Stem Cell Oncology – Adella (Ed.) © 2018 Taylor & Francis Group, London, ISBN 978-0-8153-9272-9
Family support, coping strategies and anxiety in cancer patients
D.K. Sari
Faculty of Medicine, Universitas Sumatera Utara, Medan, North Sumatera, Indonesia
W. Daulay
Faculty of Nursing, Universitas Sumatera Utara, Medan, North Sumatera, Indonesia
R. Dewi
Master Nursing Programme, Faculty of Nursing, Universitas Sumatera Utara, Medan, North Sumatera, Indonesia
ABSTRACT: This study aims to test the association between family support, coping strat-egies and anxiety at Dr. Pirngadi General Hospital, Medan. The samples are 102 cancer patients undergoing chemotherapy who were assessed, and the results of the bivariate analysis showed a significant positive association (p = 0.001 < 0.05) and strong correlation (r = 0.612) between family support and the Problem-Focused Coping (PFC) strategy, while there was a significant negative association (p = 0.001) and moderate correlation (r = −0.462) with the Emotion-Focused Coping (EFC) strategy. A significant negative association (p = 0.001) and strong correlation (r = −0.646) was found between family support and anxiety. The multivari-ate analysis showed a dominant association (p = 0.001) between family support and the PFC strategy (Odds Ratio = 12.2), EFC (OR = 0.142) and anxiety (OR = 0.039). The conclusion was that there is an association between good family support and effective coping strategies and lower anxiety levels in cancer patients undergoing chemotherapy.
Keywords: Family support, Cancer, Coping strategies, Chemotherapy
1 INTRODUCTION
Over half of cancer patients are treated with chemotherapy (Prawirohardjo, 2010). Chemo-therapy leads to various physiological and psychological side effects. The psychological side effects that may occur include stress, anxiety and depression. This stress leads to individuals using coping strategies to prevent further psychological disorders (Karabulutlu et al., 2010).
A study by Muhamad et al. (2011) stated that support from all family members, especially the spouse, plays an important role in decision-making and survival strategy.
The objective of this study is to test the association between family support, coping strategies and anxiety in cancer patients undergoing chemotherapy at Dr. Pirngadi General Hospital, Medan.
2 METHODS
3 RESULTS
3.1 Characteristics of subjects
Table 1, which shows the characeristics of cancer patients, shows that most of the patients were women, which is related to the highest prevalence being of breast cancer.
Table 2 shows that, of the 102 cancer patients undergoing chemotherapy, as many as 70 subjects (68.6%) had good family support, while poor family support was observed in 32 subjects (31.4%).
Table 3 shows that, of the 102 cancer patients undergoing chemotherapy, as many as 67 subjects (65.7%) were highly likely to use the Problem-Focused Coping (PFC) strategy, while the remaining 35 subjects (34.3%) were less likely to use the PFC strategy.
Table 4 shows that, of the 102 cancer patients undergoing chemotherapy, as many as 71 subjects (69.6%) were less likely to use the Emotion-Focused Coping (EFC) strategy, while the remaining 31 subjects (30.4%) were highly likely to use the EFC strategy.
Table 1. Characteristics of cancer patients undergoing chemother-apy (n = 102).
No Characteristics Freq. (%)
1 Age (Years)
26−45 (Adult) 32 31.3
46−65(Pre-elderly) 58 56.9
>65 (Elderly) 12 11.8
2 Sex
Male 39 38.2
Female 63 61.8
3 History of chemotherapy
1−3 65 63.7
>3−6 37 36.3
4 Cancer type
Breast cancer 45 44.1
Colorectal cancer 27 26.5
Ovarian cancer 15 14.7
Nasopharyngeal cancer (NPC) 13 12.7
Prostate cancer 2 2.0
Total 102 100
Table 2. Frequency distribution of family support (n = 102).
Family support Freq. (%)
Good 70 68.6
Poor 32 31.4
Total 102 100
Table 3. Frequency distribution of the Problem-Focused Coping (PFC) strategy (n = 102).
PFC strategy Freq. (%)
High 67 65.7
Low 35 34.3
Table 5 shows that, of the 102 cancer patients undergoing chemotherapy, as many as 53 subjects (52.0%) experienced moderate anxiety, and only 2 subjects (2.0%) experienced severe anxiety.
This study showed that there was a significant association with PFC strategy (p< 0.05). The value of 0.612 for the correlation coefficient (r) indicated a strong positive correlation, which means that subjects receiving better family support were more likely to use the PFC strategy. Similarly, a significant association was observed with the EFC strategy (p< 0.05).
