Predictors of quality of life among informal caregivers of patients with advanced cancer in palliative care: a cross-sectional study
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20254420Keywords:
Advanced cancer, WHOQoL-BREF, Sri Lanka, Quality of life, Palliative care, Family/informal caregiversAbstract
Background: Family members and informal caregivers (ICs) have been suffering many problems, issues, and burdens, which impact the quality of life (QoL). Improving the QoL of ICs is a key aspect of palliative care (PC). This study aimed to determine the predictors of QoL among ICs of patients with advanced cancer in PC.
Methods: This cross-sectional study included 422 ICs who were selected conveniently and attended the PC unit and clinics at Apeksha Hospital, Maharagama, Sri Lanka. An interviewer-administered questionnaire, which included socio-demographic and clinical characteristics, was used to collect data. QoL of ICs was assessed using the validated WHOQOL-BREF scale; higher scores indicated higher QoL. Descriptive and inferential statistics were used.
Results: The mean±SD age of the ICs was 43.13±14.92. The majority of ICs and patients were female. The mean WHOQOL‐BREF domain scores of ICs were 26.56±12.30 for physical health, 20.64±3.23 for psychological status, 10.03±1.60 for social relations, and 24.76±3.72 for the environmental domain. Predictors of QoL among ICs were age (p<0.01), religion (p<0.01), education (p<0.05), family income (p<0.01), care level (p<0.01), physical illnesses (p<0.01), emotional strain (p<0.05), self-reported general health (p<0.01), medical conditions (p<0.05), psychological conditions (p<0.01), comorbidities (p<0.05), and family/friend support (p<0.05).
Conclusions: The physical QoL was considerably high, while all domains among ICs were impaired. It is recommended to consider the predictors of QoL of ICs comprehensively who live in third-world developing countries. Sri Lankan healthcare professionals must ensure that ICs have overall well-being and receive the proper support/resources to care for their patients.
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References
Bray F, Laversanne M, Sung H, Ferlay J, Siegel RL, Soerjomataram I, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74(3):229-63. DOI: https://doi.org/10.3322/caac.21834
National Cancer Control Program. Cancer incidence data: Sri Lanka Year 2001-2005 National Cancer Control Programme. 2009. Available at: https://www.nccp.health.gov.lk/en/incedenceData. Accessed on 9 January 2025.
Ministry of Health. Annual health statistics 2019 Sri Lanka. Available at: https://www.health.gov.lk/ annual-health-bulletin/. Accessed on 9 January 2025.
Palliative care, key facts 2020. Available at https://www.who.int/news-room/fact-sheets/detail/palliative-care. Accessed 9 January 2025.
Hui D, Hannon BL, Zimmermann C, Bruera E. Improving patient and caregiver outcomes in oncology: team-based, timely, and targeted palliative care. CA Cancer J Clin. 2018;68(5):356-76. DOI: https://doi.org/10.3322/caac.21490
WHOQOL Group. WHOQOL study protocol. Geneva: WHO, Division of Mental Health; 1993.
Dilhani WNS, Vidanapathirana J. A description and comparison of palliative care services in a developed country and a developing country: England and Sri Lanka and lessons to learn. I J Coll Palliat Med Sri Lanka. 2023;1(1):1-10.
WHO. Non-communicable diseases. WHO key facts- 2025. Available at https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases. Accessed 30 December 2025.
