Right | 10 (45.5) | 5 (45.5) | 5 (45.5) | |
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Present | 3 (13.6) | 1 (9.1) | 1 | 2 (18.2) |
Absent | 19 (86.4) | 10 (90.9) | 9 (81.8) | |
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0 or 1 b. | 17 (77.3) | 8 (72.7) | 1 | 9 (81.8) |
2 b. | 5 (22.7) | (27.3) | 2 (18.2) |
There were no significant differences in the participants’ distribution between the groups concerning their age (
During the study, we evaluated changes in women health-related quality of life and experimental group participants’ engagement in meaningful activities during the nonacute period of the disease. The methods used in the study were the following: a survey using a questionnaire designed by the author, testing, experiment, and statistical data analysis. During the survey, we evaluated the participants’ sociodemographic data (age and employment status) and clinical factors: the duration of the disease, the stage of the disease, the location of the tumor, metastases, and functional status according to the ECOG. Testing was conducted twice: at the beginning of the study and after 6 weeks. In order to evaluate changes in the participants’ health-related quality of life, we used the EORTC QLQ-C30 questionnaire and its module QLQ-BR23. The principal questionnaire, EORTC QLQ-C30, consists of 30 questions forming the global health status and quality of life scale, five functional scales, three symptom scales, and six separately evaluated components. The EORTC module QLQ-BR23 is a more specific questionnaire designed for breast cancer patients and consisting of 23 questions forming four functional scales and four symptom scales. After the calculation of the results according to the formulas presented by the authors, the score intervals in all scales and separately evaluated components ranged from 0 to 100 points. The questionnaires have been translated and adapted in many languages including Lithuanian and are suitable for the evaluation of cancer patients’ health-related quality of life. In Lithuania, Banienė and Šinkariova (2015) evaluated the internal consistency of the scales of those questionnaires (0.6 ≤
The testing of the experimental group participants’ engagement in meaningful activities was also conducted at baseline and at the end of the study, using the Engagement in Meaningful Activities Survey. This survey has not been translated into Lithuanian and has not been adapted in Lithuania. For this reason, studies for the evaluation of the reliability and validity of the survey should be conducted. The results of the survey on engagement in meaningful activities reflect the level of the subjects’ engagement in meaningful activities. The survey consists of 12 statements, each of which has the minimal value of 1 point and the maximal value of 4 points, where 1 point means “rarely”; 2 points, sometimes; 3 points, often; and 4 points, always. Engagement in meaningful activities was evaluated by a sum score. There is a growing body of scientific literature validating the psychometric properties of this test. The association of the results of this test with those of the evaluation of satisfaction with life and health-related quality of life has already been proven. Eakman with coauthors (2010) have proven the test-retest reliability of this instrument (
During the course of the study, the women participated in a 6-week community-based occupational therapy program and the usual activities of various societies, whereas the control group women participated in the usual activities of the societies only.
The community-based occupational therapy program was designed taking into account the most common sequelae of breast cancer and its treatment identified in literature: arm swelling, reduced range of motion of the arm, fatigue, and impaired quality of life. According to Scaffa and Reitz (2014), active participation in community activities, social support, and engagement in meaningful activities have a positive effect on community members’ health and quality of life [
During the study, we applied occupational therapy in groups. During each session, purposeful activities were combined with creative techniques, and the sessions were made meaningful through voluntary assistance to others, that is, emotional help when communicating with other women who had the same problems and so forth. The experimental group participants also received individual consultations by an occupational therapist if needed.
Duration of the program consisted of six meetings. The description of the program is provided in Table
Description of the application of the occupational therapy program in the community of women with breast cancer.
Topic | Aims | Activities | |
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Session I | The beginning of the study | Familiarization, presentation of the study and the planned program, and initiation of the study. | Self-introduction and presentation of the study, a report on the topic of the study, initial filing out of the questionnaires, questions, and answers. |
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Session | | Socializing, cooperation, increasing the hand movement amplitude or prevention, development of positive emotions, and sharing positive experience and emotions with those facing the same or similar problems. | Sapling replanting (gardening therapy), advice and discussions about the hand movement amplitude, and donation of saplings to hospitalized women with breast cancer. |
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Session | | Experiencing relaxation and calmness, expression of emotions, socialization, prevention or reduction of lymphedema, and sharing positive experience and emotions with those facing the same or similar problems. | Folding paper cranes (art therapy) + a lecture, exercises, and discussions on lymphedema treatment and prevention, as well as on an occupational therapist’s assistance. |
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Session | | Experiencing relaxation and calmness, expression of emotions, socialization, presentation of the energy conservation principles and their practical application, and sharing positive experience and emotions with those facing the same or similar problems. | Making an original picture postcard (art therapy) while listening to specially selected calm music (music therapy) + a lecture and discussions on fatigue and energy conservation techniques (planning, adjustment of the environment, biomechanics of the body, etc.). |
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Session | | Gratuitous assistance. | Knitting socks + a lecture on the need for socks and donation of socks to preterm newborns. |
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Session VI | The end of the study | Discussion on the work done, sharing impressions and results, and conclusion of the study. | Summing-up of the program, repeated filling out of the questionnaires, feedback, discussions, questions/answers, etc. |
Occupational therapy sessions in groups were organized four times: once weekly at an arranged time in the evening (after work), up to 1.5 hours/day.
