{"paper_id":"052cd5f7-4573-495e-be8f-c47440715f03","body_text":"Psychosocial distress and associated factors among adult cancer patients at oncology units in the Amhara regional state, Ethiopia, 2022 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Psychosocial distress and associated factors among adult cancer patients at oncology units in the Amhara regional state, Ethiopia, 2022 Astewle Andargie Baye, Sitotaw Kerie Bogale, Abebu Tegenaw, Mengistu Melak Fekadie, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2217915/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Psychosocial distress is a long-term burden for cancer survivors, which has an impact on their quality of life and oncologic prognosis. Although the national cancer prevention and control program in Ethiopia has made efforts in cancer prevention, control, and management by implementing the national cancer control plan 2016–2020, no enough evidence about psychosocial distress among adult cancer patients. So it is critical to understand the magnitude of psychosocial distress and the factors that contribute to it. Objective To assess the prevalence of psychosocial distress and associated factors among adult cancer patients at oncology units in the Amhara regional state, Ethiopia. 2022. Methods A multi-center institutional based cross-sectional study was conducted among a sample of 605 adult cancer patients from April 30-June 22, 2022. A systematic random sampling technique was employed to select the study units. And data were collected through interviewers administered questionnaires by using the validated and pretested tools. Distress was assessed using the Questionnaire on Stress in Cancer Patients Revised 10. Both bivariable and multivariable logistic regression was used to describe the association between dependent and independent variables. Independent variable with p -value less than 0.25 in the bivariable logistic regression analyses were entered into multivariable logistic regression model. Variables with p -value < 0.05 in the multivariable logistic regression analyses were considered as statistically significant associated factors of psychosocial distress. Result A total of 593 adult cancer patients took part in this study with mean age of 46.86 ± 14.5 years. The overall prevalence of psychosocial distress was 63.74%. Variables such as being female (AOR = 1.98, 95% CI: 1.24–3.17), patients who lives in rural areas (AOR = 2.3, 95% CI: 1.49–3.54), community based health insurance utilization (AOR = 0.34, 95% CI: 0.23–0.51), patients on chemotherapy treatment (AOR = 2.72, 95% CI: 1.38–5.39), patients with comorbidity (AOR = 3.2, 95% CI: 1.67–6.10), and symptom burdens such as severe fatigue (AOR = 1.65, 95% CI:1.09–2.39) and severe nausea (AOR = 2.07, 95%CI: 1.43-3.00) were statistically associated with psychosocial distress. Conclusion and recommendation: In general, the findings of this study showed a relatively high magnitude in which around two-thirds of patients experienced psychosocial distress. It is better to establish and enforce the integration and coordination of psychosocial-oncology service programs at national level with parallel guidelines and policies. Amhara region cancer prevalence psychosocial distress Figures Figure 1 Background The global burden of cancer is increasing rapidly and is exceeding the current cancer control capacity ( 1 ). In sub-Saharan Africa, cancer is increasingly posing a serious threat to public health, and Ethiopia is no exception ( 2 , 3 ). It is commonly perceived as a life-threatening and potentially traumatic illness ( 4 ). Moreover, receiving a diagnosis of cancer and undergoing its treatment together comprises an extremely stressful experience ( 5 ). Throughout cancer survivorship, they could render individuals more vulnerable to long-lasting negative psychosocial outcomes ( 6 ). Recognizing that cancer survivorship is not a single event; it is a multistage process that begins at the moment of diagnosis and continues throughout one's life( 7 ). During this continuum, cancer survivors experience a variety of dreadful issues and comorbidities that involve medical, physical, and emotional aspects that can have an impact on their overall health and well-being( 8 ). One of the most prevalent comorbidity is cancer related psychosocial distress which is the leading comorbidity problem in cancer patients( 9 ). The National Comprehensive Cancer Network (NCCN) defined distress in cancer as “a multifactorial unpleasant experience of a psychological (i.e., cognitive, behavioral, emotional), social, spiritual, and/or physical nature that may interfere with one's ability to cope effectively with cancer, its physical symptoms, and its treatment ( 10 ). It extends along a continuum, ranging from common normal feelings of vulnerability, sadness, and fears to problems that can become disabling, such as depression, anxiety, panic, social isolation, and existential and spiritual crisis ( 11 ). This implies that psychosocial distress exists along spectrum that extends from normal adjustment issues to syndromes that meet the full diagnostic