There was a significant association with anxiety (p< 0.05). The value of −0.646 for the correlation coefficient (r) indicated a strong negative correlation, which means that subjects receiving better family support experienced milder anxiety.
This study showed that family support is a dominant variable that is significantly associ-ated with the use of the PFC strategy, with an Odds Ratio (OR) of 12.2, indicating that can-cer patients undergoing chemotherapy with good family support are 12.2 times more likely to use the PFC strategy.
Family support is a dominant variable that is significantly associated with the use of the EFC strategy, with an OR of 0.142 (OR < 1 = negative association), indicating that cancer patients undergoing chemotherapy with good family support are 0.142 times more likely to not use the PFC strategy.
Family support is a dominant variable that is significantly associated with anxiety, with an OR of 0.039 (OR < 1 = negative association), indicating that cancer patients undergoing chem-otherapy with good family support were 0.039 times more likely to experience mild anxiety.
4 DISCUSSION
4.1 Association between family support and coping strategies in cancer patients undergoing chemotherapy
A significant association between family support and the PFC strategy indicated a strong pos-itive correlation, which meant that subjects receiving better family support were more likely to use the PFC strategy. A significant association between family support and the EFC strategy at Dr. Pirngadi General Hospital, Medan, indicated a moderate negative correlation, which meant that subjects receiving better family support were less likely to use the EFC strategy.
These findings are similar to a study by Tan (2007), which stated that there is an asso-ciation between social support and coping strategies in cancer patients, with a positive correlation between social support and the PFC strategy and a negative correlation between
Table 4. Frequency distribution of the Emotion-Focused Coping (EFC) strategy (n = 102).
EFC strategy Freq. (%)
High 31 30.4
Low 71 69.6
Total 102 100
Table 5. Frequency distribution of anxiety at Dr. Pirngadi Gen-eral Hospital, Medan, in 2017 (n = 102).
Anxiety Freq. (%)
Severe 2 2.0
Moderate 53 52.0
Mild 47 46.0
social support and the EFC strategy. The support from all family members, particularly the spouse, greatly affected decision-making and survival strategies in managing emotions (emo-tional support), providing information on health, lifestyle and diet, as well as supporting the provision of facilities (instrumental support), which are very helpful for breast cancer patients undergoing therapy and help to increase the survival of cancer patients (Muhamad et al., 2011).
Potter and Perry (2009) stated that individual coping strategies are determined by the type of stress experienced by the individual, the individual’s life goals, beliefs about oneself and the world, and personal individual resources. An individual tends to use the PFC strategy when he/she believes that the demands from a situation or stressor can be changed, and to use the EFC strategy when he/she believes that only little or no changes can be conducted with regards to the pressure of the situation. However, in a stressful situation, an individual generally combines the PFC and the EFC strategies (Sarafino & Smith, 2011).
Effective coping strategies when facing a chronic disease such as cancer, particularly for those undergoing treatment such as chemotherapy, will greatly affect the compliance of the patient in routinely attending chemotherapy sessions and the presence of physical and psy-chological symptoms. From the results of this study, it can be concluded that good family support is one of the personal resources that contribute to the effectively high use of the PFC strategy and the effectively low use of the EFC strategy, thereby increasing the compliance of cancer patients in undergoing chemotherapy.
4.2 Association between family support and anxiety in cancer patients undergoing chemotherapy
Subjects with better family support were more likely to experience lower anxiety levels. These findings are similar to a study by Lekka et al. (2014), which stated that there was a moderate negative correlation between family support and anxiety, which meant that better family sup-port was associated with lower anxiety levels in lung cancer patients. Meanwhile, the study by Sadeghi et al. (2015) found that there was a moderate negative correlation between social support (emotional support, instrumental support and information support) and anxiety in patients undergoing haemodialysis. A study by Ng et al. (2015) stated that social support is an important factor for cancer patients undergoing treatment in order to decrease their anxiety levels and to increase their quality of life.
From the study results, it can be concluded that good family support for cancer patients undergoing intense, cyclic and long chemotherapy requiring repeated admissions, along with the physiological and psychological side effects that may appear, such as moderate anxiety, will help to decrease the anxiety levels and increase the quality of life and survivability of cancer patients.