Note that the sessions in occupational therapy groups took place in a cozy and comfortable environment, and all the tools and materials required for the activities were supplied and were of good quality. Prior to the sessions, the participants received all the necessary information, and the focus during the sessions was on the process rather than on the results.
Statistical data analysis was conducted using the
After six weeks, of 22 women randomized into the study, 21 completed the trial. The experimental group consisted of 10 participants and the control group consisted of 11. One woman withdrew from the study because of breast cancer recurrence. During the study, when applying occupational therapy in the community, we strove to improve the participants’ engagement in meaningful activities and thus their health-related quality of life. For this reason, the women’s active participation in the assignments was highly important for us, and thus, to determine the actual impact of the applied program on the aforementioned indices, we only calculated the results for women who were involved in the study.
The health-related quality of life of women with breast cancer was evaluated during the nonacute period of the disease by calculating the scores in separate scales of the EORTC QLQ-C30 questionnaire and its module QLQ-BR23. The score could range from 0 to 100 points. A higher score in the global quality of life scale indicated better quality of life, a higher score in the functional scales better functioning, and a higher score in the symptom scales a greater degree of the manifestation of the symptom.
The evaluation of the participants’ health-related quality of life at baseline using the EORTC QLQ-C30 questionnaire and its module QLQ-BR23 showed that the groups were homogeneous,
Distribution of evaluation scores in health-related quality of life questionnaire scales in the groups at baseline.
Scales of the quality of life questionnaires | Experimental group | | Control group | ||
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| | | | ||
EORTC QLQ C-30 | |||||
Global health status/QoL | 11 | 50 (33.33–83.33; 50.75) | 41.5; 0.217 | 11 | 58.33 (33.33–91.67; 59.85) |
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Physical functioning | 11 | 60 (40–86.67; 63.64) | 50; 0.519 | 11 | 73.33 (46.67–86.67; 67.88) |
Role functioning | 11 | 66.67 (16.67–100; 68.18) | 60; 1 | 11 | 66.67 (33.33–100; 69.7) |
Emotional functioning | 11 | 50 (8.33–100; 52.27) | 36.5; 0.116 | 11 | 66.67 (8.33–100; 65.91) |
Cognitive functioning | 11 | 50 (0–83.33; 54.55) | 35.5; 0.101 | 11 | 83.33 (50–100; 72.73) |
Social functioning | 11 | 50 (16.67–83.33; 48.49) | 32; 0.065 | 11 | 66.67 (50–100; 69.7) |
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Fatigue | 11 | 55.56 (33.33–77.78; 54.55) | 54.5; 0.699 | 11 | 44.44 (11.11–88.89; 50.5) |
Nausea and vomiting | 11 | 0 (0–50; 7.58) | 54.5; 0.699 | 11 | 0 (0–66.67; 12.12) |
Pain | 11 | 33.33 (0–83.33; 34.85) | 56; 0.797 | 11 | 33.33 (0–83.33; 28.79) |
Dyspnoea | 11 | 0 (0–33.33; 15.15) | 50; 0.519 | 11 | 33.33 (0–66.67; 24.24) |
Insomnia | 11 | 66.67 (0–100; 66.67) | 39; 0.171 | 11 | 66.67 (0–66.67; 48.49) |
Appetite loss | 11 | 0 (0–33.33; 9.09) | 44; 0.3 | 11 | 33.33 (0–33.33; 18.18) |