criteria for a mental disorder ( 12 ). Psychosocial distress is a long-term burden for cancer survivors, with implications for their quality of life and oncologic prognosis ( 13 ). The magnitude of psychosocial distress in the cancer survivorship cohort is reported as between 20–52% ( 14 ). About 50% of cancer patients have clinically significant unrecognized or untreated psychosocial distress during the cancer trajectory ( 15 ). It varies between economically developed and economically underdeveloped countries, with developing countries having the greatest magnitude ( 16 ). Regarding factors of distress, previous studies have revealed that estimates of the magnitude of distress vary based on the type and stage of cancer ( 17 ). High magnitudes of clinically significant level of distress were found among patients with hematologic, lung, and head and neck cancer ( 15 , 18 ). Several factors contribute to psychosocial distress in cancer patients, including advanced stages of cancer, treatment options with a variety and number of uncontrolled symptom burdens such as fatigue, pain, anxiety, difficulty in transportation, changes in role relationships, physical limitation, and fear of recurrence ( 19 , 20 ). Psychosocial distress has also been observed to vary by patient demographics, in which female gender ( 21 ) and older age were associated with higher distress ( 22 ). Moderate to severe levels of distress have resulted from being rural residents, patients with low educational status, and divorced patients ( 23 ). Evidence from the NCCN reveals that inadequate social support, living alone, severe co-morbid illnesses, financial problems, and spiritual/religious concerns put cancer patients at an increased risk of psychosocial distress ( 24 ). Distress in patients with cancer is associated with various negative outcomes, like reduced adherence to treatment ( 25 ), increased treatment toxicities ( 26 ), trouble making decisions about treatment ( 14 ) and increased morbidity ( 9 ). Furthermore, cancer patients suffering from psychosocial distress have a poor quality of life and may have a lower chance of surviving ( 27 ). It also associated with increased cancer-specific mortality ( 28 ). Significant numbers of death were recorded among United States of Americas psychosocially distressed cancer patients and even at lower levels of psychosocial distress, an increased mortality was observed ( 29 ). Given that risk of death among cancer patients with psychosocial distress was higher than non-distressed individuals ( 30 ). Long-term distress can have additional significant financial toxicity ( 31 ). In comparison to patients without a history of distress, cancer survivors with distress reported higher annual medical expenses ( 32 ). As the burden of psychosocial distress among patients is on the rise, it affects a significantly higher number of families or primary caregivers ( 33 , 34 ). Approximately two-thirds of all caregivers of distressed cancer patients who accessing a support line were severely distressed ( 35 ) . Despite the fact that distress is significant among cancer patients, it frequently remains under-recognized and under-treated, and interventions that can be helpful are not always delivered ( 36 ). The prevention, early detection, and proper management of distress are important for improving patients' quality of life and survival ( 37 ). Potential interventions targeting exercise intensity, character strengths, medical coping, and social support could all be used to reduce the burden of psychosocial distress ( 38 ). Pharmacologic interventions, social work and counseling services, supportive psychotherapy, cognitive behavioral therapy, and spiritual care are all important aspects of the therapeutic management of cancer patients who are distressed ( 14 ). Management of psychosocial distress should be recognized as a universal human right, according to the IPOS, International Standard of Quality Cancer Care, and high-quality cancer care must include the psychosocial domain in regular care ( 39 ). The NCCN also suggested psychosocial distress as the sixth vital sign, recommending its assessment after checking temperature, pulse, respiration, blood pressure, and pain ( 40 , 41 ). As a result, various countries throughout the world are implementing psychosocial distress screening programs by incorporating psychosocial-oncology services ( 42 – 44 ). But the recognition of distress and the implementation of psychosocial-oncology program are fragmented and undeveloped, particularly in African countries ( 45 ). Although the national cancer prevention and control program in Ethiopia has made efforts in cancer prevention, control, and management by implementing the national cancer control plan 2016–2020 in order to achieve the long-term goal of reducing cancer morbidity and mortality through early detection and screening, diagnosis, and provision of comprehensive intervention ( 46 ), no enough evidence about psychosocial distress among cancer patients. So it is critical to understand the magnitude of psychosocial distress and the factors that