Psychological Distress and Quality of Life of Cancer Patients
Author
[Name of the Institution]
Abstract
Cancer is a fatal disease, due to which thousands of people die because of a lack of health facilities and because of a lack of health and treatment services to cancer patients. Cancer patients suffer mental stress because of the change in their life, physical appearance and behavioral changes. The increase in the stress level hinders the treatment process of cancer patients because it leads to other psychological issues. It is important to provide the facilities that include the psycho-oncologists, while psycho-oncologists play a vital role in decreasing the stress levels of the cancer patients which will avoid any hindrances in the treatment of them and this will enhance the quality of life.
Aims and objectives of the research study PAGEREF _Toc23565563 \h 5
Main Objective PAGEREF _Toc23565564 \h 6
Literature Review PAGEREF _Toc23565565 \h 7
Psychological Stress PAGEREF _Toc23565566 \h 7
Mental Health PAGEREF _Toc23565567 \h 8
Mental illness and Cancer PAGEREF _Toc23565568 \h 9
Quality of life in cancer patients and stress PAGEREF _Toc23565569 \h 9
The United States and deaths caused by cancer PAGEREF _Toc23565570 \h 10
Methodology PAGEREF _Toc23565571 \h 11
Instrument design and data collection PAGEREF _Toc23565572 \h 12
Target population and sample size PAGEREF _Toc23565573 \h 12
Data analysis PAGEREF _Toc23565574 \h 12
Ethical Considerations PAGEREF _Toc23565575 \h 13
Bibliography PAGEREF _Toc23565576 \h 14
Psychological Distress and Quality of Life of Cancer Patients
Introduction/background
Cancer is a chronic disease, when not treated on time can cause deaths of the patients suffering from cancer. In an individual’s life, cancer spreads through different parts and dimensions which demands complete treatment approaches. However, the studies about the interventions for mental and psychological health are insufficient and they are scattered. Patients are exposed to stress when they are suffering from infections and an increase in the stress level and poor quality of life can impede the identification of patients.
Cancer patients suffer not only from this fatal disease but also psychologically, their physical appearance is changed, their behaviors change and their perceptions about life completely change. Their timely treatment is important to provide them a quality of a life. Stress is the main factor responsible for hindrance in the treatment of cancer and it changes the patients. There have been studies conducted that how stress can lead to hindrances in the medical treatment of the cancer patients however there is a need of conducting a study and there is a need to help the patients to overcome the stress by involving the society, family and the healthcare staff. In the previous studies, it showed that only 10 percent of the patients were referred for the psycho-oncological supportive sourced and 41 percent of the patients were ignored ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"YOhlIpJk","properties":{"formattedCitation":"(Barre et al., 2018)","plainCitation":"(Barre et al., 2018)","noteIndex":0},"citationItems":[{"id":136,"uris":["http://zotero.org/users/local/smYQhi21/items/4ZSEJ72Q"],"uri":["http://zotero.org/users/local/smYQhi21/items/4ZSEJ72Q"],"itemData":{"id":136,"type":"article-journal","title":"Stress and Quality of Life in Cancer Patients: Medical and Psychological Intervention","container-title":"Indian Journal of Psychological Medicine","page":"232-238","volume":"40","issue":"3","source":"PubMed Central","abstract":"Background:\nCancer pervades many dimensions of an individual's life – demanding a holistic treatment approach. However, studies with combined medical and psychological interventions (MPIs) are sparse. High-level stress and poor quality of life (QoL) can hinder patients' prognosis. The study thus aimed to analyze the impact of combined medical and psychological (psychoeducation, relaxation technique–guided imagery, and cognitive therapy) interventions on stress and QoL of cancer patients – head and neck, breast, and lung cancers.\n\nMethods:\nThe study was conducted in cancer hospitals employing one-group pretest-posttest-preexperimental design. Descriptive statistics, paired t-test, Cohen's d, and bar graphs were used to analyze the data.\n\nResults:\nFindings showed high impact of the combined MPIs in reducing both the overall stress as well as the various components of the stress scale-fear, psychosomatic complaints, information deficit, and everyday life restrictions. Significant changes were also seen in QoL and its domains – global health status, besides functional and symptom scales. Results showed a significant improvement in physical, role and emotional functioning scale, while decrement in fatigue, pain, insomnia, appetite loss, diarrhea, and constipation of symptoms scales.\n\nConclusions:\nIt can be concluded that combined MPI has a positive impact – decreasing stress and improving QoL in cancer patients, which can further enhance their prognosis.","DOI":"10.4103/IJPSYM.IJPSYM_512_17","ISSN":"0253-7176","note":"PMID: 29875530\nPMCID: PMC5968644","title-short":"Stress and Quality of Life in Cancer Patients","journalAbbreviation":"Indian J Psychol Med","author":[{"family":"Barre","given":"Prasad Vijay"},{"family":"Padmaja","given":"Gadiraju"},{"family":"Rana","given":"Suvashisa"},{"family":"Tiamongla","given":""}],"issued":{"date-parts":[["2018"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Barre et al., 2018). So there has to be a study that how oncological staff can be helpful and how their equal and timely treatment can help the cancer patients.
