Knowledge and Support of the Family as Factors Related to

Chemotherapy Adherence of Clients with Breast Cancer

Ilya Krisnana

, Aria Aulia Nastiti

and Dwi Hartini

Faculty of Nursing Universitas Airlangga, Kampus C Mulyorejo, Surabaya, Indonesia

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

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

Level of education

Uneducated

Elementary school

Junior high school

Senior high school

University graduate

Length of suffering (years)

1-2

Stadium

Stadium I

Stadium II

Stadium III

Stadium IV

Therapy

Surgical

Surgical + radiation

chemotherapy

chemotherapy+radiation

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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

Level of education

Elementary school

Junior high school

Senior high school

University graduate

Occupation

Unemployed

Farmer

Housewife

Laborers

Traders

Private employees

Government employees

Fisherman

Relationship

Husbands

Sons

Young sisters

Old sisters

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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