Knowledge and Support of the Family as Factors Related to
Chemotherapy Adherence of Clients with Breast Cancer
Ilya Krisnana
1
, Aria Aulia Nastiti
1
and Dwi Hartini
2
1
Faculty of Nursing Universitas Airlangga, Kampus C Mulyorejo, Surabaya, Indonesia
2
Saiful Anwar Hospital, Malang, Indonesia
Keywords: Knowledge, Family support, Adherence, Breast cancer.
Abstract: Chemotherapy is part of managing clients with breast cancer. A long period of chemotherapy management
requires commitment from the family. But there are still clients with breast cancer who did not run
chemotherapy completely because there was no family support to be able to treat clients well. The purpose
of this study was to analyse the correlation between knowledge and support from family to chemotherapy
adherence in clients with breast cancer. This research used a cross-sectional design. The population of this
study were 120 families who brought clients with breast cancer to the Oncology Outpatient Department to
undergo chemotherapy and by simple random sampling 100 respondents were recruited. Data on knowledge
and family support was collected by using questionnaires completed by the families. While data about
chemotherapy adherence was obtained from the Hospital Medical Records data source. The data was
analyzed by using Spearman Rank Correlation with α=0.005. The results showed that family knowledge
was strongly related to chemotherapy adherence (p=0.000, r=0.817). Family support was also associated
with chemotherapy adherence (p=0.000, r=0.389). Families who understand about the benefits, side effects
and treatment of clients with chemotherapy can support the client's health status to remain in a stable
condition for chemotherapy to be completed.
1 BACKGROUND
Breast cancer is a public health problem both
worldwide and in Indonesia and has become one of
the leading causes of death throughout the world
(Ministry of Health Republic of Indonesia, 2016).
One of the management strategies for breast cancer
is chemotherapy. However, chemotherapy can bring
unpleasant effects to clients with breast cancer.
Short-term side effects that can be experienced by
clients undergoing chemotherapy include fatigue,
nausea, vomiting, alopecia, myalgia and thrombosis
etc. (Partridge, Burstein and Winer, 2001). These
side effects can impair the clinical condition or the
health status of the client so that chemotherapy is
delayed.
The side effects and management of
chemotherapy are very important for the family to
understand. The success of clients in being able to
adhere to the treatment of chemotherapy is strongly
influenced by family support. The family's
endurance to understand the client's circumstances is
a major source of care for clients undergoing
chemotherapy (Carey et al., 1991). Results of a
preliminary survey in RSUD by Dr. Saiful Anwar
Malang in March 2017, showed that from 15 clients
with breast cancer who underwent chemotherapy at
the oncology clinic there were 7 clients (46.7%) who
said that they withdrew themselves from undergoing
a chemotherapy program. 5 clients (33.3%) were
taken by a husband, and 3 clients (20%) by nephews
and neighbours. Results from interviews with family
during initial data collection, show that from 5
families who escorted clients undergoing
chemotherapy they still do not know about the
program and side effects of chemotherapy and fewer
know about the diets that may and should not be
consumed by clients who undergo chemotherapy.
Family knowledge and support is an important
aspect to establish client compliance to undergo
chemotherapy. The results of the study in Egypt
show that the factors that play an important role in
achieving client compliance in the treatment include
client knowledge and family support to be able to
Krisnana, I., Nastiti, A. and Hartini, D.
Knowledge and Support of the Family as Factors Related to Chemotherapy Adherence of Clients with Breast Cancer.
DOI: 10.5220/0008325003450349
In Proceedings of the 9th International Nursing Conference (INC 2018), pages 345-349
ISBN: 978-989-758-336-0
Copyright
c
2018 by SCITEPRESS Science and Technology Publications, Lda. All rights reserved
345
undergo treatment (Shams and Barakat, 2010).
Family support is expected to help improve
motivation and adherence of clients with breast
cancer who are undergoing treatment programs
using chemotherapy at hospitals to improve health
status (Arofah Assalamah and Izzah Priyogo, 2015).
Research in Bangladesh showed reduced family
support due to stigma as a barrier in caring for breast
cancer patients (Steiness et al., 2018). Therefore
researchers are interested to establish the
relationship of knowledge and family support with
the compliance of breast cancer clients undergoing
chemotherapy.
2 METHODS
2.1 Research Design
This research used a correlation design with a cross-
sectional method. Data was observed in a single
measurement.
2.2 Participants
The population of this study was 120 families of
clients with breast cancer at the Oncology Clinic
RSUD Dr. Saiful Anwar Malang in the period of
October 2017. The sampling technique in this study
used simple random sampling and obtained a sample
size of 100 respondents.
2.3 Variables and Instruments
Independent variables were knowledge and family
support, while the dependent variable was adherence
to chemotherapy. The instruments in this study were
questionnaires about family knowledge and family
support. Questionnaires were completed by families
while waiting in queues for chemotherapy; while,
the instrument for chemotherapy adherence was
obtained through observation of medical records.
2.4 Analysis
Data was collected through questionnaires and
medical record observation, then analyzed using
statistical analysis Spearman Rank Correlation with
significance level α = 0.05.
2.5 Ethical Approval
This research obtained approval of ethical eligibility
from the Health Research Ethics Commission of the
Faculty of Nursing of Airlangga University number
529-KEPK and has obtained the ethical feasibility of
the Health Research Ethics Commission Dr. Saiful
Anwar Malang number 400/176 / K.3 / 302/2017.