contribute to it in order to screen and treat it as soon as possible. No study was conducted on the prevalence of psychosocial distress and associated factors in adult cancer patients in our sample. Therefore, this study is intended to identify the prevalence of psychosocial distress among adult cancer patients. And to identify factors associated with psychosocial distress. Study Design Multi-centered institutional-based cross-sectional study was conducted to identify the prevalence of psychosocial distress and associated factors among adult cancer patients attending at oncology units in the Amhara regional state, Ethiopia. Study Area And Period The study was conducted at public health facilities with oncology units in the Amhara regional state from April 30 to June 22/2022 among cancer patients who were attending for treatment and follow-up. Currently, the Amhara regional state has four specialized referral hospitals that provide comprehensive and integrated cancer care. The four institutions are Felege Hiwot comprehensive specialized hospital (FHCSH), University of Gondar comprehensive specialized hospital (UOGCSH), Dessie referral hospital (DRH), and Tibebe Ghion Specialized Hospital (TGSH). Both FHCSH and TGSH found in Bahir dar city, the capital of Amhara regional state which are 565 kilometers apart from Addis Ababa, Ethiopia. UOGCSH and DRH, on the other hand, are 738 and 396.8 kilometers from Ethiopia's capital, respectively. These oncological care facilities have been operating since 2015, with the help of a few devoted individuals, and provide comprehensive oncology care for a variety of cancer patients. Currently, region’s oncology units, such as FHCSH, UOGCSH, DRH, and TGSH have 22, 32, 16 and 8 inpatient beds for the treatment of cancer patients respectively. Source Population All adult cancer patients attending at oncology units in the Amhara regional state Study population All adult cancer patients attending at oncology units in the Amhara Regional state during the study period (April 30 - June 22/2022) Study unit Each adult cancer patient at oncology units in the Amhara regional state that fulfilled the inclusion criteria was participated in this study. Inclusion Criteria All cancer patients who were ≥ 18 years old who were attending at oncology units were included into the study. Sample Size Determination And Sampling Procedure First, oncology units which are located in the Amhara regional state were identified. According to the unit’s cancer registry of patients with cancer, each hospital, such as FHCSH, UoGCSH, DRH, and TGSH, treated about 420, 392, 224, and 70 cancer patients on average every month, respectively. And averagely the overall number of cancer patients who have been followed up on each month at the region's oncology units was 1,106. The sample was determined by using a single population proportion formula by considering the following statistical assumptions: P = proportion of patients with cancer, who experience psychosocial distress (50%), (Z /2 = 95% CI Z score, d = margin of error (5%). The final sample size was 605 considering 1.5 design effect and 10% non-respondent rate. An independent and representative sample was determined for each oncology unit by using a stratified sampling technique based on the above information. And the final sample size was determined after being proportionally assigned to each oncology unit, with 230 from FHCSH, 214 from UOGCSH, 123 from DRH, and 38 from TGSH. A systematic random sampling technique was employed to select the final actual participant samples. The k th value in the systematic random sampling procedure was calculated by dividing the source population by the total sample size. Based on the monthly attending adult cancer patients at oncology units the K th value became 2. Finally, the actual study participants were selected with every 2nd cancer patient who came to the oncologic unit for treatment and follow-up during the data collection period and met the inclusion criteria. The first study participant was selected by using the lottery method and then data was collected from every 2nd patient, starting with the first study participant selected randomly and continuing until the desired sample size was obtained. Study Variables Dependent variable Psychosocial distress Independent Variables Socio demographic factors (age, sex, marital status, religion, residence, educational status, occupation, and health insurance). Symptom burden variables Pain, fatigue(tiredness), nausea, disturbed sleep, upset, shortness of breath, problems of remembering things, lack of appetite, drowsy(sleepy), dry mouth, sadness, vomiting, and numbness Clinical and treatment factors (Cancers type, cancer stages, cancer treatment, duration of time since diagnosis, Co-morbid disease, and performance status). Psychosocial related factors Social support. Operational Definitions Psychosocial distress Psychosocial distress refers to a specific co-morbid and clinically significant condition that is experienced by cancer patients. It is identified and measured by using the Questionnaire on Distress in Cancer Patients (QSC-R10), which is a validated measurement scale with psychometric properties specific to cancer. An individual with a score of > 14 is recognized as having psychosocial distress and a score of ≤ 14 is recognized as not experiencing psychosocial distress ( 47 ). Co-morbid disease The \"coexistence of non-communicable and co-infectious diseases in addition to a primary disease of interest (cancer disease) like diabetes mellitus, hypertension, heart failure, HIV/AIDS...