Satisfaction of cancer patients receiving chemotherapy in day care units: a cross-sectional study

INTRODUCTION

Cancer is a group of diseases characterized by abnormal and uncontrolled cell growth with the potential to invade or spread to other parts of the body.¹ It begins when normal cellular functions and metabolism are altered, leading to unchecked proliferation of cells. These abnormal cells may form a tumour, which can be either benign or malignant. Malignant tumours replace healthy cells, interfere with normal physiological functions, and deprive body tissues of nutrients. Owing to its complex and often hidden nature, cancer is often referred to as an “iceberg disease”.^2,3

Worldwide, cancer ranks as the second leading cause of death after cardiovascular diseases, responsible for approximately 10 million deaths in 2020.⁴ Nearly 70% of these fatalities were reported in low- and middle-income countries, including India. India, currently transitioning epidemiologically from communicable to non-communicable diseases, faces a significant cancer burden.⁵ According to the National Cancer Registry Programme Report, there were 13.9 lakh cancer cases, projected to rise to 15.7 lakh by 2025 (ICMR). In 2022, more than 9 lakh cancer-related deaths were reported, with a five-year disease prevalence exceeding 3.2 lakh.⁶ These statistics highlight the urgent need for early detection, accurate diagnosis, and effective treatment to improve prognosis. Management of cancer requires a multimodal approach, including surgery, chemotherapy, radiotherapy, immunotherapy, and palliative care, particularly for advanced stages of the disease.⁷

Chemotherapy continues to serve as one of the fundamental approaches in cancer management and more than half of all cancer patients undergo chemotherapy at some stage of their illness. More In 2018, an estimated 63% of patients in low- and middle-income countries required chemotherapy, with this proportion expected to rise to 67% by 2040.^8,9 It is widely delivered in outpatient day care settings. Day care chemotherapy units are responsible for the administration of anticancer drugs in an outpatient setting, where patients receive their treatment during the day and return home the same day without the need for overnight hospitalization. This approach reduces hospital stay, minimizes costs, and allows patients to continue daily activities while receiving treatment.¹⁰

With the growing recognition of patient-centered care, healthcare systems have shifted focus from a “disease-centered” to a “patient-centered” approach, emphasizing not only treatment outcomes but also patient needs, preferences, and experiences. Patient satisfaction has therefore become a key outcome measure in healthcare, reflecting both the quality of services and the effectiveness of care delivery.^11,12 In cancer care, where patients often undergo prolonged and challenging treatment regimens, satisfaction with chemotherapy services in day care units is an essential determinant of overall care quality.¹³ Assessing satisfaction helps identify gaps in service delivery, informs quality improvement initiatives, and enhances patient trust and adherence to treatment.

METHODS

A quantitative research approach with a cross-sectional design was adopted for the present study. The study was conducted in the day care units of the All-India Institute of Medical Sciences, Jodhpur, Rajasthan, India, from March 15 to June 30, 2023. The inclusion criteria comprised patients diagnosed with cancer, aged above 18 years, receiving chemotherapy, able to understand and communicate in Hindi, and willing to provide written informed consent.

The sample size was determined using the single population proportion formula commonly applied in cross-sectional studies.¹⁴ Considering a 60% satisfaction rate reported in a previous study, with a 95% confidence level (Z=1.96) and a precision of 5% (d=0.05), the required sample size was computed as n=Z²×p(1−p)/d²=(1.962×0.60×0.40)/0.0025≈369.¹⁵ To account for an anticipated 10% non-response rate, the final sample size was inflated to 410 participants. A total of 500 cancer patients receiving chemotherapy in day care units were recruited using a non-probability convenience sampling technique.

Data were collected using self-structured instruments, which included a socio-demographic and clinical profile sheet, and a patient satisfaction rating scale. The self-structured patient satisfaction rating scale consisted of 25 items categorized under six subdomains: communication, accessibility, nursing care, doctor care, hospital facilities and likelihood to recommend. The tool was developed based on literature review and experts guidance. It used a 7-point Likert scale ranging from 1 (very poor) to 7 (excellent). For scoring, overall patient satisfaction was categorized into three levels: satisfied (117-175), partially satisfied (71-116) and not satisfied (25-70). The scale demonstrated strong content validity, with a scale content validity index (S-CVI) of 0.96. Internal consistency reliability, measured using Cronbach’s alpha, was reported as 0.79, indicating acceptable reliability. Data collection was carried out through face-to-face interviews.

A pilot study was conducted among 50 patients undergoing chemotherapy in day care units to assess the feasibility of the tools and procedures. Data collection for the pilot study was completed over two weeks, requiring an average of 5-10 minutes per patient. No major difficulties were encountered during the pilot study. These participants were excluded from the main study sample.

The data were analysed and interpreted in alignment with the study objectives. Data were categorized and processed using the statistical package for social sciences (SPSS) version 20. Quantitative analysis involved descriptive statistics such as mean, standard deviation, frequency, and percentage. For inferential statistics, the Fisher’s exact test was applied to examine the association between patients’ satisfaction and selected socio-demographic and clinical variables. A probability value (p value) of less than 0.05 was considered statistically significant.

Ethical approval was obtained from the Institutional Ethical Committee (Certificate reference number: AIIMS/IEC/2023/4312, dated 06/03/2023). All participants were fully informed about the objectives, procedures, confidentiality measures, and their right to withdraw from the study at any time without compromising their medical care. Written informed consent was obtained prior to enrolment.