Peeler A, Afolabi O, Adcock M, Evans C, Nkhoma K, van Breevoort D, et al. Primary palliative care in low- and middle-income countries: a systematic review and thematic synthesis of the evidence for models and outcomes. Palliat Med. 2024;38(8):776-89. DOI: https://doi.org/10.1177/02692163241248324
Kristanti MS, Hidayati NW, Maryadi. Comparison of palliative care education for family caregivers in high-and low-income countries: an integrative review. Belitung Nurs J. 2023;9(5):411-20. DOI: https://doi.org/10.33546/bnj.2713
Koçak N, Şenel G, Oğuz G, Karaca Ş, Gökse F. Quality of life and burden in family caregivers of patients with advanced cancer receiving specialized palliative care. Indian J Cancer. 2022;59(2):187-93. DOI: https://doi.org/10.4103/ijc.IJC_671_19
Kochuvilayil A, Varma RP. Understanding caregiver burden and quality of life in Kerala’s primary palliative care program: a mixed methods study from caregivers and providers’ perspectives. Int J Equity Health. 2024;23(1):92. DOI: https://doi.org/10.1186/s12939-024-02155-x
Agustina R, Ispriantari A, Konlan KD, Lin MF. Impact of early palliative care on the quality of life in caregivers of cancer patients: a systematic review. Worldviews Evid Based Nurs. 2023;20(3):178-90. DOI: https://doi.org/10.1111/wvn.12629
Meegoda L, Fernando S, Sivayogan I, Atulomah NO, Jayasiri J. Perceived palliative care needs of cancer patients, nurses and domiciliary care providers at a national cancer referral facility, Sri-Lanka. J Pioneer Med Sci. 2015;5(2):46-50.
Duimering A, Turner J, Chu K, Huang F, Severin D, Ghosh S, et al. Informal caregiver quality of life in a palliative oncology population. Support Care Cancer. 2020;28(4):1695-702. DOI: https://doi.org/10.1007/s00520-019-04970-3
Weeratunga EB, Goonewardena CSE, Meegoda MKDL. Different unmet needs among informal caregivers of patients with advanced cancer in palliative care, Sri Lanka. Proceedings of the 16th Asia Pacific Hospice Palliative Care Conference 2025 (APHC 2025), Borneo Convention Centre Kuching (BCCK), Sarawak, Malaysia. DOI: https://doi.org/10.1038/s41598-025-26469-0
Van Hof KS, Hoesseini A, Dorr MC, Verdonck-de Leeuw IM, Jansen F, Leemans CR, et al. Caregiver burden, psychological distress, and quality of life among informal caregivers of patients with head and neck cancer: A longitudinal study. IJERPH. 2022;19(23):16304. DOI: https://doi.org/10.3390/ijerph192316304
Weeratunga EB, Goonewardena CSE, Meegoda MKDL. Perceived social support and family/friend support among informal cancer caregivers at the Apeksha Hospital, Maharagama, Sri Lanka. Proceedings of 11th International Conference on Multidisciplinary Approaches/iCMA-2025, Faculty of Graduate Studies, University of Sri Jayewardenepura, Nugegoda, Sri Lanka. 66.
Ramadasa U, Silva S, Udumulla U, Perera S, Lekamwasam S. Caregiver strain among patients of palliative care in Sri Lanka: validation of modified caregiver strain index- Sinhala version. BMC Palliat Care. 2023;22(1):172. DOI: https://doi.org/10.1186/s12904-023-01270-w
Dharmakan M, Seneratne L, Vidanapathirana J. Quality of life among family caregivers of advanced cancer patients attending the palliative care clinic at National Cancer Institute, Maharagama, Sri Lanka: an observational descriptive cross-sectional study. I J Coll Palliat Med Sri Lanka. 2023;1(1).
Rukshani D, Kahandawala P, Jayawardana K, Karunarathne D, Galgamuwa LS, Kumara C, et al. Factors associated with quality of life among cancer patients in Sri Lanka. Int J Community Med Public Health. 2018;5(7):2705-13. DOI: https://doi.org/10.18203/2394-6040.ijcmph20182603
Pathirana TI, Goonawardena CSE, Wijesiriwardane I. Quality of life of caregivers and impact on the nuclear family of children with leukaemia in the National Cancer Institute of Sri Lanka. J Postgrad Inst Med. 2015;2(0):18. DOI: https://doi.org/10.4038/jpgim.7863
Bland M. An introduction to medical statistics. Oxford ; New York: Oxford University Press; 1987:365.
