PROFORMA FOR REGISTRATION

OF

SUBJECT FOR DISSERTATION

JULIE JOHN

1ST YEAR MSC NURSING

MEDICAL SURGICAL NURSING

2O10-2012

SEA COLLEGE OF NURSING

K.R PURAM, BANGALORE – 49

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES.

BANGALORE, KARNATAKA

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PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1 NAME OF THE CANDIDTE AND

ADDRESS

MS. JULIE JOHN

1ST YEAR M.SC. NURSING

SEA COLLEGE OF NURSING

BANGALORE- 49

2 NAME OF THE INSTITUTION SEA COLLEGE OF NURSING

3 COURSE AND SUBJECT MSC NURSING

MEDICAL SURGICAL NURSING

4 DATE OF ADMISSION TO THE

COURSE

03-05-2010

5 TITLE OF THE TOPIC A STUDY TO ASSESS THE

EFFECTIVENESS OF

INFORMATIONAL BOOKLET

REGARDING CHEMOTHERAPY ON

KNOWLEDGE AND ATTITUDE

AMONG CANCER PATIENTS

RECEIVING CHEMOTHERAPY

FROM SELECTED HOSPITAL

BANGALORE.

6.0 BRIEF RESUME OF THE INTENDED WORK

6.1. NEED FOR THE STUDY

“Adapt yourself to the life you have been given; and truly love the

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People with whom destiny has surrounded you”

MARCUS AURELIUS

Cancer is a group of disease with similar characteristic, which can occur all living

cells in the body and different cancer types have different natural history. The myth that

cancer affects people mostly in the developed countries is being broken by the fact that,

of the 10 million new cancer cases seen each year worldwide, nearly 5.5 million are in

the less developed countries. Cancer is the second most common cause of death in the

developed world and a similar trend has emerged in the developing countries too.1

( Chillibreeze writer- Ranjani Mohan, 2010)

WHO has estimated that 91 per cent of oral cancers in South-East Asia are

directly attributable to the use of tobacco and this is the leading cause of oral cavity and

lung cancer in India. Cancer has become one of the ten leading causes of death in India. It

is estimated that there are nearly 1.5 - 2 million cancer cases in India. Over 7 lakh new

cases of cancer and 3 lakh deaths occur annually due to cancer. Data from population-

based registries under National Cancer Registry Programme indicate that the leading sites

of cancer are oral cavity, lungs, esophagus and stomach amongst men and cervix, breast

and oral cavity amongst women. Cancers namely those of oral and lungs in males, and

cervix and breast in females account for over 50% of all cancer deaths in India. 2

A study was conducted on Kidwai Memorial Institute of Oncology, reported that

in Karnataka there would be about 1.5 lakhs cancer cases at any given time and about

35,000 new cancer cases are added to this pool each year. The studies show that over

16,000 new cases are registered every year with more than 20% from neighbouring states

of Andhrapradesh and Tamilnadu and Kerala. 3 In Bangalore, about 4000 new cases of

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cancer are reported every year, and two people die every year due to tobacco related

diseases. (2007)4

Chemotherapy is the use of cytotoxic drugs in the treatment of cancer. More than

400 cytotoxic agents are available for commercial or experimental use with approval by

the federal food and drug administration (FDA). Research continues to contribute

discoveries in the area of chemotherapy as a cancer treatment modality and as a result of

this intensive investigation, new areas have been trapped for further study such as the use

of chemotherapeiutic agents as radio sensitizers, chemoprotectants, and compounds to

reduce multi drug resistance.5

A study done in London on chemotherapy and survival care verses supportive

care alone on 2714 patients shows an increased benefit from chemotherapy by increasing

the survival rate to 23%, an absolute improvement in survival of 9% at 12 months,

increasing survival from 20% to 29%. Thus, this study supports and proves that

chemotherapy increases the survival rate among cancer patients.6

A study was conducted on adverse drug reaction profile of cisplatin-based

chemotherapy regimen in tertiary care hospital in India. Cancer patients who received

cisplatin-based cancer chemotherapy were monitored for adverse reactions. The reactions

observed were nausea, alopecia, anorexia, vomiting, taste alteration, diarrhea,

constipation, tinnitus, and hypocalcaemia.7

Various studies have shown that information provided on chemotherapy helps the

patients to cope with the therapeutic regimen. A study was conducted on the information

needs and satisfaction with and communication of cancer patients receiving palliative

chemotherapy in Hong Kong by questionnaire method. It includes questions regarding

