|Year : 2013 | Volume
| Issue : 3 | Page : 233-238
Evaluation of changes in the attitudes and behaviors of relatives of lung cancer patients toward cancer prevention and screening
D Koca, I Oztop, U Yilmaz
Department of Internal Diseases, Dokuz Eylül University, Medical Faculty, Division of Medical Oncology, Inciralti, 35340, Izmir, Turkey
|Date of Web Publication||23-Sep-2013|
Department of Internal Diseases, Dokuz Eylül University, Medical Faculty, Division of Medical Oncology, Inciralti, 35340, Izmir
Source of Support: None, Conflict of Interest: None
Background: Cancer diagnosis affects all the relatives living with the patient; however, whether the behavior of family members changes or not is unknown. To end this we evaluated the relatives of lung cancer patients. Materials and Methods: Forty-one questions were used to collect data from the relatives of lung cancer patients who had been living with them for at least one year, to evaluate changes in their attitudes and behaviors related to cancer prevention. Results: The study included 246 lung cancer patients' relatives, of them 172 (69.9%) were women and 74 (30.1%) were men. The median age was 46 years (range: 20-83 years). Patients and their relatives had been living together for an average of 28 years (range: 1-68 years), and 88 (35.7%) of the patients' relatives were their children. We found changes in the attitudes and behaviors toward prevention and screening for cancer in 92 (37.4%) of the relatives. Fifty-two (21.1%) of them changed their smoking habits, 34 (13.8%) altered their eating habits, 25 (10.2%) changed their exercise habits, 13 (5.3%) visited a doctor due to a suspicion of having cancer, 12 (4.9%) changed their lifestyles, seven (2.8%) underwent cancer screening tests, three (1.2%) started using alternative medicines, and three (1.2%) started using vitamins for cancer prevention. Conclusions: Important changes occur in the attitudes and behaviors of patients' relatives toward cancer prevention and screening after the patients are diagnosed with lung cancer. Being aware of how patients' relatives react to a family member's cancer diagnosis may provide healthcare professionals with more incentive to address the relatives' special needs.
Keywords: Attitude, behavior, lung cancer, relatives
|How to cite this article:|
Koca D, Oztop I, Yilmaz U. Evaluation of changes in the attitudes and behaviors of relatives of lung cancer patients toward cancer prevention and screening. Indian J Cancer 2013;50:233-8
|How to cite this URL:|
Koca D, Oztop I, Yilmaz U. Evaluation of changes in the attitudes and behaviors of relatives of lung cancer patients toward cancer prevention and screening. Indian J Cancer [serial online] 2013 [cited 2019 Jun 24];50:233-8. Available from: http://www.indianjcancer.com/text.asp?2013/50/3/233/118740
| » Introduction|| |
Lung cancer is the most frequently seen and fatal type of cancer in the world.  It is responsible for 19.7% of all cancer-related deaths and has a poor prognosis with five-year survival rates of below 15%. , Smoking, including passive exposure, is the cause of 80% of lung cancer. , Smokers have a 20 to 40 times higher risk of getting lung cancer than non-smokers.  Another important etiological factor is radiation exposure.  Other known causes include environmental and occupational exposure, familial risk factors, dietary factors, and some benign lung diseases. ,
Among family members living with the patient, their perceptions toward the cancer patient and the disease are important, but these vary widely in the studies.  The most important health problem encountered in the relatives of cancer patients is psychological stress,  with decreases in brain function and general body symptoms being seen less frequently. 
Both familial and environmental factors play a role in lung cancer, therefore cancer diagnosis in a family member may affect all the family living together with the patient. However, whether the behavior of other family member's changes or not after cancer diagnosis is unknown. Examples of behavioral changes are such as stopping smoking, changing dietary and exercise habits, altering their lifestyles, or undergoing cancer screening tests. The level of behavioral change varies greatly with each individual and depends on many factors, but even slight changes may provide the impetus for an early diagnosis of cancer. Additionally, an analysis of the programs for cancer prevention and screening available for relatives of patients diagnosed with cancer may help policy makers evaluate the current health policies pertaining to this area, although this might be a subjective measure.
We aimed to evaluate the changes developing in the attitudes and behaviors toward prevention and cancer screening in the relatives of lung cancer patients.
| » Materials and Methods|| |
Data was collected by asking 41 questions to the relatives of patients diagnosed with lung cancer who were treated between July 2010 and January 2011. A questionnaire was given to any parent, sibling, child, or spouse who had been living with the patient for at least one year. All patients' relatives included in the study voluntarily participated in the study.
The performance status of the patients was evaluated according to the Karnofsky Performance Status Scale (KPS). All of the patients PS values equal to or higher than 60. Thus, all of the patients were mobilized.
Patients have classified according to their some habbits and properties. Eating habits e.g. fruits, vegetables, protein, grains, and fat were recorded as consumption to low, medium, or more. Smoking habits were recorded as smokers, ex-smokers, and nonsmokers. Economic status were recorded as good, average, bad, and very bad.
