Prospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Dec 24, 2020; 11(12): 1045-1063
Published online Dec 24, 2020. doi: 10.5306/wjco.v11.i12.1045
Assessment of burden and coping strategies among caregivers of cancer patients in sub-Saharan Africa
Paulina Ackley Akpan-Idiok, Ijeoma Onyekachi Ehiemere, Ekaete Francis Asuquo, Joy Awu Ukeunim Chabo, Easter Chukwudi Osuchukwu
Paulina Ackley Akpan-Idiok, Department of Nursing Science, Faculty of Allied Medical Sciences, College of Medicine, University of Calabar, Calabar 540222, Cross River State, Nigeria
Ijeoma Onyekachi Ehiemere, Department of Nursing Sciences, University of Nigeria, Nsukka 410001, Enugu, Nigeria
Ekaete Francis Asuquo, Easter Chukwudi Osuchukwu, Department of Nursing Sciences, University of Calabar, Calabar 54022, Cross River State, Nigeria
Joy Awu Ukeunim Chabo, Department of Public Health, University of Calabar, Calabar 54022, Cross River State, Nigeria
Author contributions: Akpan-Idiok PA drafted the manuscript, collected data and assisted with data analysis; Ehiemere IO participated in the design, supervision and oversight of the study; Asuquo EF participated in the design of the study and was involved in data collection; Chabo JA participated in the review of relevant literature while Osuchukwu EC assisted in drafting the manuscript; all authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the institutional review board of the University of Calabar Teaching Hospital, Calabar, Nigeria.
Informed consent statement: All study participants, provided written consent prior to study enrollment.
Conflict-of-interest statement: The authors of this manuscript have no conflicts of interest to disclose.
Data sharing statement: There are no additional data available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Paulina Ackley Akpan-Idiok, PhD, Lecturer, Department of Nursing Science, Faculty of Allied Medical Sciences, College of Medicine, University of Calabar, Calabar, Calabar 540222, Cross River State, Nigeria. packleyaidiok@yahoo.com
Received: May 29, 2020
Peer-review started: May 29, 2020
First decision: September 18, 2020
Revised: September 29, 2020
Accepted: November 11, 2020
Article in press: November 11, 2020
Published online: December 24, 2020
Processing time: 202 Days and 18.6 Hours
ARTICLE HIGHLIGHTS
Research background

Nigeria is known to have the highest cancer mortality rate in Africa with an annual death toll of 10000 persons; with a cancer incidence of 100000, 300000 and 500000 in 1990, 2010 and 2013, respectively, and 41000 cancer-related deaths were recorded in 2014 alone. The upsurge in the incidence of cancer may pose serious challenges in caregiving with its attendant burden on the patients and caregivers. The physical, psychological, social, spiritual and financial impact of caregiving is considerable and often negative. Ample evidence has shown that caring for an advanced cancer patient may be associated with physical problems such as weight loss, sleeplessness, fatigue and exhaustion. Also, psychological symptoms such as depression, anxiety, feeling of isolation and reduced self-esteem may be experienced. They often cause a social burden resulting in restriction of time, disturbances in routines, diminished opportunities for leisure activities and loss of income. Recent descriptive surveys and qualitative studies of caregivers’ cancer care experiences in India and Nigeria show that 38.9% of caregivers of cancer patients reported symptoms of depression. 41% to 62% of caregivers of advanced cancer patients experienced a high level of psychological burden compared to 19.2% of the general population.

Research motivation

Cancer is a devastating and debilitating chronic disease that affects both the patient and family members. Available evidence has confirmed that the care of chronically ill relatives by family members can be very challenging. This is because caregiving of cancer patients often presents a high level of burden on the caregivers. Consequently, this requires the adoption of coping mechanisms to cushion the effect of the burden experienced during caregiving.

Research objectives

To determine the burden experienced  and coping strategies among caregivers of advanced cancer patients attending University of Calabar Teaching Hospital (UCTH), Cross River State, Nigeria.

Research methods

The study adopted a descriptive cross-sectional study design and the study population consisted of informal family caregivers providing services to histologically diagnosed advanced cancer patients receiving treatment at the UCTH as at the time of the survey. A researcher-developed structured questionnaire, a 22-item standardized validated Zarit Burden Interview (ZBI) and a modified 17-item Coping Orientation to Problems Experienced (COPE) Inventory were used to collect data from 250 eligible informal caregivers who were selected with regard to caregiver’s characteristics, caregivers’ level of burden and caregivers’ coping strategies, respectively. Data gathered from the respondents were collated, coded and analyzed using Statistical Package for Social Sciences (SPSS version 20.0) software and Predictive Analytical Software (PAS version 19.0). Chi-square was used to test for associations between categorical variables at the 0.05 level of significance. Results are presented in tables and charts.

Research results

Assessment of burden level revealed that a reasonable proportion of the caregivers [97 (46.19%)] experienced severe burden, and 37 (17.62%) experienced trivial or no burden, while 76 (36.2%) perceived moderate burden. The results showed that the coping strategies used by caregivers to ease the level of burden experienced during caregiving included; acceptance, reprioritization, appreciation, family, positive self-view and empathy. It was also found that there was a strong association between caregivers’ level of burden and coping strategies (P = 0.030).

Research conclusions

There was a strong association between socio-demographic characteristics (age, education, functional ability, desire to continue caregiving, types of cancer) and caregivers’ coping strategies

Research perspectives

Further studies on caregiver’s burden level and coping strategies in patients with comorbidities should also be carried out.