Cancer patients, because of the illness and their well-being are unintentionally subjected to the behavioral changes, their families, societies, and other institutions.
The psychological and physiological changes in the cancer patients make them worried and stressed, and stress leads to anxiety and depression in the cancer patients which disturbs the treatment cycle. Cancer patients not only need to be treated for cancer but also their mental illnesses because they suffer from higher levels of stress and this increased level of stress causes patients to attempt suicide because their mental health is not good and they are not in a stable state to make better decisions. This also disturbs the quality of life of patients, hence it is important to treat them for stress management along with cancer.
Limitations
The current work has been done on the psychological issues and its consequences, but for this research study, there are some limitations. The psycho-oncology staff would not be available during the data collection and, the cancer patients are more sensitive towards the behaviors, so the researcher has to ask a question in proper behavior. And the researcher has not enough time to interview the patients, doctors and the healthcare staff.
Aims and objectives of the research study
The aims and objectives of the research study are
To find out the importance of the psycho-oncological in the treatment of cancer patients
To find out the importance of treating the mental illness of time
To find out the role of family, caregivers, and society in the treatment of stress in cancer patients
Identifying the factors responsible for the increase in the stress and their impacts on the quality of life of the cancer patients would help future studies. It will help to investigate more factors responsible for the increase in the stress of cancer patients. While the role of psycho-oncology staff is important in the stress release in the cancer patients
Main Objective
The main objective of the study is to find the role of psycho-oncology staff in the treatment of cancer patients and their stress management.
Literature Review
The literature review presents a deep understanding of the psychological stress and quality of life of the patients of cancer. In academics, it is important to create a clear understanding and developing the idea of the topic.
Psychological Stress
An individual, when it starts to perceive that, the external environment is demanding excessively, and the demands exceed the adaptive capacities of an individual. Psychological stress starts occurring when an individual is unable to manage the stress level caused by an overburden of the external demands. Psychological stress can be caused by feelings of emotional tensions and it can be caused by any event or a feeling leading to frustration, anger, and nervousness. There are two types of stress; acute stress and the other one is chronic stress, however, acute stress is the stress for a short period, while chronic stress is the stress, which remains for a longer duration, and chronic stress can cause a health-related problem. Stress is the negative emotional experiences and these negative experiences are because of the biochemical, physiological and changes in the behaviors, which direct an individual towards the adopting behavior for the experiences. There are two events to happen after being stressed, an individual manipulates the situations that have caused stress, or he/she may cope with it and manage the stress.