Statistical Package for the Social Sciences for Windows (SPSS) Version 15.0 was used for the statistical analysis of the data, and the chi-square test was used for comparing the rates of each group independently. A P value of <0.05 was accepted as being statistically significant.
| » Results|| |
General characteristics of the relatives of the patients
Two hundred and forty-six relatives of lung cancer patients were included in the study. A total of 198 lung cancer patients, 112 (56.5%) were male and 86 (43.5%) were female. One hundred and fifty lung cancer patients had only one relative, and 48 patients had two relatives. As we evaluate in perspective of relatives; amount of relatives whose patients were at stage I was fifty-seven out of 190 (23.2%), stage II was eight (3.3%), stage III was 55 (22.4%), and stage IV was 126 (51.2%). The median age of the patients' relatives was 46, ranging from 20 to 83 years. The group was comprised of 172 (69.9%) females and 74 (30.1%) males.
162 of 198 (81.8%) patients were smokers. 64 (32.3%) patients were female and 98 (49.4%) were male. 129 of 246 (52.4%) patients relatives were smokers. 57 (23.1%) patients relatives were female and 72 (29.3%) were male. 154 patients relatives with 132 smoker patients also smoked.
Patients had been living together with their relatives for an average 28 (1-68) years, one hundred and fifty relatives (61.0%) had been living in the same city with the patient since birth for an average of 31 (20-68) years, sixty-nine of the relatives (39.0%) had been living in a different city from the patient for an average of 18 (2-72) years. Most of the relatives were children of the patients (35.7%). Many of the relatives learned that the patient had cancer when it was first diagnosed (74.8%), but 62 of them (25.2%) learned it at a later date. The median duration for this time was 60 days, but there was a wide variance from seven to 365 days. Forty-five of the relatives also had more than one lung cancer patient in the family [Table 1].
Most of the relatives were primary school graduate (28.9%). Most of the patients' relatives were from a middle income family (65.4%). When the occupations of the relatives were assessed, it was found that most of them were housewives (31.4%). Fourteen of the relatives (5.7%) had chronic lung diseases, and they were undergoing regular medical follow-ups. Forty-five of the relatives (18.3%) were undergoing regular medical laboratory tests [Table 2].
The patients' relatives were questioned about their physical activities, and according to their self-declarations, half of them were very mobile (50.0%). However, only 52 of them (21.1%) were exercising regularly. When the relatives were questioned about their eating habits, it was found that most of them were consuming fruit and vegetables (n = 140; 56.9%). One hundred and twenty-nine of the relatives (52.4%) were smokers [Table 3].
None of the relatives were using any alternative medicines or vitamins before the patients were diagnosed with cancer.
Changes in the attitudes and behaviors of the relatives of patients who had been diagnosed with lung cancer
Ninety-two (37.4%) of the relatives developed changes in their attitudes and behaviors toward the prevention and screening of cancer after they learned that a relative had been diagnosed with lung cancer. Fifty-two of the relatives (21.1%) changed their smoking habits, thirty-four (13.8%) relatives changed their eating habits, twenty-five (10.2%) of the relatives changed their exercise habits, thirteen of the relatives made an appointment to see a doctor due to the suspicion that they had cancer themselves, twelve (4.9%) of the relatives changed their lifestyle, three (1.2%) of the relatives started using alternative medicines, and another three (1.2%) started taking vitamins to protect against cancer [Table 4].
|Table 4: Changes in the attitudes and behaviors of patients' relatives (n = 246)|
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Different characteristics of the patients' relatives had various effects on the changes in attitudes and behaviors that emerged after they learned the patient had lung cancer. The statistically significant data regarding this is shown in [Table 5].
|Table 5: Correlations of different attitudes and behaviors with characteristics of patients' relatives (n = 246)|
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| » Discussion|| |
Attitudinal and behavioral changes in the relatives of cancer patients toward cancer prevention and screening are important. Health professionals, being aware of these changes may provide guidance when examining their social relationships and supply an impetus for early intervention and diagnosis of health problems which might go unnoticed. It also can help determine whether the current healthcare levels for cancer prevention and screening are adequate. Especially doctors, nurses and health care professionals are effective in changing the behavior of patients' relatives. Because of the potential benefits from evaluating the changes in patient's relatives, we undertook this study which assessed 246 relatives of lung cancer patients.
We found that 37.4% of patients' relatives developed attitudinal and behavioral changes toward cancer prevention and screening after they learned that the patients had lung cancer. Determined to the some factors influenced the attitudes and behaviors patients' relatives. Relatives to be sibling, spouse, or parent of patient's, relatives to be a high school or university graduate, patients had stage IV cancer, relatives had worked in the marble or banking industry or been a blue-collar worker or singer, relatives had lived with the patient for a long or short period of time, relatives to be female, to be another lung cancer patient in the family, and relatives learned the disease of patient at the time of patient's diagnosed to cancer. However, ıt is found that patient's brothers are less, but patient's wife, mother and father, are more affecting the patient.
