RESEARCH SYNOPSIS OF PARTIAL

FULLFILLMENT OF MSc NURSING DEGREE

SRIMANTA SANKARADEVA UNIVERSITY OF HEALTH
SCIENCES (SSUHS)

1. TITLE A study to assess the level of Depression

among cancer patients undergoing
radiotherapy, in a cancer hospital,
Guwahati, Assam.

2. NAME OF THE STUDENT SANGEETA SAHA

SIGNATURE:

DATE:

3. NAME OF THE DR.B.BOROOAH CANCER INSTITUTE.

INSTITUTION

4. NAME OF THE MRS.LILY LALHLUTMAWII

SUPERVISOR ASSOCIATE PROFESSOR.

SIGNATURE:

DATE:
TITLE OF THE RESEARCH:
 A study to assess the level of depression among cancer patients
undergoing radiotherapy in a cancer hospital, Guwahati, Assam.

BACKGROUND OF THE STUDY:

Cancer patients live with the burden of the disease and its treatment. Receiving a
diagnosis of cancer is associated with psychological symptoms secondary to significant
distress such as feeling of pain, hopelessness, fear, anxiety, and depression. Previous
reports show that the most common psychiatric disorders experienced by cancer patients
is depression and adjustment disorder after the use of radiation therapy. Evidence
suggests that the occurrence of some psychological symptoms elevates in patients under
radiotherapy. [1]

Radiotherapy is now one of the most effective means for local or regional control of
cancer. Cancer patients receive radiotherapy either as their primary treatment or as
adjuvant treatment along with chemotherapy and/or surgery. About 45% of patients with
malignancy require radiotherapy. Previous studies also show that the period of
radiotherapy may provide a valuable opportunity for screening and intervening for
psychological distress. [2]

Depression is prevalent in cancer patients and has been associated with poor survival of
cancer patients. It can occur at any time during the course of the disease and may worsen
over time. Identification of factors associated with depression in cancer patients who
were treated with radiotherapy might aid the health care team in identifying who might be
in need of additional psychosocial support. [3]

NEED OF THE STUDY:

Cancer-related and treatment-related short-term, long-term, and late health effects are
using incidence and survival data from the Surveillance, Epidemiology, and End Results
cancer registries; vital statistics from the Centers for Disease Control and Prevention's
National Center for Health Statistics; and population projections from the US Census
Bureau. More than 16.9 million Americans (8.1 million males and 8.8 million females)
with a history of cancer with depressive episodes associated with treatment with radiation
1
therapy were alive on January 1, 2019; this number is projected to reach more than 22.1
million by January 1, 2030 based on recent statistics data. [4]

IN INDIA, the National Institute of Mental Health reveals that 25% of cancer
patients living with chronic pain are also likely to be depressed. Patients with cancer
often find depression to be the most distressing adverse effect of radiation therapy, more
than the pain, nausea, and vomiting associated with the cancer and treatments. Radiation-
related depression is closely associated with irradiated tumors of the brain, head and
neck, breast, lung, pelvis, and lymphatic system. [5]

IN ASSAM, cancer cases are projected to rise by a steep 13.5% by 2025 a research by
the National Centre For Disease Informatics and Research (NCDIR) under the ICMR, [6]
and adding to it, 2730 new cases of radiotherapy patients had come for treatment and 920
cases got admitted in Dr.B.Borooah Cancer Institute, as per the statistical data of the
Annual Report of Dr.B.Borooah Cancer Institute, Guwahati, Assam. [7]

LACUNAE IN PRESENT KNOWLEDGE:

After reviewing literature, it was found that many studies have looked at the level of
depression associated with chemotherapy treatment only. Researchers have studied how
radiation therapy and level of depression has become one of the alarming issues in
oncology setting.

However there has been a lot of attention given to this alarming issue because this
depression is becoming one of the leading distressing adverse effects of radiation therapy.

Thus till now very less study has been performed on level of depression among cancer
patients undergoing radiation therapy in entire Assam state therefore the researcher wants
to carry out this study among radiotherapy patients of selected cancer hospitals of
Guwahati, Assam, so that it helps us to know the level of depression among cancer
patients undergoing radiation therapy both theoretically and practically.
STATEMENT OF THE PROBLEM:
 A study to assess the level of depression among cancer patients
undergoing radiotherapy, in a cancer hospital, Guwahati, Assam

OBJECTIVES OF THE STUDY:

 GENERAL OBJECTIVE:-
 To assess the level of depression among cancer patients undergoing radiotherapy.