The World Health Organization quality of life assessment (WHOQOL): Development and general psychometric prospects. Soc Sci Med. 1988;46(12):1569-86. DOI: https://doi.org/10.1016/S0277-9536(98)00009-4
Kumarapeli V, Seneviratne RDA, Wijeyaratne CN. Validation of WHOQOL-BREF to measure quality of life among women with polycystic ovary syndrome. J Coll Community Phys Sri Lanka. 2006;11(2):1. DOI: https://doi.org/10.4038/jccpsl.v11i2.8252
Manivannan M, Karunanithi G, Lakshminarayanan S. Correlation between quality of life and burden in caregivers of advanced stage cancer patients on best supportive care. IJPC. 2022; 29:89-93. DOI: https://doi.org/10.25259/IJPC_175_2022
Ng ALS, Fernandez ELL. Palliative care research in a developing country: a scoping review. IJPC. 2025;31:209-13. DOI: https://doi.org/10.25259/IJPC_337_2024
EORTC QLQ-C30 questionnaire. Available from: https://qol.eortc.org/questionnaire/eortc-qlq-c30/. Accessed 9 January 2025.
World Bank Overview. 2025. Available at: https://www.worldbank.org/en/country/srilanka/overview. Accessed on 9 January 2025.
Weeratunga EB, Goonewardena CSE, Meegoda MKDL. Quality of life among informal caregivers of patients with advanced cancer in palliative care at the Apeksha Hospital, Maharagama, Sri Lanka. Proceedings of the International Conference on Sexual and Reproductive Health/ReproSex. Sri Lanka. 2024;140-141.
Weeratunga EB, Goonewardena S, Meegoda L. Prevalence and associated factors of depressive symptoms among informal caregivers of patients with advanced cancer who received palliative care in Sri Lanka. Asian Pac J Cancer Prev. 2025;26(6):1997-2007. DOI: https://doi.org/10.31557/APJCP.2025.26.6.1997
Weeratunga E, Goonewardena S, Meegoda L. Prevalence and associated factors of depressive symptoms among informal caregivers of patients with advanced cancer at the Apeksha Hospital, Maharagama, Sri Lanka. Proceedings of the International Research Symposium of the Faculty of Allied Health Sciences (iRuFARS 2024), University of Ruhuna, Matara, Sri Lanka. 33.
Weeratunga EB, Goonewardena CSE, Meegoda MKDL. Exploration of experiences of cancer patient-informal caregiver dyad in palliative care at Apeksha Hospital, Maharagama, Sri Lanka. JCCPSL-Global Public Health Summit (GPHS) 2025 and 30th Annual Academic Sessions, Hilton Residence/Sri Lanka; 2025.
Gardiner C, Robinson J, Connolly M, Hulme C, Kang K, Rowland C, et al. Equity and the financial costs of informal caregiving in palliative care: a critical debate. BMC Palliat Care. 2020;19(1):71. DOI: https://doi.org/10.1186/s12904-020-00577-2
Weeratunga E, Senadheera C, Hettiarchchi M, Ekanayake U, Perera B. Psychosocial factors associated with quality of life of patients with cancer in Southern Sri Lanka. 2019;30-41.
Weeratunga EB, Senadheera C, Hettiarachchi M, Ekanayake U, Perera B. The prevalence and correlates of depressive symptoms in patients with cancer treated in a Tertiary health care facility in Southern Sri Lanka. Int J Med Sci. 2021;8(2):13-29. DOI: https://doi.org/10.4038/ijms.v8i2.137
Weeratunga E, Senadheera C, Hettiarachchi M, Ekanayake U, Perera B. Development and validation of a Religious and Spiritual Support Scale in Sri Lanka: a psychometric study. IHTP. 2023;3(1),71-87. DOI: https://doi.org/10.32920/ihtp.v3i1.1717
Zoysa PD, Wickrama T. Mental health and cultural religious coping of disabled veterans’ in Sri Lanka. JMVH. 2011; 19(3): 4-12.
Kumar DS. Building palliative care programme in developing countries and role of home-based care. Available at: https://www.salzburgglobal.org/ fileadmin/user_upload/Documents/2010-2019/2016/Session_562/Public_Health_approach_in_NCD_-_PC_Chapter_Final.pdf. Accessed on 9 January 2025.
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