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four areas; patients demographic details, information needs perceptions on information

disclosure and perception on the clinical decision making process. A total 97 patients

were recruited and male to female ratio was 2:1. The result shows that females’ patients

were found to have more information needs than males. It was found that around 1/3rd of

patients were not given explanation or information about the prognosis and stage of

cancer. 60% of patients reported that they would like to have further information.8

A study was conducted in Delhi, India, to evaluate the effectiveness of

informational booklet on risk factors of cancer. The opinion regarding informational

booklet was collected from 30 undergraduate students. The study result showed that

93.67% students gained sufficient information from the booklet. Thus, this study

concludes that informational booklet was effective in increasing the knowledge of the

people.

With the expanded role of nurse, chemotherapy by itself has become an area of

specialization. Studies have found that there is lack of knowledge among cancer patients

regarding the side effects, and its management and educating cancer patients regarding

chemotherapy will help them to cope up and also ensure compliance with the treatment

regimen. Hence the researcher felt the need to develop an informational booklet as an

educational aid to improve the knowledge and attitude of patients regarding

chemotherapy.

6.2. REVIEW OF LITERATURE

. A study was conducted in French on chemotherapy, an age revealing process. The

study reports that elderly persons want to know about their diagnosis and therapeutic

alternatives. The respondents were feeling in good health before as well as having gone

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through hard times to enhance acceptability of chemotherapy. Possible issues are

perceived in a limited but often overestimated lap of life. At this time, actual age is not

present in the patients mind. But as a result of the treatment, patient feels sign of ageing.

Cancer and chemotherapy give rise to a feeling of loneliness and vulnerability never

known until this age.10

A study was conducted in Pakistan on 230 patients to assess the influence of

patient’s perception, beliefs and knowledge about cancer on treatment decision making.

The result shows that 28% did not have proper information about chemotherapy, 27%

thought that cancer is contagious, 27% believed in some myth, and 39.6 % thought that

cancer can be prevented by regular religious activities. 11

A study was conducted in USA on attitudes toward information about genetic risk

for cognitive impairment after cancer chemotherapy.160 breast cancer survivors (BC

group) and 205 healthy controls (HC group) were randomly assigned to respond to two

different clinical scenarios of genetic-related risk of cognitive impairment and severity of

CI after chemotherapy. Results indicated that the importance ascribed to genetic

information was greatest than CI likelihood and severity were both high and low (P<.05).

And the BC group was less likely to indicate genetic information would affect their

decision to receive chemotherapy than HC group (P>.001).Study concludes that women

believe it is important to receive genetic information, they might benefit from assistance

in the difficult task of integrating information about survival and risk for adverse late

effects from cancer treatment.12

A study was conducted in Italy on chemotherapy induced peripheral

neurotoxicity. The study shows that chemotherapy induced peripheral neurotoxicity

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(CIPN) is a common potentially severe and dose limiting adverse effect of cancer

treatment, however the effects of CIPN on the daily life of individual are not completely

understood. CIPN can be induced by several types of drugs that are widely used in the

treatment of solid and hematological malignancies. No drugs capable of preventing the

occurrence of CIPN or ameliorating its long term course are available and chemotherapy

schedule modification is often required to limit its severity, which could potentially

prevent patients from receiving the most effective treatment for cancer.13

A study was conducted in Manipal, India on Hair loss among 8 cancer

chemotherapeutic patients The results shows that, all had diffuse moderate aloepecia

within 1 month of starting treatment. Of the 8, 3 had only telogen hairs and 3 had high

dystrophic hair count. Both anagen and telogen effluvium are implicated.14

A study was conducted in Uttar Pradesh, India, on unusual nail pigmentation

following cyclophosphamide-containing chemotherapy regimen. The study reports that

patient developed pigmentation of nails after six cycles of cyclophosphamide,

methotrexate, and 5-flourouracil chemotherapy, each repeated after 28 days for breast

cancer. The patient developed nail pigmentation that started proximally and spread

distally and involved all the nails of both hands and feet except the second and third

toenails of right foot.15

A study was conducted in India, Kerala to evaluate the effect of chemotherapy on

distress, anxiety and depression among cancer patients. A total of 117 patients were

evaluated by using distress inventory for cancer (DIC2) and hospital anxiety and

depression scale (HADS). Majority of the patients were taking chemotherapy for solid

tumors (52; 44.4%). The results shows that the mean distress score was 24, 18 (15.38%)