 SPECIFIC OBJECTIVES:-

1. To assess the level of depression in cancer patients undergoing radiotherapy.

2. To find the association between the level of depression in cancer patients
undergoing radiotherapy with selected demographic variables.

OPERATIONAL DEFINITION:-
 ASSESS:- In this study it refers to“ Assess means to evaluate or estimate the level
of depression”.
 DEPRESSION: - “Depression is a mood disorder that causes a persistent feeling
of sadness and loss of interest, it affects how we feel, think and behave and can
lead to a variety of emotional and physical problems.” [8]
In this study it refers to the “Patients having depression while undergoing
radiation therapy treatment”.
 RADIOTHERAPY:- In this study it refers to “Radiotherapy is the use of high-
energy penetrating radiation (x-rays, gamma rays, proton rays, and neutron rays)
to kill cancer cells.[9]

 CANCER PATIENTS: This means “A person who is receiving medical

treatment for a malignant growth or tumor” [10]
In this study cancer patient refers to, “A person who has been diagnosed with
some type of malignant disease by a physician and will be receiving radiotherapy
for the treatment of cancer during the time of data collection.
 CANCER HOSPITAL: This means “The specialized hospital devoted to the
field of cancer including diagnosis, treatments and research.”[11]
In this study, it refers to a cancer hospital of Guwahati,
Assam

 ASSUMPTION:
Patients undergoing radiotherapy will have some level of depression.

 HYPOTHESIS :-
The hypothesis will be tested on 0.05 level of significance.
 H1– There will be significant relation between radiotherapy and level of
depression among cancer patients.
 H2– There will be significant association between level of depression and
selected demographic variable among radiotherapy patients.

REVIEW OF LITERATURE:

 Guro Lindviksmoen Astrup, MSc, RN, et al. (2020) conducted a longitudinal

study of depressive symptoms in patients with head and neck cancer
undergoing radiotherapy the patients undergoing radiation therapy in the RT
unit at the Department of Oncology, Norwegian Radium Hospital (NRH), and
Oslo University Hospital. The severity of depressive symptoms increased during
radiotherapy, and then decreased over time. The portion of patients who reported
clinically meaningful levels of depressive symptoms at each assessment ranged
from 29% to 42%. In addition, having surgery prior to radiotherapy was
associated with lower levels of depressive symptoms at initiation of radiotherapy.
A moderate proportion of patients reported levels of depressive symptoms that
indicated the need for clinical evaluation. Several patient characteristics were
associated with depressive symptoms. [12]

 Turky H. Almigbal et al (2019) conducted a study on Assessment of

psychological distress among cancer patients undergoing radiotherapy in
Saudi Arabia in the public tertiary level hospitals in Saudi Arabia among cancer
patients to assess the level of depression undergoing radiotherapy. A total of 148
cancer patients undergoing radiotherapy from five different public tertiary-level
hospitals in Saudi Arabia participated in this study. The Psycho-Oncology
Screening Tool was used to identify levels of depression of cancer patients
 undergoing radiotherapy. Depressive symptoms and social concerns in receiving
radiotherapy were assessed. The patients’ type of cancer and was significantly
associated with the level of depressive symptoms. Cancer patients undergoing
radiotherapy displayed above-average levels of depression. This may have
significant implications on their adherence for treatment and patient outcomes.
Routine screening and support services or psychosocial care for patients are
warranted among cancer patients undergoing radiotherapy.[13]

 Kavita Gupta(Dec 2016)conducted a study on Anxiety & Depression

Assessment of cancer patients undergoing Chemotherapy or Radiotherapy
treatment by the use of computerized developed version of Questionnaire
(WHOQOL-Bref, ZSAS, ZSDS)in Medical and Radiation Oncology department
of Dr. B.L. Kapur Memorial Hospital, New Delhi, India. A total of 60 cancer
patients were included in the study in which Chemotherapy group consisted of
30n cancer patients and Radiotherapy group consisted of 30n cancer patients. In
the study, 6(20%) were males and 24(80%) were females in the chemotherapy
group, and, 15(50%) were males and 15(50%) were females in the radiotherapy
group. Majority of the patients 32(53.34%) were in the age range of 46-60 years.
Utilizing technology to implement QOL assessments into clinical practice has
several advantages that make it more feasible for physicians to use QOL
information with their patients for predicting and determining anxiety and
depression scores during cancer treatment. Electronic methods of assessment are
more accurate and less time-consuming than paper-and pencil questionnaires
(manual method).[14]

