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Table of Contents
Year : 2021  |  Volume : 22  |  Issue : 2  |  Page : 164-167

Knowledge of skincare and quality of life of cancer patients receiving radiation therapy

1 Professor & Head, Department of Pediatric Nursing, Father Muller College of Nursing, Mangalore, Karnataka, India
2 Final Year B.Sc Nursing Students, Father Muller College of Nursing, Mangalore, Karnataka, India

Date of Submission25-Jul-2020
Date of Decision03-Mar-2021
Date of Acceptance25-May-2021
Date of Web Publication05-Oct-2021

Correspondence Address:
Prof. Seema Shankarsingh Chavan
Department of Pediatric Nursing, Father Muller College of Nursing, Mangalore - 575 002, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJCN.IJCN_72_20

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Cancer is a disease in which cells proliferate abnormally. Approximately 60% of patients with cancer receive radiation therapy as a part of their treatment. Projections show that cancer cases in India (2010–2020) are likely to go up from 979,786 cases within the year 2010 to 1,148,757 cases in the year 2020. The study aimed to assess the knowledge of skincare and quality of life (QOL) of cancer patients receiving radiation therapy. The study adopted a cross-sectional descriptive design amongst 123 cancer patients recruited by simple random technique. Knowledge questionnaire assessing skincare and WHOQOL-BREF scales were used to collect data. An informational pamphlet on skincare for cancer patients receiving radiation therapy was distributed after the study completion. Majority of the patients (31.7%) belonged to the age group of 46–55 years and 29.3% were with a primary level of education. Amongst the participated patients, most (43.1%) had received radiation therapy for <11 days, 61.8% used Ayurveda treatment and 48.8% were diagnosed with gastrointestinal cancers. Most (48.0%) received radiation on the head and neck and more than half of the patients (58.5%) were taking chemotherapy along with radiation therapy. The study also found that 55.28% of patients had a good level of knowledge and 52.84% had satisfactory level of QOL. The study concluded that over half the proportion of the cancer patients receiving radiation therapy had some knowledge on skincare and had satisfactory QOL. Thus, we strongly recommend strategies towards the development and implementation of interventions for skincare to improve the QOL.

Keywords: Cancer patients, knowledge, quality of life, radiation therapy, skincare

How to cite this article:
Chavan SS, Sebastian B, Binu BM, Saldanha CM, Viegas CC, Anish C. Knowledge of skincare and quality of life of cancer patients receiving radiation therapy. Indian J Cont Nsg Edn 2021;22:164-7

How to cite this URL:
Chavan SS, Sebastian B, Binu BM, Saldanha CM, Viegas CC, Anish C. Knowledge of skincare and quality of life of cancer patients receiving radiation therapy. Indian J Cont Nsg Edn [serial online] 2021 [cited 2022 May 28];22:164-7. Available from: https://www.ijcne.org/text.asp?2021/22/2/164/327560

  Introduction Top

Cancer is a fatal disease, which is caused due to the proliferation of highly destructive and invasive group of cells with the potential to metastasise and cause death.[1] As per the Indian Council of Medical Research report published in May 2016, the expected new cancer cases in India is around 14.5 lakh, and they also reported that the figure is likely to reach 17.3 lakh in 2020. About 7.36 lakh people are expected to have deaths due to cancer in 2016; the report also revealed that only 12.5% of patients come for treatment to a hospital in the early stage of cancer.[2]

Radiation therapy is important in the management of oncology conditions and approximately three-fourth of patients diagnosed with cancer receive radiation therapy during their treatment. The side effects of radiation can negatively impact their quality of life (QOL).[3] One of the side effects of radiation includes skin reactions with erythema because of which desquamation may occur depending on the amount and dose of the radiation administered. The side effects of the skin can be managed by taking special care with the use of creams and lotions and complete protection of the skin.[4]

Many patients receiving radiation may be unaware of this side effect as well as skincare. Therefore, this study was conducted to assess the knowledge on skincare and QOL of cancer patients receiving radiation therapy and the relationship between the knowledge and QOL as well as the association between the knowledge on skincare, QOL and selected baseline variables.

  Methods Top

The study was conducted in the radiation therapy department of a tertiary care hospital in Mangalore. A cross-sectional study design was used. The estimated sample size was 123 with the assumption that the proportion of the population was 25%, considering the confidence interval of 95% and 5% absolute precision. Out of 249 patients, 123 were selected using computer generated random numbers. All those who received radiation therapy were included in the study and patients who were intellectually compromised or critically ill were excluded from the study.