Constipation | 11 | 33.33 (0–100; 42.42) | 48; 0.438 | 11 | 0 (0–100; 24.24) |
Diarrhoea | 11 | 0 (0–66.67; 9.09) | 60; 1 | 11 | 0 (0–100; 12.12) |
Financial difficulties | 11 | 66.67 (33.33–100; 69.7) | 42; 0.243 | 11 | 66.67 (0–100; 51.52) |
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EORTC QLQ BR-23 | |||||
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Body image | 11 | 58.33 (0–83.33; 51.51) | 28.5; 0.562 | 11 | 41.57 (25–91.67; 48.48) |
Sexual functioning | 11 | 100 (0–100; 81.82) | 60; 1 | 11 | 100 (33.33–100; 81.82) |
Sexual enjoyment | 5 | 66.67 (33.33–100; 73.33) | 9; 0.548 | 5 | 66.67 (33.33–100; 60) |
Future perspective | 11 | 33.33 (0–66.67; 33.33) | 51.5; 0.562 | 11 | 33.33 (0–66.67; 27.27) |
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Systemic therapy side effects | 11 | 23.81 (4.76–61.90; 31.6) | 58; 0.898 | 11 | 28.57 (4.76–57.14; 29) |
Breast symptoms | 11 | 41.67 (8.33–75; 38.64) | 41; 0.217 | 11 | 25 (0–66.67; 28.79) |
Arm symptoms | 11 | 33.33 (0–77.78; 37.37) | 63; 0.898 | 11 | 44.44 (0–88.89; 38.38) |
Upset by hair loss | 6 | 16.67 (0–33.33; 16.67) | 28.5; 0.573 | 8 | 33.33 (0–100; 29.17) |
Statistical significance was determined according to the nonparametric Mann–Whitney-Wilcoxon criterion, no significant differences between the groups,
Prior to the application of the community-based occupational therapy, the poorest evaluations in the EORTC QLQ-C30 questionnaire among the experimental group participants were on the global quality of life (50 (33.33–83.33; 50.75)), emotional functions (50 (8.33–100; 52.27)), cognitive functions (50 (0–83.33; 54.55)), and social functions (50 (16.67–83.33; 48.49)). The participants were also found to demonstrate the highest degrees of the manifestation of insomnia (66.67 (0–100; 66.67)) and the financial difficulties (66.67 (33.33–100; 69.7)). The results of the EORTC QLQ-BR23 questionnaire showed that the participants gave the poorest evaluations of the future perspective (33.33 (0–66.67; 33.33)) and demonstrated the highest degrees of the manifestation of breast symptoms (41.67 (8.33–75; 38.64)) such as pain, edema, tenderness, or skin problems.
Among the control group participants, the poorest evaluations in the EORTC QLQ-C30 questionnaire at baseline were on the global quality of life (58.33 (33.33–91.67; 59.85)), and the participants were found to demonstrate the highest degrees of the manifestation of insomnia (66.67 (0–66.67; 48.49)) and financial impact (66.67 (0–100; 51.52)). The results of the EORTC QLQ-BR23 questionnaire showed that the participants gave the poorest evaluations of the future perspective (33.33 (0–66.67; 27.27)) and demonstrated the highest degrees of the manifestation of arm symptoms (44.44 (0–88.89; 38.38)) such as pain and edema.
The evaluation of changes in the overall scores of the quality of life questionnaire EORTC QLQ-C30 scales between the groups showed that, compared to baseline data, after six weeks (at the end of the study), the experimental group demonstrated statistically significantly better results in the global quality of life (
Characteristics of changes in the evaluation scores of the scales of the global quality of life questionnaire EORTC QLQ-C30 in the experimental and the control group women.