4.3 Variables dominantly associated with coping strategies in cancer patients undergoing chemotherapy
These results are similar to the findings by Kim et al. (2010), which stated that social support for breast cancer patients is associated with the use of coping strategies. Nasir and Muhith (2011) stated that an effective coping strategy is one that helps an individual to tolerate and accept a psychologically stressful situation and ignore the stressors that cannot be managed.
From these results, it can be concluded that in a cancer patient undergoing intense, cyclic and long chemotherapy requiring repeated admissions, good family support will increase the compliance of the cancer patient in undergoing chemotherapy to increase the quality of life.
4.4 Variables dominantly associated with anxiety in cancer patients undergoing chemotherapy
The results are similar to that from a study by Aberha et al. (2016), which stated that the lack of social support in patients with hypertension was the factor most associated with anxi-ety. Social interaction plays a role in the adaptation of a patient towards a chronic disease. An individual with anxiety will show poor physical, cognitive and emotional responses and is at risk of maladaptive behaviour that will prevent the individual from learning various methods to alleviate anxiety, and therefore social support, particularly from the family, may influence the individual to form new adaptive behaviours to help him/her adapt and learn (Videbeck, 2008).
From the results, it can be concluded that in a cancer patient undergoing intense, cyclic and long chemotherapy requiring repeated admissions, good family support will help the patient to adapt and decrease their anxiety towards chemotherapy, in order to increase their quality of life.
5 CONCLUSIONS
From the study results, it can be concluded that family support is significantly associated with coping strategies (PFC and EFC) as well as with anxiety in cancer patients undergoing chemotherapy. It is hoped that the results of this study are used as an input for providing health education for the family members of patients on the importance of family support, which would increase the quality of life of the patients.
REFERENCES
Aberha, M., Gebeyehu, A. & Ayano, G. (2016). Prevalence and factors associated with anxiety among patients with hypertension on follow up at Menelik-II Referral Hospital, Addis Ababa Ethiopia.
Journal of Psychiatry, 19(4), 378. doi:10.4172/2378–5756.1000378.
Karabulutlu, E.Y., Bilici, M., Cayir, K., Tekin, B.S. & Kantarci, R. (2010). Coping, anxiety and depression in Turkish patients with cancer. European Journal of General Medicine, 7(3), 296–302. Kim, J., Han, Y.J., Shaw, B., McTavish, F. & Gustafson, D. (2010). The role of social support and coping
strategies in predicting breast cancer patients’ emotional well-being. Journal of Health Psychology,
15(4), 543–552. doi:10.1177/1359105309355338.
Lekka, D., Pachi, A., Tselebis, A., Zafeiropoulos, G., Bratis, D., Evmolpidi, A., … Syrigos, K.N. (2014). Pain and anxiety versus sense of family support in lung cancer patients. Pain Research and Treatment,
2014, Article ID 312941. doi:10.1155/2014/312941.
Muhamad, M., Afshari, M. & Kazilan, F. (2011). Family support in cancer survivorship. Asian Pacific Journal of Cancer Prevention, 12, 1389–1397.
Nasir, A. & Muhith, A. (2011). Dasar-Dasar Keperawatan Jiwa; Pengantar dan Teori. Jakarta, Indonesia: Salemba Medika.
Ng, G., Mohamed, S., See, H.M., Harun, F., Dahlu, M., Sulaiman, H.A. & Zainal, Z.N. (2015). Anxiety, depression, perceived social support and quality of life in Malaysian breast cancer patients: A 1-year prospective study. Health and Quality of Life Outcomes, 13, 205. doi:10.1186/s12955-015-040 1–7. Potter, P.A. & Perry, A.G. (2009). Fundamental Keperawatan [Fundamentals of nursing] (Book 2, 7th ed.).
Jakarta, Indonesia: Salemba Medika.
Prawirohardjo, S. (2010). Buku Acuan Nasional Onkologi Ginekologi. Jakarta, Indonesia: YBP-SP. Sadeghi, H., Saeedi, M., Rahzani, K. & Esfandiary, A. (2015). The relationship between social support
and death anxiety in hemodialysis patients. Iranian Journal of Psychiatric Nursing, 2(8).
Sarafino, P.E. & Smith, W.T. (2011). Health psychology: Biopsychosocial interaction (7th ed.). Hoboken, NJ: John Wiley & Sons.
Sastroasmoro, S. (2011). Dasar-dasar metodologi penelitian klinis. Jakarta, Indonesia: CV Sagung Seto. Tan, M. (2007). Social support and coping in Turkish patients with cancer. Cancer Nursing, 30(6), 498–
504. doi:10.1097/01.NCC. 0000300158.60273.ba