The instrument used for the study consisted of demographic data and clinical profile of the patients. Knowledge on skincare was assessed using a self-administered questionnaire which had 11 items on selected aspects such as prevention and treatment of skin issues after radiation therapy, expected complications and use of cosmetics. The correct answer was coded as '1' and others were coded as 'zero'. The maximum knowledge score was 11 and the minimum was 0. The knowledge score was classified as poor, average, good and very good. Content validity was established by sending the tool to 11 experts. Knowledge questionnaire was presented on 15 patients and test–retest reliability was found to be 0.97. The QOL was assessed using WHOQOL-BREF scale on four domains such as physical health, psychological and social relationships and environment.[5] The minimum score was 26 and the maximum score was 130. The tool was translated to Kannada and translated back to English and the language reliability was 0.87.

Ethical consideration

Permission for the study was obtained from the concerned ethics committee (ethical clearance no. FMIEC/CCM/54/2019). Informed written consent was obtained from the patients who fulfilled the inclusion criteria. Confidentiality and anonymity of respondents were maintained.

Data collection

The data were collected for a period of 8 weeks from the patients undergoing radiation therapy. The structured questionnaire was administered to them after explaining and the patients filled in the questionnaire and handed over to the investigator.

Data analysis

Each respondent was given a unique code. All the data were protected using a password and were accessible to the investigator and other research staff working on the project. The combined data in the aggregate form were reported. Survey data underwent coding followed by recording into an electronic database for analysis. Data were analysed using IBM SPSS Statistics for Windows, version 23 (IBM Corp., Armonk, NY, USA). Descriptive statistics were used to present the demographic data, and Chi-square test was used to analyse the association between knowledge on skincare of cancer patients receiving radiation therapy, QOL and selected demographic variables. Karl Pearson correlation test was used to analyse the correlation between knowledge and QOL of cancer patients receiving radiation therapy regarding skincare and P < 0.05 was considered as statistically significant.

  Results Top

Radiation therapy has improved cancer survival rates and also improved the management of malignancies. Besides, they also have been associated with some reactions and thus management of these symptoms is very important.[6],[7] The present study found that 31.7% of the patients belonged to the age group of 46–55 years. Majority of them (64.2%) were married and (67.5%) belonged to a nuclear family. The majority of patients (60.02%) resided in rural areas. Nearly half (43.1%) of patients had received information on skincare from health personnel and had received radiation for an average duration of 9 days. In addition, this study reported that most of the patients (33.3%) had to travel 0–5 km from home to healthcare facility, many (61.8%) had used Ayurveda as other systems of treatment. Forty-nine per cent of patients were diagnosed with gastrointestinal cancers and 48.0% of them had head and neck as the site of radiation. Majority (58.5%) patients received concurrent chemotherapy.

Majority (55.28%) were having good level of knowledge and 2.43% of them had poor level of knowledge [Figure 1].{Figure 1}

The overall mean QOL score was 76.48 ± 11.95. This study found that the highest mean percentage (61.13%) of QOL of cancer patients receiving radiation therapy was obtained in the domain of social and lowest mean percentage (57.51%) was obtained in the physical domain [Figure 2].{Figure 2}

There was a very weak-positive correlation between knowledge on skincare and QOL of cancer patients receiving radiation therapy (r = 0.10, P > 0.05) [Table 1].{Table 1}

There was no significant association found between the knowledge and demographic variable except for educational status (P = 0.03) and no significant association between QOL and other variables except system for medical treatment (P = 0.02).

  Discussion Top

The present study found that the majority of the patients (31.7%) belonged to age group 46–55 years. Amongst the participated patients, more than half of the patients (67.5%) belonged to a nuclear family. Nearly half (43.1%) of patients had received knowledge on skincare from health personnel and received radiation for a duration of fewer than 11 days. Majority of patients in other comparable studies belonged to the age group of 41–60 years, 73% were married, 54% belonged to the nuclear family, 83% were living in a rural area, 34% had information about radiation therapy from health personnel and (40%) had 10–19 radiation fractions.[4],[8],[9]

The present study reveals that more than half of the patients (55.28%) reported a good level of knowledge on skincare. Comparable studies reveal that baseline knowledge which was unsatisfactory improved on consecutive tests and a mean ± standard deviation (SD) on knowledge score was 18.70 ± 3.06.[10],[11] It may be concluded that the knowledge about side effects improves over time as patients may seek more information as side effects intensify with treatment. A cross-sectional one-time assessment may not be adequate to measure knowledge for this group.

More than half of our study participants (52.84%) reported satisfactory QOL with a mean percentage (58.82%). QOL was highest in the social domain with a mean ± SD of 9.17 ± 2.73 and mean percentage of 61.13% and lowest in the physical domain. The physical symptoms that cancer patients experienced due to radiation therapy were influential in affecting QOL. Comparable studies also reported that QOL was lowest in physical parameter with a mean percentage of 55.5% and the patient's QOL improved after 1 month of radiation therapy with a mean overall QOL score of 53.07 ± 12.68.[12],[13] Physical symptoms associated with radiation therapy such as skin irritation and fatigue were the most common complaints that were reported amongst patients undergoing radiation therapy.[6] Follow-up could have reflected on the status of QOL of our patients which was a limitation of our study.