 Lynne I. Wagner, PhD(January 12, 2016)conducted a study on Screening for

Depression in Cancer Patients Receiving Radiotherapy: Feasibility and
Identification of Effective Tools in the NRG Oncology RTOG 0841 Trial.
Four hundred sixty-three patients from 35 community-based radiation oncology
sites and 2 academic radiation oncology sites were recruited. Sixty-six percent of
the 455 eligible patients (n 5 299) were women, and the eligible patients had
breast (45%), gastrointestinal (11%), lung (10%), gynecologic (6%), or other
cancers (27%). Seventy-five (16.5%) exceeded screening cutoffs for depressive
symptoms. Forty-two of these patients completed the SCID. Another 37 patients
whose screening was negative completed the SCID. Among the 79 patients
completing the SCID, 8 (10.1%) met the criteria for major depression, 2 (2.5%)
met the criteria for dysthymia, and 6 (7.6%) met the criteria for an adjustment
disorder. The PHQ-2 demonstrated good psychometric properties for screening
for mood disorders, which were equivalent to the PHQ-9 and superior to the
NCCN-DT. These findings support using the PHQ-2 to identify patients in need
 of further assessment for depression, which has a low prevalence but is a
clinically significant comorbidity. These findings could inform the
implementation of distress screening accreditation standards.[15]

 Juliana Maria de Paula et al (April 2012) conducted a study on Symptoms of

depression in patients with cancer of the head and neck undergoing
radiotherapy treatment: a prospective study. This is a prospective exploratory
quantitative study of 41 patients with head and neck cancer, undergoing
radiotherapy treatment in the Oncology Outpatient Clinic of the Beneficência
Portuguese Hospital of Ribeirão Preto. Data were collected through the Beck
Depression Inventory instrument, and analyzed quantitatively by means of the
Statistical Package for the Social Sciences. Symptoms of dysphoria were found to
increase throughout the treatment, as well as the number of patients with
depression. The results show the importance for the healthcare professionals to
detect the prevalence and the levels of the symptoms of depression, since these
symptoms tend to increase and may lead to consequences such as a lack of
adherence to treatment and a decrease in the quality of life of these patients.[16]

METHODOLOGY
 - RESEARCH APPROACH:- Quantitative research approach will be adopted
for study
 -RESEARCH DESIGN: Descriptive design (Exploratory descriptive design)

Schematic representation of research design:

 STATEMENT OF THE PROBLEM

A study to assess the level of depression among cancer patients undergoing

radiotherapy.

RESEARCH APPROACH
QUANTITATIVE RESEARCH APPROACH

RESEARCH DESIGN

DESCRIPTIVE RESEARCH DESIGN

SETTINGS

A CANCER HOSPITAL, GUWAHATI, ASSAM

POPULATION

PATIENTS UNDERGOING RADIOTHERAPY

SAMPLE

100 SAMPLES OF PATIENTS UNDERGOING RADIOTHERAPY

SAMPLING TECHNIQUE

PURPOSIVE SAMPLING TECHNIQUE.

 TOOLS

-DEMOGRAPHIC PERFOMA TOOL

-BECK DEPRESSION INVENTORY TOOL

VARIABLES
RESEARCH VARIABLES: RADIOTHERAPY,

DEPRESSION

ANALYSIS
DESCRIPTIVE AND INFERENTIAL STATISTICS (SPSS)

INTERPRETATION OF FINDINGS AND

CONCLUSION

FIG: Schematic representation of research design

 SETTING OF THE STUDY: The study will be conducted in a cancer hospital

of Guwahati Assam.
 POPULATION: Patients undergoing radiotherapy
 -SAMPLING TECHNIQUE: Purposive Sampling technique.
 SAMPLE SIZE – The sample size is approximately 100.

INCLUSION CRITERIA:-
-Patients who are willing to participate
 -Patients who speak English/Assamese.
-Patients who are receiving radiotherapy.

EXCLUSION CRITERIA:-
-Patients who are not willing to participate
-Patients who do not speak English/ Assamese.

RESEARCH VARIABLES:
-Radiotherapy patients
-Depression

TOOLS /INSTRUMENTS:-

TOOLS 1:- Demographic Perform

TOOLS 2:- Beck Depression Inventory tool.

VALIDATION OF TOOL:

In order to determine the content validity, the tool will be validated by experts.

PRE TEST OF TOOL:

Tool will be tested by pilot study.