\"( 48 , 49 ). Symptoms burden Severity of symptoms experienced by cancer patients measured by using M. D. Anderson Symptom Inventory measurement tool. Each symptom lists considered as severe if the score rated as greater or equal to seven from a scale from 0–10 in which 0 (no symptom) and 10 (as bad as you can imagine) ( 50 ). Perceived social support How cancer patients perceive friends, family members and others as sources available to provide material, psychosocial and overall support during times of need. Measured by using Oslo 3-item social support scale and considered as poor, moderate, and strong social support if scores become 3–8, 9–11, and 12–14 respectively( 51 ) Performance status It describes a patient’s level of functioning in terms of their ability to care for themselves. Eastern Cooperative Oncology Group performance status (ECOG PS) measurement scale is used which has six grades ranging from 0 to 5. Patients with grades of ECOG PS of 0 and 1 labeled as having good performance status whereas grades of ECOG PS 2, 3, and 4 is considered as having poor performance status( 52 ). Data collection tools and procedure A structured written questionnaire was used to collect the data. It consisted of socio-demographic factors of the respondents, clinical and treatment factors, Questionnaire on psychosocial distress in Cancer Patients-Short Form (QSC-R10); the core symptom burden list experienced by cancer patients, perceived social support and Eastern Cooperative Oncology Group performance status (ECOG PS). Level of psychosocial distress was measured by using the Amharic version of QSC-R10. The QSC-R10 is a 10-item psycho-oncological screening instrument for self-assessment of psychosocial distress specific to cancer disease and its treatment. It comprises the following items: fear of disease progression, feeling tired and weak, reduced work and recreation activities, feeling tense and/or nervous, disturbed sleep, feeling physically imperfect, pain, missing partner's empathy, few opportunities to speak with psycho-oncological professionals, and not feeling well informed about disease/treatment. Patients indicate whether each item applies to them, and if so, how severely. Thus, each item is rated on a six-point scale ranging from 0 (the problem does not apply to me) to 5 (the problem applies to me and is a very serious problem). A total distress score is calculated by adding each item ratings. This questionnaire shows good psychometric properties; from the previous study Cronbach’s Alpha for the total score is 0.85. A validated cutoff score > 14 was used to identify patients with clinical significant level of psychosocial distress, possibly requiring psychosocial-oncological treatment ( 47 ). The content validity index and the Cronbach’s alpha for this tool in this study were 0.91 and 0.89, respectively. The core symptom burden experienced by cancer patients was assessed by using the Amharic version of the MD Anderson Symptom Inventory (MDASI) tool. The Amharic version of MD Anderson Symptom Inventory (MDASI) is a valid and reliable multi-symptom assessment tool developed for use in cancer patients. It contains 13 core symptom items rated at their severest level in the past 24 hours, including pain, fatigue, nausea, disturbed sleep, feeling upset, shortness of breath, difficulty remembering, lack of appetite, drowsiness, dry mouth, sadness, vomiting, and numbness or tingling. Each symptom is rated on an 11-point scale ranging from 0 to 10, with 0 = no presence of the symptom and 10 = the symptom at its highest severity level. A symptom was severe if it was rated greater than or equal to 7 on a scale of 0–10. And the cut of score is reliable with alpha coefficient of 0.83( 50 ). To measure level of social support among patients with cancer, the valid and reliable tool such as Amharic version of Oslo 3-item Social Support Scale (OSS-3) was used. The three items cover different fields of social support, and the OSS-3 sum score ranges from 3 to 14 and is calculated by summarizing the raw scores of the items. Scores 3–8, 9–11, and 12–14 indicate poor, moderate, and strong social support respectively ( 51 , 53 ). To measure cancer patients' level of performance status, the Eastern Cooperative Oncology Group Performance Status (ECOG PS) was used. The Eastern Cooperative Oncology Group Performance Status (ECOG PS) is a simple tool that is accepted and recognized by world health organization (WHO) and used by nurses and physicians in everyday practice to assess the functional status of patients, with a range from 0 (fully active) to 5 (dead) ( 52 ). The Amharic