Scales of the quality of life questionnaire | EGr | EGr change | CGr | CGr change | Difference between the groups at the end | ||
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Before | After | Before | After | ||||
EORTC QLQ C-30 | |||||||
Global health status/QoL | 50 | 66.67 | −2.829; 0.005 | 58.33 | 50 | −1.956; 0.05 | 0; 0.001 |
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Physical functioning | 60 | 70 | −2.384; 0.017 | 73.33 | 60 | −1.012; 0.311 | 20; 0.013 |
Role functioning | 66.67 | 75 | −1.023; 0.306 | 66.67 | 66.67 | −1.409; 0.159 | 25.5; 0.036 |
Emotional functioning | 50 | 62.5 | −2.670; 0.008 | 66.67 | 58.33 | −1.480; 0.139 | 8.5; 0.001 |
Cognitive functioning | 50 | 66.67 | −2.060; 0.039 | 83.33 | 50 | −2.388; 0.017 | 10; 0.001 |
Social functioning | 50 | 66.67 | −1.951; 0.051 | 66.67 | 50 | −2.410; 0.016 | 13; 0.002 |
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Fatigue | 55.56 | 44.44 | −2.555; 0.011 | 44.44 | 66.67 | −2.568; 0.010 | 5; 0.001 |
Nausea and vomiting | 0 | 0 | −1.089; 0.276 | 0 | 0 | −1.289; 0.197 | 51; 0.809 |
Pain | 33.33 | 16.67 | −0.933; 0.351 | 33.33 | 33.33 | −0.213; 0.832 | 41.5; 0.349 |
Dyspnoea | 0 | 0 | −1; 0.317 | 33.33 | 33.33 | −1.382; 0.167 | 32.5; 0.114 |
Insomnia | 66.67 | 33.33 | −2.280; 0.023 | 66.67 | 66.67 | −1.890; 0.059 | 19; 0.01 |
Appetite loss | 0 | 0 | −0.707; 0.480 | 33.33 | 33.33 | −1.633; 0.102 | 48; 0.654; |
Constipation | 33.33 | 16.67 | −1.890; 0.059 | 0 | 0 | −0.730; 0.465 | 48; 0.654; |
Diarrhoea | 0 | 0 | −1; 0.317 | 0 | 0 | −0.816; 0.414 | 40.5; 0.314; |
Financial difficulties | 66.67 | 66.67 | −1.236; 0.216 | 66.67 | 66.67 | −2.041; 0.041 | 23.5; 0.024 |
The evaluation of changes in the overall scores in the scales of the quality of life questionnaire module EORTC QLQ-BR23 between the groups showed that, compared to baseline data, after six weeks (at the end of the study), the experimental group demonstrated statistically significantly better results in the systemic therapy side effects (
Characteristics of changes in the evaluation scores of the scales of the global quality of life questionnaire module EORTC QLQ-BR23 in the experimental and the control group women.
Scales of the quality of life questionnaire | EGr | EGr change | CGr | CGr change | Difference between the groups at the end | ||
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Before | After | Before | After | ||||
EORTC QLQ BR-23 | |||||||
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Body image | 58.33 | 58.33 | −0.512; 0.609 | 41.67 | 41.67 | −1.2; 0.23 | 53; 0.918 |
Sexual functioning | 100 | 66.67 | −2.041; 0.041 | 100 | 83.33 | 0; 1 | 32.5; 0.114 |
Sexual enjoyment | 66.67 | 50 | −1.604; 0.109 | 66.67 | 66.67 | −0.816; 0.414 | 4.5; 0.095 |
Future perspective | 33.33 | 33.33 | −0.184; 0.854 | 33.33 | 33.33 | −0.184; 0.854 | 55; 1 |
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Systemic therapy side effects | 23.81 | 23.81 | −2.092; 0.036 | 28.57 | 38.1 | −2.371; 0.018 | 11; 0.001 |
Breast symptoms | 41.67 | 25 | −2.352; 0.019 | 25 | 33.33 | −0.511; 0.61 | 24.5; 0.029 |
Arm symptoms | 33.33 | 23.61 | −0.986; 0.324 | 44.44 | 44.44 | −0.106; 0.915 | 48; 0.654 |
Upset by hair loss | 16.67 | 33.33 | −1.633; 0.102 | 33.33 | 33.33 | −1.841; 0.066 | 22.5; 0.852 |
Considering the calculated strength of the effect, when a moderate effect was ≥0.5 and a strong effect was ≥0.8, we found not only statistically, but also clinically significant changes (
Among the experimental group women with breast cancer, engagement in meaningful activities was evaluated during the nonacute period of the disease. The evaluation was performed based on the results of the Engagement in Meaningful Activities Survey (EMAS)—the sum score that could range from 12 to 48 points, where <29 points indicated insufficient engagement; 29–41 points, moderate engagement; and >41 points, good engagement.
During the evaluation of the participants’ engagement in meaningful activities at baseline, the median score in the experimental group was 29 points, the lowest score being 24 points (insufficient engagement) and the highest score being 35 points (moderate engagement). At the end of the study, after the application of the 6-week community-based occupational therapy program, the evaluation scores of the participants’ engagement in meaningful activities changed statistically significantly (
Changes in the engagement in meaningful activities in the experimental group participants,
We also analyzed the relationship between breast cancer patients’ engagement in meaningful activities and changes in their health-related quality of life. The results of the analysis showed that when evaluating the health-related quality of life on the EORTC QLQ-C30 questionnaire, the evaluation scores showed a statistically significant direct moderate relationship (
We also found a statistically significant inverse moderate relationship (
We found a statistically significant inverse moderate relationship (
We did not find any statistically significant relationship for the evaluation scores of other functional or symptom scales of the quality of life questionnaire EORTC QLQ-C30 or any scale of the module EORTC QLQ-BR23,
Relationship between engagement in meaningful activities and evaluations scores of health-related quality of life (EORTC QLQ-C30) in women with breast cancer.