3 RESULTS
Based on information from medical records 71% of
clients adhere to the implementation of
chemotherapy, while 29% are not adherent in the
implementation of chemotherapy. Families of clients
with breast cancer have sufficient knowledge about
chemotherapy with the level of education as senior
high school graduates (40%) (see Table 2). Family
knowledge about the treatment and side effects of
chemotherapy was strongly related to client
chemotherapy adherence with p = 0.000 (<0.05) and
r = 0.625. This can mean that adequate family
knowledge has an important role in maintaining the
health status of breast cancer clients to remain
stable, so chemotherapy can be continued.
Table 1: Characteristics of breast cancer client
demographics.
Characteristics f
Age (years)
20-40
41-65
>65 years
18
76
6
Level of education
Uneducated
Elementary school
Junior high school
Senior high school
University graduate
15
35
27
21
2
Length of suffering (years)
<1
1-2
3
4
5
6
43
49
3
1
2
2
Stadium
Stadium I
Stadium II
Stadium III
Stadium IV
2
21
61
16
Therapy
Surgical
Surgical + radiation
chemotherapy
chemotherapy+radiation
66
1
26
7
INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research
346
Family support can also determine adherence in the
implementation of chemotherapy in clients with
breast cancer. Through the Spearman Rank
Correlation statistical test, it was found that families
with sufficient support were associated with
chemotherapy adherence with p = 0.000 and r =
0.236. The family members who have close relations
with the clients are husbands and sons (see Table 2).
Families have adequate support for the clients
with breast cancer to adhere to chemotherapy
treatment. Most clients were diagnosed with breast
cancer for 1-2 years and most were in stage III
(Table 1).
Families were willing to take clients with breast
cancer to the hospital regularly to undergo
chemotherapy. Family became a place for clients to
complain and share experiences that occurred during
treatment.
Families who provide full support both
psychologically and materially in the form of family
willingness to deliver clients to the hospital to
undergo chemotherapy determine the level of
adherence in the implementation of chemotherapy.
4 DISCUSSION
4.1 The Relationship Between
Knowledge and Chemotherapy
Adherence
Based on the results of the study, the relationship
between family knowledge and chemotherapy client
adherence to breast cancer treatment with a positive
correlation value means the better the family
knowledge, the higher the compliance of breast
cancer clients to undergo chemotherapy on schedule.
Families who understand the benefits, side effects
and treatment of clients with chemotherapy have a
major contribution in achieving chemotherapy
compliance through the willingness to deliver clients
with breast cancer under chemotherapy at the
hospital. Conversely, chemotherapy non-compliance
can also result from family ignorance about treating
clients with breast cancer, so that the health
condition of the client can deteriorate which can
result in a delay in the implementation of
chemotherapy. Non-compliance of clients to
undergo chemotherapy can also be caused by the
unwillingness of families to take clients to hospital
or can also be caused by transportation facilities
difficult to access by family and clients. This is in
line with the results of the study (Freedman et al.,
2017) which states that it can also be influenced by
the degree of education regarding non-compliance
with breast cancer caused by personal reasons e.g.
child care and transportation difficulties.
Knowledge is closely related to education. A
total of 37% of families have a secondary level of
education. Low education may be associated with a
low level of understanding of treatment. Knowledge
of chemotherapy treatment is related to a client's
compliance to undergo chemotherapy for breast
cancer (Pertiwi, Karini and Agustin, 2012).
4.2 The Relationship Between Family
Support and Chemotherapy
Adherence
Family support has an important role in compliance
with breast cancer client treatment. Family support
when caring foe family members with breast cancer
can maintain stable health. In addition to support in
care, family support by delivering clients to the
hospital is a very important aspect. Full support from
the family can increase the client's motivation to
follow the treatment activities thoroughly, in line
with the research (Sari, Dewi and Utami, 2012). The
Table 2: Characteristics of family.
Characteristics
Age (years)
20-40
41-65
>65
f
54
46
0
Level of education
Elementary school
Junior high school
Senior high school
University graduate
d
19
32
40
9
Occupation
Unemployed
Farmer
Housewife
Laborers
Traders
Private employees
Government employees
Fisherman
6
20
13
8
11
40
1
1
Relationship
Husbands
Sons
Young sisters
Old sisters
48
43
8
1
Knowledge and Support of the Family as Factors Related to Chemotherapy Adherence of Clients with Breast Cancer
347
instrumental support that families provide to clients
includes family willingness to help finance the care
and treatment of clients. Another type of support
provided by the family is emotional support.
Emotional support provided by the family is able to
provide a sense of comfort, feeling cared for and
loved, giving help in the form of spirit, attention and
individuals who receive the support feel valued.
Instrumental support includes physical and material
support, in tangible forms such as finance
(Friedman, Bowden and Jones, 2010).
This support is shown by family assistance to
clients when going to the hospital to meet the
schedule of chemotherapy. Clients who gain family
support can eliminate the temptation of disobedience
and can often form support groups to achieve
compliance (Kusumawardani, 2014). The husband is
the closest family member to clients with breast
cancer. Preparedness of the husband to be able to
take clients to the hospital can be a factor that
increases the client's spirit to heal and adhere to the
treatment.
Husbands who pay less attention to the wife can
impair the psychological behavior of clients post
radical mastectomy. Conversely, a husband who
gives full attention to the wife can trigger the
emergence of the spirit and motivation of the client
to heal (Anggraeni and Ekowati, 2010).
5 CONCLUSIONS
Family knowledge and support have a positive
relationship with chemotherapy adherence. The
better the knowledge and the higher the family
support, the higher the chemotherapy compliance in
the client with breast cancer. Family knowledge
about treatment and side effects of chemotherapy
plays a role in shaping support for clients with breast
cancer to be able to adhere to chemotherapy
management.
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