According to ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"yA83s61t","properties":{"formattedCitation":"(Sklar and Anisman, 1981)","plainCitation":"(Sklar and Anisman, 1981)","noteIndex":0},"citationItems":[{"id":"CQoSmFZT/3YcX2nUT","uris":["http://zotero.org/users/local/F0XOCTdk/items/E949AI4T"],"uri":["http://zotero.org/users/local/F0XOCTdk/items/E949AI4T"],"itemData":{"id":400,"type":"article-journal","title":"Stress and cancer","container-title":"Psychological Bulletin","page":"369-406","volume":"89","issue":"3","source":"APA PsycNET","abstract":"Consistent with human research suggesting that stress may influence the carcinogenic process, data from infrahuman experiments have revealed that aversive insults may potentiate or inhibit tumorigenicity, with nature of the change dependent on psychological, experiential, and organismic variables. Exacerbation of tumor growth is evident following acute exposure to uncontrollable but not controllable stress, and the effects of aversive stimuli vary as a function of prior stress history and social housing conditions. The fact that stress influences neurochemical, hormonal, and immunological functioning and that these changes are subject to many of the same manipulations that influenced the carcinogenic process suggests a relation between these 3 mechanisms and the stress-induced alterations of tumor growth. This contention is supported by findings showing that pharmacological manipulations that modify these endogenous substrates have predictable effects on tumorigenesis. (10¼ p ref) (PsycINFO Database Record (c) 2016 APA, all rights reserved)","DOI":"10.1037/0033-2909.89.3.369","ISSN":"1939-1455(Electronic),0033-2909(Print)","author":[{"family":"Sklar","given":"Lawrence S."},{"family":"Anisman","given":"Hymie"}],"issued":{"date-parts":[["1981"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Sklar and Anisman, 1981), stress makes an impact on the poisonous processes which may inhibit tumors and the changes in these processes lead to psychological and organismic changes in individuals and this is revealed by the experiments done on the infrahuman. The tumor grows due to exposure to the stress, which cannot be controlled, and the stimulus functions depend on the social conditions and the stress history of the patients.
Mental Health
According to ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ZRZrz0eE","properties":{"formattedCitation":"(Manderscheid et al., 2009)","plainCitation":"(Manderscheid et al., 2009)","noteIndex":0},"citationItems":[{"id":"CQoSmFZT/WbysjKdC","uris":["http://zotero.org/users/local/F0XOCTdk/items/M94AKEB4"],"uri":["http://zotero.org/users/local/F0XOCTdk/items/M94AKEB4"],"itemData":{"id":403,"type":"article-journal","title":"Evolving Definitions of Mental Illness and Wellness","container-title":"Preventing Chronic Disease","volume":"7","issue":"1","source":"PubMed Central","abstract":"Understanding of the definitions of wellness and illness has changed from the mid-20th century to modern times, moving from a diagnosis-focused to a person-focused definition of mental illnesses, and from an \"absence of disease\" model to one that stresses positive psychological function for mental health. Currently, wellness refers to the degree to which one feels positive and enthusiastic about oneself and life, whereas illness refers to the presence of disease. These definitions apply to physical as well as mental illness and wellness. In this article, we build on the essential concepts of wellness and illness, discuss how these definitions have changed over time, and discuss their importance in the context of health reform and health care reform. Health reform refers to efforts focused on health, such as health promotion and the development of positive well-being. Health care reform refers to efforts focused on illness, such as treatment of disease and related rehabilitation efforts.","URL":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2811514/","ISSN":"1545-1151","note":"PMID: 20040234\nPMCID: PMC2811514","journalAbbreviation":"Prev Chronic Dis","author":[{"family":"Manderscheid","given":"Ronald W."},{"family":"Ryff","given":"Carol D."},{"family":"Freeman","given":"Elsie J."},{"family":"McKnight-Eily","given":"Lela R."},{"family":"Dhingra","given":"Satvinder"},{"family":"Strine","given":"Tara W."}],"issued":{"date-parts":[["2009",12,15]]},"accessed":{"date-parts":[["2019",11,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Manderscheid et al., 2009), illness is the state in which there is disease and well-being means that there is no illness and an individual feels pessimistic about his/her own life. Over the last decades, the definitions of mental illness have changed. The conditions, which affect the behaviors, emotions, and cognition of the individuals, are stated as mental illness. During the 1960s and 1970s, people suffering from mental illness or diseases were labeled and deinstitutionalization at that time was moving very fast. During the 1990s, the population of the mentally ill was increasing very rapidly and most of them were homeless. Those who were suffering because of severe mental disorders were let free from the hospitals and there were very few community-based services were available. Mentally well-being means to be a healthy person not only physiologically but also psychologically; while stressed and unhealthy mind is one of the main issues of the cancer patients and it is studied that they are most stressed during their treatment and after the treatment when they