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were found to have anxiety while 19 (16.23%) had depression. High social status was the

only factor found to influence distress while female gender was the only factor found to

influence depression in the present study.16

A randomized controlled trial study was conducted in Greece on Impact of

providing booklets about chemotherapy to newly presenting patients with cancer. This

study investigated the impact of a booklet about chemotherapy on patient satisfaction,

quality of life (QoL) and emotional distress, and assessed booklet use. The results show

that baseline characteristics were well balanced between the two groups. Experimental

group patients reported being significantly more satisfied with the information received

and care overall than those in the control group, felt significantly more and better

informed, and perceived the information received as being clearer and detailed. The

majority considered the booklet useful to read and helpful in recalling chemotherapy-

related Information.17

A purpose-based information assessment (PIA) was done to assess the

effectiveness of an informational booklet. One hundred and eighty-two patients and

family members were provided with a booklet on early-stage prostate cancer and its

treatment options, in the context of a clinical trial comparing two booklets. The results

shows that 86% of the participants wanted information for a mean of 5.8 purposes. 72.5%

rated the booklet at different levels of helpfulness across their purposes.18

STATEMENT OF THE PROBLEM

A study to assess the effectiveness of informational booklet regarding chemotherapy on

knowledge and attitude among cancer patients receiving chemotherapy from a selected

cancer hospital, Bangalore.

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6.3 OBJECTIVES

1 To assess the knowledge of cancer patients regarding chemotherapy through

pretest.

2 To assess the attitude of cancer patients regarding chemotherapy through pretest.

3 To evaluate the effectiveness of informational booklet regarding chemotherapy

among cancer patients through post test.

4 To determine the relationship between post test knowledge scores of cancer

patients regarding chemotherapy with their selected demographic variables.

5 To determine the relationship between post test attitude scores of cancer patients

regarding chemotherapy with their selected demographic variables.

6.4 HYPOTHESIS

H1: There will be significant difference between pre test and post test knowledge

scores among cancer patients regarding chemotherapy .

H2: There will be significant difference between pretest and post test attitude scores

among cancer patients regarding chemotherapy .

H3:- There will be significant association between post test knowledge scores among

cancer patients on knowledge of chemotherapy with selected demographic variables.

H4: There will be significant association between post test attitude scores among

cancer patients on chemotherapy with selected demographic variables

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6.5 RESEARCH VARIABLES

1) Independent variables

In this study independent variables refers to the informational booklet.

2) Dependent variable

In this study dependent variables refers to the knowledge and attitude of cancer patients

receiving chemotherapy.

3) Demographic variables

In this study demographic variables refers to age, sex , education ,occupation ,income,

marital status.

6.6 OPERATIONAL DEFINITIONS

Effectiveness:

The significant increase in the level of knowledge among cancer patients receiving

chemotherapy after administering booklet.

Informational booklet:

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It is small books which contain facts or truth on a particular topic. In this study it refers to

the small booklet containing chemotherapy schedule, side effects due to chemotherapy

and its management.

Chemotherapy:

This is the treatment of malignant disease with drugs containing specific anti-cancer

effects.

Knowledge:

In this study knowledge refers to the written responses of the patient regarding

chemotherapy which was measured through knowledge questionnaire.

Attitude:

In this study attitude refers the expressed belief and feelings of cancer patients towards

cancer chemotherapy and was measured by an attitude scale.

Cancer:

It is a disease caused by an uncontrolled division of abnormal cell in any part of the body.

Cancer patients:

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In this study cancer patient refers to a person who has been diagnosed with some type of

malignant disease by a physician and will be receiving chemotherapy for the treatment of

cancer during the time of data collection.

7. 0 MATERIALS AND METHODS

7.1. SOURCES OF DATA:

Data will be collected from selected hospital Bangalore.