RESULTS

Data presented in Table 1 depicts that most of the patients (49.40%) were aged between 41-60 years, more than half of the patients (56.60%) were female, most of the patients (43.40%) were non-literate and half of the patients (51.40%) were homemaker. More than half of the patients (55.40%) were having monthly income of less than 10,000 rupees. More than half of the patients (61%) were residing in rural area. Most common diagnosis were breast cancer (23%) and oral cavity cancer (22.40%). Nearly one third patients (34.60%) having second stage of cancer, followed by stage I (30.40%). Half of the patients (57.20%) had taken 1-3 cycles of chemotherapy. Nearly one third (34.20%) of patients had taken radiation therapy and 18.80% of patients were having comorbidities like diabetes, hypertension etc.

Table 2 depicts patient satisfaction across 6 subdomains. The analysis of patient satisfaction revealed that highest composite mean score recorded in the communication domain (4.84±0.75) followed closely by recommendation to others (4.78±0.60) and hospital facilities (4.74±0.67). Domains of nursing care (4.71±0.71) and doctor care (4.71±0.70) demonstrated almost identical satisfaction levels, while accessibility showed slightly lower score (4.70±0.73). At the item level, the most highly rated aspect was the explanation of follow-up time at discharge (5.53±0.93; rank 1), indicating strong patient appreciation for clear discharge guidance. Other highly rated items included clean and freshly prepared beds (4.83±0.54; rank 2), nursing officers’ caring and friendly behaviour (4.79±0.62; rank 3), and willingness to recommend the hospital (4.78±0.60; rank 4). In contrast, the lowest satisfaction was reported for washroom maintenance (4.55±0.91; rank 25), followed by clarity of treatment instructions (4.63±0.80; rank 24) and explanation of procedures, investigations, and warning signs (4.64±0.81; rank 23). Overall, findings highlight that while communication and supportive facilities were strong contributors to patient satisfaction, aspects of hospital hygiene and detailed procedural explanations were identified as needing further improvement.

Table 3 illustrates the distribution of patient satisfaction levels among individuals receiving chemotherapy in day care units. Out of the total, a vast majority of 480 patients (96%) achieved scores between 117-175, indicating that they were satisfied with the services. A smaller group of 15 patients (3%) obtained scores in the range of 71-116, reflecting partial satisfaction. Only 5 patients (1%) scored between 25-70, signifying dissatisfaction. These results highlight that overall satisfaction was notably high, with only a minimal proportion reporting lower levels of satisfaction.

Association of level of patient satisfaction with selected demographic and clinical variables was also analysed. Results shows that there was a significant association of patient satisfaction with age of patient (p=0.002) whereas other demographic and clinical variables not significant.

DISSCUSSION

Patient satisfaction is considered a vital indicator of the quality of care in cancer treatment, particularly within day care units. It constitutes one of 2 essential components of care quality, which emphasize respecting and understanding patients’ needs and delivering services accordingly. Satisfaction is largely determined by the gap between expected and perceived quality of care-when the perceived quality exceeds expectations, it reflects better service quality, whereas when it falls below expectations, it indicates poorer service quality. An efficiently designed healthcare delivery system not only enhances patient satisfaction but also contributes to improve overall QoL.¹⁶

The present study was conducted to assess the satisfaction of cancer patients undergoing chemotherapy in the day care chemotherapy unit of AIIMS Jodhpur. The findings revealed that the majority of patients (49.40%) were aged between 41-60 years, and more than half (56.60%) were female. These findings are comparable with a study by Samant et al which reported a median age of 68 years, with 54% female respondents and 45% male respondents. The distribution of cancer types in the present study showed that breast cancer (23%) and oral cavity cancer (22.40%) were most common, which aligns with national statistics reported by the ICMR-National Institute of Cancer Prevention and Research.¹⁷

In terms of satisfaction, study highlighted that 96% of patients were satisfied with services received, while only 1% expressed dissatisfaction. These findings are consistent with a study conducted by Patel et al in Central India, which also reported high level of satisfaction (93.2%) among women attending day care oncology units.¹⁸ Similarly, Khairy et al found that 60% of cancer patients expressed satisfaction with health care services provided at day care units, while 40% dissatisfied.¹⁵

The present study also demonstrated a statistically significant association between patient satisfaction and age (p=0.002), while no significant association was found with other demographic or clinical variables. This suggests that age may influence patients’ perceptions and expectations of health care, whereas other factors such as gender, type of cancer, or duration of treatment may not play a significant role.

The study contributes to the understanding of patient satisfaction among individuals receiving chemotherapy, which is an important determinant of treatment compliance, trust in health services, and overall health outcomes. It also underscores the need for continuous education and support for patients to enhance their chemotherapy experience. However, certain limitations should be acknowledged: the use of non-probability convenience sampling and the restriction to a single study setting limit the generalizability of the findings. Furthermore, due to the cross-sectional design, causal relationships between variables cannot be established, as exposure and outcomes were assessed simultaneously.

CONCLUSION

The study concludes that the majority of cancer patients receiving chemotherapy in day care chemotherapy unit were satisfied with the care provided. Patient satisfaction reflects not only the perceived needs and expectations of patients but also their overall experience with both medical and non-medical aspects of care. As a multidimensional concept, it highlights the importance of holistic patient-centered care in oncology. The findings emphasize the need for continuous quality improvement and patient education programs to further enhance satisfaction and ensure positive treatment experiences.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee (AIIMS/IEC/2023/4312, dated 06/03/2023)

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