are cancerous free because of the trauma ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"IilcFiXA","properties":{"formattedCitation":"(Kang et al., 2012)","plainCitation":"(Kang et al., 2012)","noteIndex":0},"citationItems":[{"id":"CQoSmFZT/oRkcWQLr","uris":["http://zotero.org/users/local/F0XOCTdk/items/I5KAIHI7"],"uri":["http://zotero.org/users/local/F0XOCTdk/items/I5KAIHI7"],"itemData":{"id":407,"type":"article-journal","title":"Cancer-specific stress and mood disturbance: implications for symptom perception, quality of life, and immune response in women shortly after diagnosis of breast cancer","container-title":"ISRN nursing","page":"608039","volume":"2012","source":"PubMed","abstract":"Purpose. To determine the levels of cancer-specific stress and mood disturbance in women shortly after diagnosis of breast cancer and to assess their associations with symptom perception, quality of life, and immune response. Design. Descriptive and correlational. Sample and Setting. One hundred women with newly diagnosed breast cancer were recruited from interdisciplinary breast clinics. Methods. Baseline data were collected using standardized questionnaires and established bioassay prior to the initiation of cancer adjuvant therapy. Blood samples were collected about the same time of day. Results. High cancer-specific stress was significantly correlated with high mood disturbance, which, in turn, was correlated with high symptom perception, poor quality of life, and an immune profile indicating high neutrophils and low lymphocytes. Conclusions. High cancer-specific stress and related mood disturbance show extensive negative relationships with multiple behavioral, clinical, and biological factors. Implications for Nursing. Routine screening for cancer-related stress and mood disturbance should be incorporated into nursing practice for all patients diagnosed with cancer. Given broad negative associations with other biobehavioral factors, early identification of patients at risk and provision and evaluation of stress and mood management programs may have a beneficial effect on subsequent health outcomes over time.","DOI":"10.5402/2012/608039","ISSN":"2090-5491","note":"PMID: 23316388\nPMCID: PMC3539323","shortTitle":"Cancer-specific stress and mood disturbance","journalAbbreviation":"ISRN Nurs","language":"eng","author":[{"family":"Kang","given":"Duck-Hee"},{"family":"Park","given":"Na-Jin"},{"family":"McArdle","given":"Traci"}],"issued":{"date-parts":[["2012"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Kang et al., 2012).
Patients after treatment still suffer from mental illness and stress because of the trauma, physical changes, the severity of the disease and they suffer from family issues during and after their illness. Mental illness and stress make an impact on the quality of life of patients suffering from cancer and these results in posttraumatic stress disorder (PSD), depression and anxiety and deteriorates the quality of life of patients. When stress has reduced the quality of life increases in the cancer patients and the stress also includes the social stresses so they need to be controlled to ensure the quality of life in cancer patients ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"ChYwo3p8","properties":{"formattedCitation":"(Kreitler et al., 2007)","plainCitation":"(Kreitler et al., 2007)","noteIndex":0},"citationItems":[{"id":"CQoSmFZT/CH7G4WG6","uris":["http://zotero.org/users/local/F0XOCTdk/items/S6KXK6K9"],"uri":["http://zotero.org/users/local/F0XOCTdk/items/S6KXK6K9"],"itemData":{"id":411,"type":"article-journal","title":"Stress, self-efficacy and quality of life in cancer patients","container-title":"Psycho-Oncology","page":"329-341","volume":"16","issue":"4","source":"PubMed","abstract":"The purpose of the study was to examine the effect of different stressors on various domains of quality of life (QOL) in cancer patients. The study focused on testing a model describing interrelations between two kinds of stress antecedents, two mediating variables--perceived stress and self-efficacy--and QOL. The participants were 60 cancer patients of both genders and various diagnoses. They were administered questionnaires of background information, QOL, perceived stress and general self-efficacy. Two stress indices were defined empirically: health stress (based on advanced disease stage, long disease duration, and undergoing treatment) and social stress (based on unemployment, recent immigration, and older age). Confirmatory factor analysis enabled defining five factors of QOL. Hierarchical regression analyses showed that the index of social stress was related to more QOL scales than the index of health stress and very few interactions with the mediating variables. Structural equation modeling provided a more comprehensive and accurate view. It showed that the index of health stress affected QOL mainly through perceived stress, and that self-efficacy affected QOL by reducing perceived stress and increasing QOL. The major conclusions are that QOL is affected negatively by both health stresses and social stresses, but the former are mediated primarily by the experience of perceived stress.","DOI":"10.1002/pon.1063","ISSN":"1057-9249","note":"PMID: 16888704","journalAbbreviation":"Psychooncology","language":"eng","author":[{"family":"Kreitler","given":"Shulamith"},{"family":"Peleg","given":"Dina"},{"family":"Ehrenfeld","given":"Mally"}],"issued":{"date-parts":[["2007",4]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Kreitler et al., 2007).