7.2 METHOD OF COLLECTION OF DATA

7.2.1 Research design:

Pre experimental study (one group pre test and post test design)

7.2.2 Population

Cancer patients who are receiving chemotherapy admitted in the selected hospitals.

7.2.3 Sample size:

The sample size will be 60.

7.2.4 Sampling technique:

Purposive sampling technique will be adopted.

7.2.5 Criteria for selection of sample

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Inclusion criteria:

Both male and female cancer patients who are receiving chemotherapy for the

treatment of cancer.

Patients who were present during the time of data collection.

Who can read and write kannada and English.

Patients between the age group of 20-60 years.

Exclusion criteria

Patients who are critically ill.

Patients who are receiving radiotherapy.

Who are professionals from the medical and nursing field.

Who are admitted in the other hospitals.

7.2.6 Research Setting:

Oncology wards in selected hospitals in Bangalore.

7.2.7 Tools for data collection:

a) A structured interview schedule to collect demographic variables.

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b) A structured self administered questionnaire will be given to cancer patients to

assess the pre test and post test knowledge.

c) Likert scale to assess the attitude of the cancer patients regarding

chemotherapy.

7.2.8 Data collection procedure:

The investigator will obtain permission from concerned authority and data will

be collect from the cancer patients based on inclusion and exclusion criteria. Pre test

will be conducted on 60 samples using structured self administered questionnaire

followed by distribution of informational booklet regarding chemotherapy. After 10 days

post test will be conducted by using the same questionnaire to assess the effectiveness of

informational booklet.

7.2.9 Data analysis method

Data analysis will be done by using descriptive and inferential statistics. The

descriptive statistics like frequency distribution, mean, standard deviation and percentage

will be used to assess the socio demographic variables. The inferential statistics like

paired’t’ test and chi-square test will be used to compare the pre and post knowledge

scores and to find out the association between the pre test knowledge scores with

selected socio demographic variables respectively.

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7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION

TO BE CONDUCTED ON PATIENTS OR OTHER HUMAN OR ANIMALS?

No. Only informational booklet will be given and standard questionnaire will be used to

assess the knowledge and attitude among cancer patients receiving chemotherapy.

7.4 HAS ETHICAL CLEARANCE HAS BEEN OBTAINED FROM YOUR

INSTITUTION IN CASE OF 7.3?

Yes, a written permission from the hospital authority wil be obtained. Consent will be

obtained from patients before study. Confidentiality and anonymity of the subject will be

maintained.

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8. LIST OF REFERENCES

1) Rajani Mohan Indian Talent Global Content.2010 Nov. Available from : URL :

http://www.chillibreeze.com/articles-various/cancer-in-India.asp.

2) Cancer in India. Available from : URL :

http://webcache.googleusercontent.com/search?q=cache

3) Dr.k.Ramachandra Reddy. Department of epidemiology and biostatistics.hospital

based cancer in India,Karnataka. Available from :

URL .http://kidwai.kar.nic.in/statistics.htm

4) Rohit Kumar Tripathi .cancer in India 2010. Available from : URL :

http://www.scribd.com/doc/25852536/Cancers-in-India.

5) Martha. E, Janet S, Sherly E. Oncology Nursing.USA. Mosby Elsevier Publication ;

2007.

6) Cochrane Database Syst Rev.Chemotherapy and supportive care versus supportive

care alone for advanced non-small lung cell cancer ..2010;12(5):CD007309. Available

from : URL : http://www.ncbi.nlm.nih.gov/pubmed/20464

7) Surendiran A, Balamurugan N, Gunaseelan K, Akhtar S, Reddy KS, Adithan C.

Adverse drug reaction profile of cisplatin-based chemotherapy regimen in a tertiary care

hospital in India: An evaluative study. Indian J Pharmacol [serial online] 2010

[cited 2010 Dec 8];42:40-3. Available from:  URL:

http://www.ijp-online.com/text.asp?2010/42/1/40/62412

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8) Dr.Patrica CM Poon.The information needs and satisfaction with communication of

cancer patients receiving palliative chemotherapy.HKSPM Newsletter 2009 Sep;2(25).

Available from : URL : http://doc.google.com/viewer?