versions of a written questionnaire were used to collect the data for the current research. After obtaining permission from the appropriate authorities, the data were collected by four BSC nurses and four supervisors with BSC in nursing chosen by the researchers. All the necessary data from the sample was collected by using face-to-face interviews using structured questionnaires. Information regarding some variables which are not known by the respondents, like cancer stage, was collected from their follow-up chart on the oncology unit Data entry, processing and analysis First the collected data were checked for completeness by the principal investigator. Then the data was coded and entered using Epi Data statistical software version 3.1 and then exported to stata statistical software version-15 for final analysis. The outcome variable was identified as a categorical variable of psychosocial distress “caseness,” where scores > 14 were coded as 1 (distressed) and scores ≤ 14 were coded as 0 (not distressed). Before analysis, missing values were checked by the principal investigator. Basic descriptive and summary statistics was used to describe results and computed by using frequencies, percentages, means, and standard deviation. And the findings were described in the form of tables, and graphs as appropriate. Binary logistic regression was used to determine statistical association between the independent and the dependent variables at 95% confidence level. All variables associated with the dependent variable with p -value less than 0.25 in the bivariable logistic regression analyses were entered into multivariable logistic regression model in order to identify the association between the dependent and independent variables and to control for potential confounders. Multicollinearity was checked between independent variables through variance inflation factor for continuous independent variables and spearman’s rank correlation for categorical independent variables. Model fitness was checked by using the Hosmer and Lemeshow’s goodness of fit test. The p-value for the test was 0.52 which was greater than 0.05 indicating that the model fitted the data. Variables with p -value < 0.05 in the multivariable logistic regression analyses were considered as statistically significant associated factors of psychosocial distress. Data quality assurance For the assurance of data quality, an appropriate data collection tool was designed and evaluated by experienced researchers. Amharic versions of the structured questionnaire were used for data collection. First the questionnaire was prepared in English, and then it was translated to Amharic and back to English. A pretest on 5% of the total sample size was conducted at Tikur Anbassa Specialized Hospital oncology unit prior to three week before the commencement of the actual data collection. The pretest aimed to assess whether the checklist items are easily understood by the data collector and the study participants and to evaluate the appropriateness of the tool for the planned study. Careful modification of the checklist was done before the main study began to improve data quality. After pretest data collectors and supervisors were trained for a couple of days before the data collection on the roles, tasks, and how to ensure the confidentiality of the study participants. Close monitoring and evaluation were carried out by the supervisors and principal investigators. The collected data were reviewed and checked for completeness before data entry. The principal investigators recoded the collected data. Ethical Considerations The study was carried out after letter of approval was obtained from ethical review committee of Bahir Dar University, college of medicine and health sciences with protocol internal review board’s decisions protocol number (CMHS/IRB 01–008). Written official letter was submitted to quality and research coordinator offices of each study areas and permission letter was also submitted for each respective oncologic unit coordinators. Objectives and purpose of the study were explained for the study participants and confirmation of the consent by the participant was obtained by signing on a consent form attached to the data collection tool. The privacy of the participants was kept during the interview. For confidentiality purposes, respondent’s personal identifier details were not required and these were made known to them. Further, all information generated from the participants were treated with confidentiality and only be reported as a group data summary without disclosing any potentiality of identifying information for any research participant. Results Socio-demographic characteristics A total of 593 adult cancer patients participated in this study, yielding a response rate of 98.02%. Among those, 401(67.62%) were females. The mean age of the participants was 46.86 ± 14.5 years. In terms of marital status, more than two-third (70.15%) of the participants were married. Nearly three-quarters of the respondents (81.28%) were Orthodox Christianity. The majority, 422(71.16%) were rural residents. More