Mental illness and Cancer
Patients of cancer go through pain whether it is physiological, or it is psychological. They go through some major changes like losing their weight, losing their hair, having psychological issues of anxiety and depression. Psychiatric patients are at much greater risks and their mortality rate is higher than the rest of the population while different health sectors can invest to make policies and facilitate the psychiatric patients and provide them access to healthcare. The mortality of cancer patients is higher, and cancer also results in the suicides of the patients counting to 10 times. In cancer, the mortality rate of psychiatric patients is higher as compared to the general population. The patients of cancer who survive depends on the treatment and therapies which are effective for their health. The populations belonging to the lower class, immigrants and poor skills do not have access to the diagnosis and for the screening which will result in higher rates of morbidity and mortality which is linked with cancer ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"s5Z2C1eq","properties":{"formattedCitation":"(Kisely et al., 2013)","plainCitation":"(Kisely et al., 2013)","noteIndex":0},"citationItems":[{"id":132,"uris":["http://zotero.org/users/local/smYQhi21/items/G9BG8PCZ"],"uri":["http://zotero.org/users/local/smYQhi21/items/G9BG8PCZ"],"itemData":{"id":132,"type":"article-journal","title":"Cancer-Related Mortality in People With Mental Illness","container-title":"JAMA Psychiatry","page":"209-217","volume":"70","issue":"2","source":"jamanetwork.com","abstract":"<h3>Context</h3>There is a 30% higher case fatality rate from cancer in psychiatric patients even though their incidence of cancer is no greater than in the general population. The reasons are unclear, but if increased cancer mortality were due to lifestyle only, cancer incidence should be similarly increased. Other hypotheses include delays in presentation, leading to more advanced staging at diagnosis, and difficulties in treatment access following diagnosis.<h3>Objective</h3>To assess why psychiatric patients are no more likely than the general population to develop cancer but are more likely to die of it.<h3>Design, Setting, and Patients</h3>A population-based record-linkage analysis compared psychiatric patients with the Western Australian population, using an inception cohort to calculate rates and hazard ratios. Mental health records were linked with cancer registrations and death records from January 1, 1988, to December 31, 2007, in Western Australia.<h3>Main Outcome Measures</h3>Metastases, incidence, mortality, and access to cancer interventions.<h3>Results</h3>There were 6586 new cancers in psychiatric patients. Cancer incidence was lower in psychiatric patients than in the general population in both males (rate ratio = 0.86; 95% CI, 0.82-0.90) and females (rate ratio = 0.92; 95% CI, 0.88-0.96), although mortality was higher (males: rate ratio = 1.52; 95% CI, 1.45-1.60; females: rate ratio = 1.29; 95% CI, 1.22-1.36). The proportion of cancer with metastases at presentation was significantly higher in psychiatric patients (7.1%; 95% CI, 6.5%-7.8%) than in the general population (6.1%; 95% CI, 6.0%-6.2%). Psychiatric patients had a reduced likelihood of surgery (hazard ratio = 0.81; 95% CI, 0.76-0.86), especially resection of colorectal, breast, and cervical cancers. They also received significantly less radiotherapy for breast, colorectal, and uterine cancers and fewer chemotherapy sessions.<h3>Conclusions</h3>Although incidence is no higher than in the general population, psychiatric patients are more likely to have metastases at diagnosis and less likely to receive specialized interventions. This may explain their greater case fatality and highlights the need for improved cancer screening and detection.","DOI":"10.1001/jamapsychiatry.2013.278","ISSN":"2168-622X","journalAbbreviation":"JAMA Psychiatry","language":"en","author":[{"family":"Kisely","given":"Stephen"},{"family":"Crowe","given":"Elizabeth"},{"family":"Lawrence","given":"David"}],"issued":{"date-parts":[["2013",2,1]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Kisely et al., 2013).
