Identifying the psychosocial needs of Emirati and expatriate breast cancer survivors in the U.A. E.: A mixed method investigation in a hospital setting
Cancer is considered as a chronic disease which requires high-quality, long-term, post-treatment care (Drayton, et. al., 2012; Phillips & Currow, 2010). However, long-term survivorship care has become a growing healthcare burden requiring numerous resources including psychosocial support, late and long-term side effects monitoring, follow-up care to screen cancer progression, recurrence or newly developed or secondary cancers (Howell, et. al., 2011; McCorkle, 2011; Morgan, 2009). Breast cancer is the most frequent cancer in the world and in the United Arab Emirates (UAE); yet there is little known about breast cancer survivors’ psychosocial concerns in the UAE. Research shows that meeting the full range of psychosocial needs significantly contributes to survivor’s wellbeing and potentially elevates the quality of the patient’s life (Holland & Reznik, 2005; Institute of Medicine, 2008; Culbertson, et. al., 2020). Thus, it is important to understand and meet the needs of the country’s diverse population to help cancer patients deal with the range of psychosocial issues they may experience. The aim of this study was to investigate the psychosocial concerns of breast cancer survivors in a hospital setting in the UAE and the association with cultural factors related to two groups: Emiratis and expatriates. A two-phase mixed methods study was conducted involving a cross-sectional quantitative survey to examine survivors’ concerns and semi-structured interviews to develop an in-depth understanding of their needs. Among 205 breast cancer survivors who completed Phase One, twenty six percent were Emiratis and eighty seven percent were expatriates with the mean age of 49 years (both groups). Sixty percent of participants were diagnosed in 2018 or after that period. Around seventy four percent of survivors had regional stage disease and thirty eight percent of survivors had multimodality treatment. Fifty nine percent were on treatment whereas forty one percent had their treatment complete or had no treatment. Seventy two percent coded their quality of life as “good”. The severity scores of each psychosocial domain were calculated based on the participants’ reported concerns using mean scores. Information concerns were the highest reported concerns with the mean score 4.3. Emotional needs were the second most concerning reported with a mean score of 3.4. Physical needs were reported by the survivors with some level of concerns, mainly pain and fatigue (p=0.031). Survivors had a significant level of social and financial concerns (p<0.001). Regression analysis t-test results indicated no significant differences in information and emotional needs between Emiratis and expatriates. However, a significant difference was found in physical and social & financial domains in two groups. There were no significant religious or spiritual concerns reported by survivors in both groups. A Chi-square test showed no association “between nationality and age” (Sig=0.287) and “between nationality and stage” (Sig=0.083) of the disease. Results also demonstrated significant positive association between physical concerns and received treatment whereas information concerns were significantly associated with age and type of the treatment received. The association between quality of life and psychosocial concerns was also explored using correlation analysis techniques. There was a negative correlation found between quality of life and the scores of psychosocial concerns including physical, social, emotional as well as spiritual concerns (p< 0.01) and a significant correlation was found between quality of life and information concern (p<0.01). Multiple regression results showed significant positive association between physical concerns and received treatment, whereas information concerns were significantly associated with age and type of the treatment received. Physical and emotional concerns were found to make the strongest contribution to explain quality of life (QOL) (p<0.001, and p=0.001 respectively). In phase two, thematic analysis revealed three broader themes including “living experience with breast cancer, survivors’ psychosocial concerns” and “survivors’ experience with healthcare providers which revealed in-depth concerns amongst cancer survivors about addressing their physical, informational, social, financial, emotional, and spiritual needs related to living with cancer.Cancer survivors continue to face challenges and symptoms even after their treatment is completed (Tian, Cao & Feng; 2019; Rutten, 2005; Siemsen, 2001), however, culturally tailored psychosocial support would likely improve their survivorship experience. In order to do that, health providers need to facilitate the development of comprehensive and integrated cancer services to meet the ongoing psychosocial needs of cancer patients. The study has indicated several gaps and barriers in the provision of high-quality cancer care such as lack of routine assessment of survivors’ psychosocial concerns. It also highlights the need for further research in psychosocial needs and cancer survivorship care particularly in the region.KEY WORDS: Breast cancer, psychosocial needs, expatriate in the United Arab Emirates, cultural dimensions of cancer care, cancer trajectory.
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