Quality of Life and Symptom Burden Following Depression Screening and Treatment among Patients Living with Cancer at Kamuzu Central Hospital in Malawi: A Comparison of Two Treatment Models
Jonathan Chiwanda Banda1,3*, Wingston Felix Ng’ambi2, Leo Masamba5, Michael Udedi3, Olive Liwimbi6, Chifundo Colleta Zimba4, Moses Kamzati7, Richard Nyasosela8 and Adamson Sinjani Muula1,2
1Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
2The Africa Center of Excellence in Public Health and Herbal Medicine, Kamuzu University of Health Sciences Blantyre, Malawi
3Department of Curative and Medical Rehabilitation Services, Non-Communicable Diseases & Mental Health Unit, Ministry of Health, Lilongwe, Malawi
4Department of Epidemiology, University of North Carolina Project, Lilongwe, Malawi, & Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States
5Oncology Department, Queen Elizabeth Central Hospital, Blantyre, Malawi
6Psychiatry and Behavioral Sciences, Zomba Mental Hospital, Zomba, Malawi
7International Training & Education Center for Health (I-TECH)- Malawi, Department of Global Health, University of Washington, City Centre, Lilongwe, Malawi
8National Cancer Center, Kamuzu Central Hospital, Lilongwe, Malawi
*Corresponding Author: Jonathan Chiwanda Banda, Non-Communicable Diseases and Mental Health Unit, Department of Curative and Medical Rehabilitation Services, Ministry of Health, P.O. Box 30377, Lilongwe 3, Malawi.
Published: July 23, 2024
Abstract
Background: Cancer is commonly associated with depression and depressive symptoms. Depressive disorders often worsen over the course of cancer treatment, persist after cancer therapy, recur with the recurrence of cancer and impact on function and medical outcomes. We aimed at assessing whether depression management could happen at the cancer center without referral to the mental health clinic.
Methods and materials: We conducted a quasi-experimental study for screening and treatment of depressive symptoms among patients living with cancer, who were attending oncology services at Kamuzu Central Hospital between May, 2021 and August, 2022. The intervention arm had screen and treat for depressive symptoms as an integrated approach to cancer care within the study site while the comparison arm had screen and refer patients diagnosed with depressive symptoms to usual mental health clinic. Patients were followed-up for six months and health related quality of life was measured using Euroqol-5 dimession-3 levels tool during each visit. Depressive symptoms were evaluated using the Patient Health Questionnaire-9.
Results: There were 214 participants in the study; 112 in the comparison and 102 in the intervention group. The majority (65%) were females and at least 36% of the participants were in the middle age group (26-45 years); 29% of the participants had unknown HIV status. Participants of high socio-economic status were twice more likely to report poor quality of life than those with lower socio-economic status 1.99 (95% CI: 1-12-3.53, p<0.02). Employed participants were less likely to report poor quality of life 0.62 (95% CI: 0.42-0.90, p<0.01). Poor quality of life was steadily declining with each successive clinic visit, 0.07 (95% CI: 0.05-0.10, p< 0.001) and there were similar patterns of improvement in quality of life between study arms, 1.06 (95% CI:0.73-1.54, p<0.77).
Conclusion: Depression screening and treatment could be integrated within the cancer care for improved quality of life in Malawi. While persons accessing care within hospital can benefit from HIV testing and referral for treatment if found HIV positive, Malawian cancer patients at Kamuzu Central Hospital might not have benefitted from these services as a handful of participants in our study had not been tested.
Keywords: Quality of life; Cancer; Depression
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