9) Bairwa K S.A study to develop and evaluate the effectiveness of an informational

booklet on cancer risk factors. Nursing Journal of India. 2002 Oct.Available from:

URL:http://findarticles.com/p/articles/mi_qa4036/is_20021/ai_n9122241

10) Anchisi S,Anchisi A.Going through chemotherapy :an age revealing process. Article

in French 2008 May; 28-95 FMC Onco:F44-50 Available from :

URL :http://www.ncbi.nlm.nih.gov/pubmed.

11) Kumar S,Shaikh AJ,Khalid S,Masood N. Influence of patient ’s perceptions,beliefs

and knowledge about cancer on treatment decision making in Pakistan,Asian Pac

journal2010;11(1):251-5. Available from : URL : http://www.ncbi.nlm.nih.gov/pubmed.

12) Andrykowski MA, Burris JL, Walsh E, Small BJ, Jacobensen PB. Attitudes toward

information about genetic risk for coginitive impairment after cancer chemotherapy in

USA. Clinical oncology2010 July; 28(21):3442-7. http://www.ncbi.nlm.nih.gov/pubmed

13) Cavaletti G,Marmiroli P. Chemotherapy induced peripheral neurotoxicity.

Department of neuroscience and biomedical technologies in Itali.2010 Dec;6(12):657-

66 . Available from : URL : http://www.ncbi.nlm.nih.gov/pubmed/21060341

14) Chadha V, Shenoi SD. Hair loss in cancer chemotherapeutic patients in Manipal.

Indian J Dermatol Venereol Leprol [serial online] 2003 [cited 2010 Dec 8];69:131-2.

Available from: URL :http://www.ijdvl.com/text.asp?2003/69/2/131/5896

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15) Santhosh Kumar,Rakesh Dixit,Saurabh Karmakar,Sayan Paul.Unusual nail

pigmentation following cyclophosamide-containing chemotherapy regimen in Uttar

Pradesh.Indian journal2010;42 (4): 243-244 Indian J Pharmacol [serial online] 2010

[cited 2010 Dec 8];42:243-4. Available from:URL: http://www.ijp-online.com/text.asp?

2010/42/4/243/68433.

16) Manoj Pandey,Gangadharan P Sarita,Nandkumar Devi,Bejoy C Thomas,Badridien M

Hussaal oncologyn,Rita Krishna .Distress, anxiety,and depression in cancer patients

undergoing chemotherapy in Kerala,India.jounal of surgical oncology.2006;4:68 .

Available from : URL :.http://www.wjso.com/content/4/1/68

17) G.Iconomou,A.Viha,A.Koutras,I.Koukourikou,V.Mega,T.Maka.etal. Impact of

providing booklets about chemotherapy to newly presenting patients with cancer in

Greece. Annals of oncology2005;17(5) :515-520.Oxford journals Available from : URL :

http://annonc.oxfordjournals.org/content/17/3/515.full

18) Deb Feldman Stewart,Sarah Brennenstuhi. A purpose – based evaluation of

information for patients:An approach to measuring effectiveness. 2007 mar; 65(3):311-

319.Avaliable from : URL: http://www.sciencedirect.com/science

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9 SIGNATURE OF THE

CANDIDATE

10 REMARKS OF THE GUIDE THIS STUDY WILL BE HELPFUL TO MANAGE SIDE EFFECT CAUSED BY CHEMOTHERAPY AMONG CANCER PATIENTS

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11.1

11.2

11.3

11.4

11.5

11.6

NAME AND DESIGNATION OF

GUIDE

SIGNATURE

CO- GUIDE

SIGNATURE

HEAD OF THE DEPARTMENT

SIGNATURE

MRS. HEMAM SANGEETA DEVI

HOD, MEDICAL SURGICAL

NURSING

SEA COLLEGE OF NURSING

BANGALORE – 49

MRS.GEETHA G

LECTURER

SEA COLLEGE OF NURSING

BANGALORE -49

MRS. HEMAM SANGEETA DEVI

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12.1

REMARKS OF THE PRINCIPAL

SIGNATURE

THE TOPIC SELECTED FOR THE STUDY IS RELEVENT AND CAN BE FORWARDED FOR NEEDFUL ACTION.

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