Quality of life in cancer patients and stress
The forms of cancer are various and the development in our body in ways that demand complete treatment. The medical conditions of cancer patients are hindered because of stress and poor QOL. Stress is the major factor responsible for the psychological issues in patients suffering from cancer. Quality of life in the health care of cancer patients is an important parameter, QOL is the parameter to asses the goals, objectives, the future plantings and expectations within the cultural frameworks and their value systems. Stress deteriorates the QOL in cancer patients because it promotes the negative feelings and hopelessness in them hindering the medical treatments. For cancer, the availability of a psycho-oncologist is important to have quality services and healthcare ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"OSoUIbny","properties":{"formattedCitation":"(Barre et al., 2018)","plainCitation":"(Barre et al., 2018)","noteIndex":0},"citationItems":[{"id":136,"uris":["http://zotero.org/users/local/smYQhi21/items/4ZSEJ72Q"],"uri":["http://zotero.org/users/local/smYQhi21/items/4ZSEJ72Q"],"itemData":{"id":136,"type":"article-journal","title":"Stress and Quality of Life in Cancer Patients: Medical and Psychological Intervention","container-title":"Indian Journal of Psychological Medicine","page":"232-238","volume":"40","issue":"3","source":"PubMed Central","abstract":"Background:\nCancer pervades many dimensions of an individual's life – demanding a holistic treatment approach. However, studies with combined medical and psychological interventions (MPIs) are sparse. High-level stress and poor quality of life (QoL) can hinder patients' prognosis. The study thus aimed to analyze the impact of combined medical and psychological (psychoeducation, relaxation technique–guided imagery, and cognitive therapy) interventions on stress and QoL of cancer patients – head and neck, breast, and lung cancers.\n\nMethods:\nThe study was conducted in cancer hospitals employing one-group pretest-posttest-preexperimental design. Descriptive statistics, paired t-test, Cohen's d, and bar graphs were used to analyze the data.\n\nResults:\nFindings showed high impact of the combined MPIs in reducing both the overall stress as well as the various components of the stress scale-fear, psychosomatic complaints, information deficit, and everyday life restrictions. Significant changes were also seen in QoL and its domains – global health status, besides functional and symptom scales. Results showed a significant improvement in physical, role and emotional functioning scale, while decrement in fatigue, pain, insomnia, appetite loss, diarrhea, and constipation of symptoms scales.\n\nConclusions:\nIt can be concluded that combined MPI has a positive impact – decreasing stress and improving QoL in cancer patients, which can further enhance their prognosis.","DOI":"10.4103/IJPSYM.IJPSYM_512_17","ISSN":"0253-7176","note":"PMID: 29875530\nPMCID: PMC5968644","title-short":"Stress and Quality of Life in Cancer Patients","journalAbbreviation":"Indian J Psychol Med","author":[{"family":"Barre","given":"Prasad Vijay"},{"family":"Padmaja","given":"Gadiraju"},{"family":"Rana","given":"Suvashisa"},{"family":"Tiamongla","given":""}],"issued":{"date-parts":[["2018"]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Barre et al., 2018). The proper provision of the early interventions to the patients of stress and cancer will help them to decrease the stress and improve the quality of life.