Cancer patients need help during treatment at the hospital, follow-up care and further treatment takes place at home whenever possible,  the people who have taken on the responsibility for caring of these patients have heavy burdens and may have some social and emotional problems as a result.  For example, the development of important changes in the lifestyles of the caregivers of the cancer patients was observed.  Moreover, changes in the lifestyles of the relatives and caregivers varied according to the stage of cancer of their patients.  We searched the literature for research about the relatives of cancer patients, and found that most of the studies focused on their psychological problems with little or no data available regarding other issues. ,,,,, The situation with lung cancer is similar, and it is not clear whether or not it causes a change in attitudes and behaviors other than adding psychological stress to the other members of the family after the diagnosis. Other possible changes include efforts to quit smoking, changing dietary and exercise habits, being referred to a doctor because of a suspicion of having cancer, or realizing the need for cancer prevention and screening. According to a study about smoking, it is stated that; the stress appear and activity's done due to the stress might lead relatives to quit smoking.  However, there are no clear data on this subject. Also it is shown that, having relatives who smoke increases the risk of being caught cancer even though the patient is not a smoker.
We investigated the changes in the attitudes and behaviors toward cancer prevention and screening and the related issues surrounding this rather than study the psychological problems of lung cancer patients' relatives since this has been researched previously in the literature. For example, clarifying possible health problems can provide both an early diagnosis and also point to possible interventions. We think that this is important for both personal and community health. It can also provide important information which would improve government health policies regarding their programs for cancer prevention and screening. How policy makers respond to health care crises such as lung cancer is a non-precise but important indicator of whether the healthcare policies of a country are successful. Forming special healthcare units that would inform and advise patients' relatives would meet an important community health service need.
| » Conclusions|| |
In conclusion, important changes occur in the attitudes and behaviors of patients' relatives toward cancer prevention and screening after the patients are diagnosed with lung cancer. Helping cancer patients' relatives be aware of positive changes in their smoking, eating, and exercising habits, to make appointments with a doctor when they suspect they may have cancer, undergoing tests for cancer screening, changing lifestyles, using alternative medicines and vitamins to protect themselves against cancer, and referring these patients to special units formed by health care professionals should be important goals of any community health service. Being informed of how patients' relatives react to a loved one's cancer diagnosis should provide health care professionals with more incentive to address the relatives' special needs.
| » References|| |
|1.||Jemal A, Siegel R, Ward E, Hayo Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin 2009;59:225-49. |
|2.||David SS, Giuseppe G, Christopher RK. Non-small-cell lung cancer. In: DeVita VT, Lawrence TS, Rosenberg SA, editors. DeVita, Hellman, and Rosenberg's Cancer Principles and Practice of Oncology. 8 th ed. Philadelphia: Lippincott Williams and Wilkins; 2008. p. 896-946. |
|3.||Giovino GA. Epidemiology of tobacco use in the United States. Oncogene 2003;21:7326-40. |
|4.||Alberg AJ, Samet JM. Epidemiology of lung cancer. Chest 2003;123(1 Suppl):21S-49S. |
|5.||Peto R, Darby S, Deo H, Silcocks P, Whitley E, Doll R. Smoking, smoking cessation, and lung cancer in the UK since 1950: Combination of national statistics with two case-control studies. BMJ 2000;321:323-9. |
|6.||Kaufman EL, Jacobson JS, Hershman DL, Desai M, Neugut AI. Effect of breast cancer radiotherapy and cigarette smoking on risk of second primary lung cancer. J Clin Oncol 2008;26:392-8. |
|7.||Beckett WS. Epidemiology and etiology of lung cancer. Clin Chest Med 1993;14:1-15. |
|8.||Kagawa-Singer M, Wellisch DK. Breast cancer patients' perceptions of their husbands' support in a cross-cultural context. Psycho oncology 2003;12:24-37. |
|9.||Couper JW, Bloch S, Love A, Duchesne G, Macvean M, Kissane DW. The psychosocial impact of prostate cancer on patients and their partners. Med J Aust 2006;185:428-32. |
|10.||Wagner CD, Bigatti SM, Storniolo AM. Quality of life of husbands of women with breast cancer. Psycho oncology 2006;15:109-20. |
|11.||Given BA, Given CW, Kozachik S. Family support in advanced cancer. CA Cancer J Clin 2001;51:213-31. |
|12.||Siminoff LA, Wilson-Genderson M, Baker S Jr. Depressive symptoms in lung cancer patients and their family caregivers and the influence of family environment. Psycho oncology 2010;19:1285-93. |
|13.||Rhee YS, Yun YH, Park S, Shin DO, Lee KM, Yoo HJ, et al. Depression in family caregivers of cancer patients: The feeling of burden as a predictor of depression. J Clin Oncol 2008;26:5890-5. |
|14.||Braun M, Mikulincer M, Rydall A, Walsh A, Rodin G. Hidden morbidity in cancer: Spouse caregivers. J Clin Oncol 2007;25:4829-34. |
|15.||McBride CM, Pollak KI, Garst J, Keefe F, Lyna P, Fish L, et al. Distress and motivation for smoking cessation among lung cancer patients' relatives who smoke. J Cancer Educ 2003;18:150-6. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]