RELIABILITY OF TOOL:

Reliability of the tool will be tested by split half method.

ETHICAL CONSIDERATION AND ETHICAL PERMISSION:

1. The proposal will be submitted to the scientific committee of Dr. B.Borooah
Cancer Institute and departmental ethical committee of Dr. B.Borooah Cancer
Institute for approval to conduct the study.
2. Informed consent will be taken from the subjects.

PLAN FOR DATA COLLECTION :-

The data will be collected by taking informed consent from the subjects using
Demographic proforma and Beck Depression Inventory tool and the research will be
conducted in the schedule period of six (6) weeks.

PLAN FOR DATA ANALYSIS:-

Data will be collected organized, tabulated and analysis by using experimental statistics
and inferential statistics (SPSS) software:-

 Frequency, percentage, means, standard deviation will be used to determine the

result.
 Inferential statistics like paired-test and chi square test will be used to fine the
association.

PLANNING FOR DISSEMINATION OF THE RESULTS:

After completing the study, the manuscript will be submitted to the university and to
the institution.

LIST OF REFERENCES:

1. Almutairi KM, Fu JB. Assessment of psychological distress among cancer patients

undergoing radiotherapy, in Journal of psychology research and behavior
management, 20 August 2019 Volume-12 Pages 691—700,
https://doi.org/10.2147/PRBM.S209896.
2. Heidi E Stiegelis, Psychological functioning in cancer patients treated with
radiotherapy in the leading International journal for Communication in Healthcare,
Febrauary 2004, Volume 52, Issue 2, and Pg- 131-220.Available from-
Patient Education and Counseling | Vol 52, Issue 2, Pages EX1-EX2, 131-220
(February 2004) | ScienceDirect.com by Elsevier
3. Mari Lloyd-Williams, Depression--an independent predictor of early death in
patients with advanced cancer, 2009 Feb, Pg no-127-132, Available from-
Depression--an independent predictor of early death in patients with advanced cancer
- PubMed (nih.gov)

4. Cancer Survivor Population Expected to Reach 22.1 Million by 2030 by

CAREVIVE on June 20, 2019, Available from-
Cancer Survivor Population Expected to Reach 22.1 Million by 2030 | Carevive -
cancer care management & patient engagement tools

5. World Cancer Report 2008 | PDF | Preventive Healthcare | Cancer (scribd.com)

6. Times of India (TOI) news updation on 05-02-2021, Guwahati division of TOI.
7. Annual Report 2020, Dr.B.Borooah Cancer Institute.
8. Definition by MAYO’s clinic, Depression (major depressive disorder) care at
Mayo Clinic.
9.Radiotherapy,encyclopedia,
www.encyclopedia.com/medicine/divisions-diagnostics-and-procedures/medicin
10. Malignant Tumor – Symptoms, Causes, Diagnosis, Treatment, Available from
Malignant Tumor Symptoms, Causes, Diagnosis, Treatment (healthcheckup.com)
11. Oncology | Definition of Oncology by Merriam-Webster
12. Astrup GL, Rustøen T, Miaskowski C, Paul SM, Bjordal K. A longitudinal study
of depressive symptoms in patients with head and neck cancer undergoing
radiotherapy. Cancer nursing. 2015 Nov 1; 38(6):436-46.
13. Almigbal TH, Almutairi KM, Fu JB, Vinluan JM, Alhelih E, Alonazi WB, Batais
MA, Alodhayani AA, Mubaraki MA. Assessment of psychological distress among
cancer patients undergoing radiotherapy in Saudi Arabia. Psychology research and
behavior management. 2019; 12:691.
14. Gupta K. Anxiety & Depression Assessment of cancer patients undergoing
Chemotherapy or Radiotherapy Treatment by the use of computerized developed
version of Questionnaire (WHOQOL-Bref, ZSAS, ZSDS). Anxiety; 3(2).
15. Wagner LI, Pugh SL, Small Jr W, Kirshner J, Sidhu K, Bury MJ, DeNittis AS,
Alpert TE, Tran B, Bloom BF, Mai J. Screening for depression in cancer patients
receiving radiotherapy: Feasibility and identification of effective tools in the NRG
Oncology RTOG 0841 trial. Cancer. 2017 Feb 1;123(3):485-93.
16. Paula JM, Sonobe HM, Nicolussi AC, Zago MM, Sawada NO. Symptoms of
depression in patients with cancer of the head and neck undergoing radiotherapy
treatment: a prospective study. Revista latino-americana de enfermagem. 2012;
20:362-8.