The United States and deaths caused by cancer
From 1980 to 2014 the mortality rate for cancer has decreased by 20.1 percent but the mortality rate has increased in few regions over these past years. The main and leading cause of mortality and morbidity is cancer. During the period between 1980 and 2014, the total deaths of cancer recorded were 19511910. The deaths caused by breast cancer were recorded as; 1573593, pancreatic cancer; 1157878 and 209314 deaths due to uterine cancer. Cancer types varied from place to place in the United States like the breast cancer was recorded the most in the areas of Mississippian river and the southern belt, liver cancer was recorded in the Texas-Mexico, while the records of kidney cancer were from the North and South Dakota. The data was recorded from the National Center for Health Statistics and the population was counted from the Census Bureau and the NCHS and also from the Human Morality Database starting from the year of 1980 to 2014 ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"vOftxvz9","properties":{"formattedCitation":"(Mokdad et al., 2017)","plainCitation":"(Mokdad et al., 2017)","noteIndex":0},"citationItems":[{"id":128,"uris":["http://zotero.org/users/local/smYQhi21/items/5EDUR8WC"],"uri":["http://zotero.org/users/local/smYQhi21/items/5EDUR8WC"],"itemData":{"id":128,"type":"article-journal","title":"Trends and Patterns of Disparities in Cancer Mortality Among US Counties, 1980-2014","container-title":"JAMA","page":"388-406","volume":"317","issue":"4","source":"jamanetwork.com","abstract":"<h3>Introduction</h3><p>Cancer is a leading cause of morbidity and mortality in the United States and results in a high economic burden.</p><h3>Objective</h3><p>To estimate age-standardized mortality rates by US county from 29 cancers.</p><h3>Design and Setting</h3><p>Deidentified death records from the National Center for Health Statistics (NCHS) and population counts from the Census Bureau, the NCHS, and the Human Mortality Database from 1980 to 2014 were used. Validated small area estimation models were used to estimate county-level mortality rates from 29 cancers: lip and oral cavity; nasopharynx; other pharynx; esophageal; stomach; colon and rectum; liver; gallbladder and biliary; pancreatic; larynx; tracheal, bronchus, and lung; malignant skin melanoma; nonmelanoma skin cancer; breast; cervical; uterine; ovarian; prostate; testicular; kidney; bladder; brain and nervous system; thyroid; mesothelioma; Hodgkin lymphoma; non-Hodgkin lymphoma; multiple myeloma; leukemia; and all other cancers combined.</p><h3>Exposure</h3><p>County of residence.</p><h3>Main Outcomes and Measures</h3><p>Age-standardized cancer mortality rates by county, year, sex, and cancer type.</p><h3>Results</h3><p>A total of 19 511 910 cancer deaths were recorded in the United States between 1980 and 2014, including 5 656 423 due to tracheal, bronchus, and lung cancer; 2 484 476 due to colon and rectum cancer; 1 573 593 due to breast cancer; 1 077 030 due to prostate cancer; 1 157 878 due to pancreatic cancer; 209 314 due to uterine cancer; 421 628 due to kidney cancer; 487 518 due to liver cancer; 13 927 due to testicular cancer; and 829 396 due to non-Hodgkin lymphoma. Cancer mortality decreased by 20.1% (95% uncertainty interval [UI], 18.2%-21.4%) between 1980 and 2014, from 240.2 (95% UI, 235.8-244.1) to 192.0 (95% UI, 188.6-197.7) deaths per 100 000 population. There were large differences in the mortality rate among counties throughout the period: in 1980, cancer mortality ranged from 130.6 (95% UI, 114.7-146.0) per 100 000 population in Summit County, Colorado, to 386.9 (95% UI, 330.5-450.7) in North Slope Borough, Alaska, and in 2014 from 70.7 (95% UI, 63.2-79.0) in Summit County, Colorado, to 503.1 (95% UI, 464.9-545.4) in Union County, Florida. For many cancers, there were distinct clusters of counties with especially high mortality. The location of these clusters varied by type of cancer and were spread in different regions of the United States. Clusters of breast cancer were present in the southern belt and along the Mississippi River, while liver cancer was high along the Texas-Mexico border, and clusters of kidney cancer were observed in North and South Dakota and counties in West Virginia, Ohio, Indiana, Louisiana, Oklahoma, Texas, Alaska, and Illinois.</p><h3>Conclusions and Relevance</h3><p>Cancer mortality declined overall in the United States between 1980 and 2014. Over this same period, there were important changes in trends, patterns, and differences in cancer mortality among US counties. These patterns may inform further research into improving prevention and treatment.</p>","DOI":"10.1001/jama.2016.20324","ISSN":"0098-7484","journalAbbreviation":"JAMA","language":"en","author":[{"family":"Mokdad","given":"Ali H."},{"family":"Dwyer-Lindgren","given":"Laura"},{"family":"Fitzmaurice","given":"Christina"},{"family":"Stubbs","given":"Rebecca W."