Quality of life, symptom burden and associated factors among lung cancer patients: baseline study of three public hospitals across sub- Saharan Africa

Background Cancer patients in Sub-Saharan Africa (SSA) are diagnosed late partly due to community lack of knowledge about the disease, social and cultural factors, health system challenges, and inadequate health care worker knowledge. These delays in diagnosis as well as inadequate treatment options contribute to the high mortality from lung cancer in SSA. Quality of life (QoL) is an important outcome measure for cancer patients undergoing treatment. Objective To describe the quality of life among lung cancer patients in three teaching hospitals in SSA. Methods This is a prospective cross-sectional study of lung cancer patients at three teaching hospitals in Sub-Saharan Africa (SSA-Kenya (BMC), Tanzania (MTRH) and South Africa (The Lung Laboratory Research and Intervention Unit Helen Joseph Hospital). Trained interviewers collected data on demographics, clinical information and performance status using the Eastern Cooperative Oncological Group Performance Scale (ECOG-PS). Patients’ QoL was assessed using the 30-item European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Results A total of 210 lung cancer patients consented and were enrolled across the three sites. Global Health Status in this cohort is low, the median score was 41.7 (range: 0-100) and differed between sites. Wits Core patients had higher social functioning, while BMC and MTRH had higher financial difficulty scores. Poor ECOG-PS score (3-4) was associated with poorer Global QoL (GqoL) score (aOR = 2.9; 95% CI: 1.4 - 5.9), and patients with higher symptom burden had poorer GQoL. Conclusion The QoL among lung cancer patients in the three sites is low. Poor QOL in the study is associated with level of education, performance status, fatigue, pain, dyspnoea, insomnia, loss of appetite and constipation. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement No financial disclosure ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethical approval was obtained from the University of Witwatersrand Human Research Ethics Committee (Medical) (Ref: M180436), MTRH Institutional Research and Ethics Committee IREC (0004048), BMC/CUHAS Ethics & Review Committee (Certificate number CREC/278/2018) and National Institute for Medical Research (Certificate number MR/53/100/598). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data used to support the research findings is included as part of the supporting information.