The present study shows that an association was found between knowledge and educational status (P = 0.03). Another study has reported that cancer patients' knowledge was associated with daily Internet use (P = 0.022), higher education (P = 0.022) and paid employment (P < 0.001).[10] However, another study reported that higher QOL was associated with patients' marital status, education, employment, family support and duration of illness.[13] Our findings could be a result of many patients opting for other systems of medical treatment causing disruption of current treatment impacting their QOL. Our study also reported weak-positive correlation between knowledge and QOL of cancer patients receiving radiation therapy (r = 0.10; P > 0.05). We did not find any literature reporting such correlates. Whether this finding is a reflection of only sociocultural factors and the extent of its impact remains to be explored further. Another limitation of our study was the lack of development of interventional strategies to improve QOL which we strongly recommend in future studies.

  Conclusion Top

Radiation therapy is known to negatively affect and deteriorate the QOL of cancer patients. However, QOL improves after a few months of treatment which possibly could be due to the completion of radiation therapy. Thus, we recommend assessment of knowledge and QOL of cancer patients as routine practice over all visits and develop interventions to improve on the QOL.


The authors would like to place gratitude to RGUHS for funding this study and thank the management, and staff of Father Muller College of Nursing for their support. We are thankful to all participants for their wholehearted co-operation.

Financial support and sponsorship

This study was funded by RGUHS, Bangalore.

Conflicts of interest

There are no conflicts of interest.

  References Top

Wallner PE, Steinberg ML, McBride WH, Hahn SM, Zietman AL. Fork in the road: Choosing the path of relevance. Int J Radiat Oncol Biol Phys 2015;92:214-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25968821. [Last accessed on 2019 Sep 18].  Back to cited text no. 1
DNA India.com. ICMR: New Delhi, India; c2016. Available from: https://www.dnaindia.com/india/report-over-17-lakh-new-cancer-cases-in-india-by-2020-icmr-2213764. [Last accessed on 2016 Oct 20; Last updated on 2016 May 18].  Back to cited text no. 2
Aggarwal A, Lewison G, Rodin D, Zietman A, Sullivan R, Lievens Y. Radiation therapy research: A global analysis 2001-2015. Int J Radiat Oncol Biol Phys 2018;101:767-78.  Back to cited text no. 3
Binu VS, Chandrashekhar TS, Subba SH, Jacob S, Kakria A, Gangadharan P, et al. Cancer pattern in western Nepal: A hospital based retrospective study. Asian Pac J Cancer Prev 2007;8:183-6.  Back to cited text no. 4
World Health Organization. WHOQOL-BREF. Introduction, Administration, Scoring and Generic Version of Assessment; 1996. Available from: https://www.who.int/mental_health/media/en/76.pdf. [Last accessed on 2019 Aug 28].  Back to cited text no. 5
Yucel B, Akkaş EA, Okur Y, Eren AA, Eren MF, Karapinar H, et al. The impact of radiotherapy on quality of life for cancer patients: A longitudinal study. Support Care Cancer 2014;22:2479-87.  Back to cited text no. 6
Rukshani DL, Kahandawala P, Jayawardana K, Karunarathne D, Galgamuwa LS, Kumara C, Gamage C. Factors associated with quality of life among cancer patients in Sri Lanka. Int J Community Med Pub Health 2018;5:2705-13.  Back to cited text no. 7
Jyothi B, Nagarathnam M, Devi K. Assessment of knowledge on selected side effects and coping strategies among patients receiving radiation therapy in a state of Andhra Pradesh. J Nur Health Sci 2019;7:40-6.   Back to cited text no. 8
Dutta S, De A, Ray S, Basu M, Misra R. Quality of life and its determinants; among cancer patients in radiotherapy outpatient department of a tertiary care hospital of Kolkata. Prev Med Holistic Health 2018;4:24-30   Back to cited text no. 9
Nagaraju V, Pandit N, Narasimaiah L, Rajanna M. Incidence and patternof cancer patients attending to tertiary care hospital Mandya Institute of Medical Science, Mandya, Karnataka, India. Int Surg J 2016;3:505-8  Back to cited text no. 10
Berger O, Gronberg BH, Loge JH, Kaasa S, Sand K. Cancer patient's knowledge about their disease and treatment before, during and after treatment: A prospective, longitudinal study. BMC Cancer 2018;18:381.  Back to cited text no. 11
Nigam K, Prakash K. Quasi experimental non randomized study on effectiveness of instructional strategy on knowledge, practice and quality of life of head and neck cancer patients receiving radiotherapy in selected cancer research institute, Uttarakhand. Nucl Med Radiat Ther 2016;7(313):2  Back to cited text no. 12
Gangane N, Khairkar P, Hurtig AK, Sebastian MS. Quality of life determinants in breast cancer patients in central rural India. Asian Pac J Cancer Prev 2017;18:3325-32.  Back to cited text no. 13


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