},{"family":"Bertozzi-Villa","given":"Amelia"},{"family":"Morozoff","given":"Chloe"},{"family":"Charara","given":"Raghid"},{"family":"Allen","given":"Christine"},{"family":"Naghavi","given":"Mohsen"},{"family":"Murray","given":"Christopher J. L."}],"issued":{"date-parts":[["2017",1,24]]}}}],"schema":"https://github.com/citation-style-language/schema/raw/master/csl-citation.json"} (Mokdad et al., 2017). In the same period, the mortality for cancer has declined in the United States and mortality of cancer also has decreased in the United States. The data figures show how the types of cancer varied from place to place, however, the reasons for this are still unknown but the ratio of the cancer patients has decreased from these past decades. The variation in the cancer diseases is caused by smoking, obesity and some other factors but in the past few years these are services declined because of the socio-economic growth and access to medical and high-quality health. However, the level of obesity varies in the different regions of the United States and the socio-economic factors are also different, so the access to medical care and quality services in the health also varies and is different. The local information can be used in the identification of the aids needed for the communities and to investigate cancerous hotspots and their root causes. Identification of the root causes would help in controlling cancer among the underdeveloped regions and populations where they already lack basic healthcare facilities and quality services in medicine. According to different studies of cancer types, they have suggested that no matter what quality you provide, and how effective it is that does not stop the negative psychological impacts in the patients. The cost-effective approach will help the Quality of Life of the cancer patients but those patients who needed psychological support were not taken care of.
However, the present healthcare system aims to serve those who are suffering
Early interventions in cancer patients can improve the stress in the cancer patients and in curing their disease
Methodology
The methodology section includes the instrument design and data collection, target population, data analysis, and ethical considerations in the research. This research study will be based on the quantitative method and it will be based on the questionnaire because they do not confuse the researcher while analyzing data and to avoid useless responses from the respondents. The questionnaire will be based on the close-ended question because the researcher wants to limit the respondents from unnecessary discussions. A closed-ended questionnaire will provide exact data that will be analyzed through the SPSS.
Instrument design and data collection
The instrument design will be questionnaire and the data will be collected through the questionnaire and it will be analyzed in the SPSS
Target population and sample size
The target population of the researcher is cancer patients, few family members of cancer patients, caregivers and psycho-oncologists. The selection of the target population is based on the nature of the research and these are the main respondents of the research study.
The sample size for the research study would be 56 patients and 44 random samplings between the family members and psycho-oncologists.
Data analysis
Data will be analyzed in the SPSS for a reliable outcome and to avoid human errors. The statistical tool for the research study will be regression because this research aims to identify the cause and effect.
Ethical Considerations
A researcher while conducting research has to take ethical considerations. A researcher has to take care of the privacy of the respondents, who are cancer patients, psycho-oncology staff, caregivers and few of the family members of the cancer patients. To avoid compromising on the quality of the research, these requirements pf the ethical consideration have to be made sure, while the researcher has to make sure that he/she is not violating the consideration. The main priority while conducting research is to take care of the anonymity of the respondents otherwise it will be treated as illegal. Biases are natural but the researcher has to be neutral from the beginning to the end of the research study otherwise it will change the results and the output will not be reliable.
Bibliography
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Gov UK, 2013. Emergency response and recovery. [Online] Available at: https://www.gov.uk/guidance/emergency-response-and-recovery[Accessed 21 April 2019].
Home Office, 2006. Recovery: An Emergency Management Guide, s.l.: Cabinet Office UK Government.
Huber, R. C. & Pickett, R. L., 2006. Response! : planning & training for emergency recovery. Andover, MN: Expert Publishing.
IFPO, 2001. Developing the Emergency Response Plan. [Online] Available at: https://www.ifpo.org/resource-links/articles-and-reports/safety-fire-protection-and-emergency-management/developing-the-emergency-response-plan/[Accessed 21 April 2019].