Scales of the quality of life questionnaire | Relationship with changes in the engagement in meaningful activities |
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EORTC QLQ-C30 | |
Global health status/QoL | |
| |
Physical functioning | |
Role functioning | |
Emotional functioning | |
Cognitive functioning | |
Social functioning | |
| |
Fatigue | |
Nausea and vomiting | |
Pain | |
Dyspnoea | |
Insomnia | |
Appetite loss | |
Constipation | |
Diarrhoea | |
Financial difficulties | |
Relationship between engagement in meaningful activities and evaluations scores of health-related quality of life (EORTC QLQ- BR23) in women with breast cancer.
Scales of the quality of life questionnaire | Relationship with changes in the engagement in meaningful activities |
---|---|
EORTC QLQ-BR23 | |
| |
Body image | |
Sexual functioning | |
Sexual enjoyment | |
Future perspective | |
| |
Systemic therapy side effects | |
Breast symptoms | |
Arm symptoms | |
Upset by hair loss | |
Statistical significance was determined according to Spearman’s correlation coefficient; the association was statistically significant when
A review of both Lithuanian and foreign literature revealed a lack of research or any kind of projects in the context of applying community-based occupational therapy for women with breast cancer, which encouraged us to conduct this study where objectives were set: to evaluate the short-term effects of community-based occupational therapy on changes in health-related quality of life among women with breast cancer and on changes in the experimental group women’s engagement in meaningful activities and to analyze the associations between engagement in meaningful activities and changes in health-related quality of life.
In Lithuania, over 1.5 thousand new cases of breast cancer are diagnosed annually [
In total, 21 women participated in and successfully completed the study. Of these, 10 women participated in a 6-week community-based occupational therapy program consisting of 4 group sessions (once a week, ~1.5 hours/day). The program was designed according to the guidelines provided in the only source of literature describing a study similar to ours—a project by Robinson (2015). The basis for those guidelines was a community-based occupational therapy program for women with breast cancer, aimed at maximizing their capacity for daily activities after the completion of the treatment [
We evaluated health-related quality of life by using the questionnaires of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Group—the global EORTC QLQ-C30 questionnaire and its module designed specifically for breast cancer, EORTC QLQ-BR23. These questionnaires have been translated into and adapted in many languages, including Lithuanian, and are suitable for the evaluation of health-related quality of life in individuals with breast cancer [
EORTC questionnaires have been recommended by a number of foreign researchers [
According to literature data, active engagement in meaningful activities positively affects the quality of life, and thus, in order to improve breast cancer patients’ health-related quality of life, the women were involved in meaningful activities during the occupational therapy sessions [
In this study, we strived to reveal the essence of occupational therapy in the community of women with breast cancer and the influence of this therapy on those women’s health-related quality of life. The results of the study showed that occupational therapy significantly improves breast cancer patients’ health-related quality of life and engagement in meaningful activities on the community level during the nonacute period of the disease.
One of the limitations of this study is a small number of participants in the groups, and thus in the future, this or a similar study should be performed with a larger sample. We also think that, in further studies, it would be expedient to evaluate whether a longer period of program application or a greater number of sessions would affect the results and improve the effectiveness of the program. In addition, future studies could be expanded by involving specialists of other areas (psychologists, art therapists, marketing specialists, etc.) because a successful implementation of the program requires not only the general competence of an occupational therapist, but also organizational skills, knowledge in marketing, and so forth in order to induce interest, attract, and invite the maximal possible numbers of women. The strong side of the study is that this was a new study in our country and that it provided positive emotions not only for the participants of the study, but also for hospitalized women who did not participate in the study, as voluntary assistance to others added meaningfulness to the sessions.
The authors declare that there are no conflicts of interest or financial support regarding the publication of this paper.
All the authors have reviewed and approved the manuscript before submission.
The study was conducted with the permission of the Bioethics Center of the Lithuanian University of Health Sciences (no. BEC-SR (M)-186), the permission of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Group to use the quality of life questionnaire EORTC QLQ-C30 and its module EORTC QLQ-BR23 in the study, and the permission of the Associate Professor A. M. Eakman from Colorado State University to use the Engagement in Meaningful Activities Survey (EMAS) in the study. The manuscript does not concern any commercial product.