than half (54.13%) could not write and read. The majority, 338 (57%) of the respondents were farmers. Considering the respondent’s community-based health insurance utilization, more than half (55.65%) cancer patients utilized community-based health insurance (Table 1 ). Table 1 Socio-demographic characteristics of adult cancer patients at oncology units, in the Amhara regional state, Ethiopia, April 30-June22/2022 (n = 593). Variables Category frequency Percent Sex Male 192 32.38 Female 401 67.62 Age 18–24 39 6.58 25–40 169 28.50 41–59 254 42.83 ≥ 60 131 22.09 Marital status Single 81 13.66 Married 416 70.15 Divorced 65 10.96 Widowed 31 5.23 Religion Orthodox 482 81.28 Muslim 108 18.21 Protestant 3 0.51 Residence Urban 171 28.84 Rural 422 71.16 Educational status Unable to write and read 321 54.13 Able to write and read 102 17.20 Primary school level 49 8.26 Secondary school level 56 9.44 College and above 65 10.96 Occupation Employed 62 10.46 Un employed 87 14.67 Merchant 89 15.01 Farmer 338 57.00 Student 17 2.87 Health insurance No 263 44.35 Yes 330 55.65 Clinical and treatment related characteristics Among 593 participants, the leading type of cancer was breast cancer, accounting for 157(26.48%). Regarding the length of time since the diagnosis of their cancer, more than half (52.11%) had a history of cancer diagnosis of less than one year duration. The majority of the participants were presented with advanced stages of cancer. Considering the current cancer treatment, around 330 (55.65%) patients received chemotherapy treatment alone. About 98 (16.53%) cancer patients had comorbid diseases. The majority (50.76%) of the patients had a good performance status (Table 2 ). Table 2 Clinical and treatment related characteristics of adult cancer patients at oncology units, in the Amahra regional state, Ethiopia, April 30-June 22/2022 (n = 593). Variables Category Frequency Percent Cancer type Breast cancer 157 26.48 Gynecological cancer 135 22.77 GIT cancer 147 24.79 Hematological cancer 93 15.68 Others 61 10.29 Time since diagnosis < 1 year 309 52.11 ≥ 1 year 284 47.89 Cancer stage Stage I 48 8.09 Stage II 49 8.26 Stage III 197 33.22 Stage IV 299 50.42 Current treatment type No treatment received 54 9.11 Chemotherapy 330 55.65 Surgery 23 3.88 Mixed 186 31.37 Comorbidity No 495 83.47 Yes 98 16.53 ECOG PS Poor 292 49.24 Good 301 50.76 Core symptoms burden and psychosocial issues The most frequently reported severe symptoms by the participants were fatigue, nausea, and pain, which accounted for (40.30%), (35.24%), and (29.17%) respectively. Nearly half (49.58%) of the patients had a history of strong social support (Table 3 ). Table 3 Core symptom burden and psychosocial issue characteristics of adult cancer patients at oncology units in the Amhara regional state, Ethiopia, April 30-June 22/2022 (n = 593). Variables Category Frequency Percent Severe pain No 420 70.83 Yes 173 29.17 Severe fatigue No 354 59.70 Yes 239 40.30 Severe nausea No 384 64.76 Yes 209 35.24 Sever disturbed sleep No 445 75.04 Yes 148 24.96 Severe feeling of upset No 478 80.61 Yes 115 19.39 Severe shortness of breath No 551 92.92 Yes 42 7.08 Severe problem on remembering things No 553 93.25 Yes 40 6.75 Severe lack of appetite No 436 73.52 Yes 157 26.48 Severe feeling of drowsy No 557 93.93 Yes 36 6.07 Severe dry mouth No 548 92.41 Yes 45 7.59 Severe feeling of sad No 544 91.74 Yes 49 8.26 Severe vomiting No 508 85.67 Yes 85 14.33 Severe numbness No 549 92.58 Yes 44 7.42 Social support Strong 294 49.58 Moderate 156 26.31 Poor 143 24.11 Prevalence of psychosocial distress The prevalence of psychosocial distress among adult cancer patients attending at oncology units in the Amhara regional state was found to be 63.74% (95% CI: 59.86–67.62) (Fig. 1 ). Factors associated with psychosocial distress A total of twenty-eight possibly factor variables such as sex, age group, marital status, religion, residence, educational status, occupational status, status on community-based health insurance utilization, cancer type, length of time since diagnosis of cancer, stage of cancer, treatment type, comorbidity, ECOG performance status, thirteen severe symptom burdens, and level of social support to be associated with psychosocial distress were entered into the binary logistic regression model. In bivariable logistic regression, those variables such as sex, age group, residence, community based health insurance utilization, cancer type, cancer stage, time since diagnosis, treatment type, comorbidity, performance status, fatigue, nausea, vomiting, numbness, and level of social support were significant at 0.25 significant level. And those variables with a P-value of ≤ 0.25 in the binary logistic analysis were entered into multivariable logistic analysis to identify the independent variables associated with psychosocial distress. In multivariable logistic regression analysis, seven variables such as sex, residence, health insurance, treatment type, comorbidity, fatigue, and nausea were significant at a p-value of less than 0.05 and 95% confidence interval. In this study, 272 (67.83%) female and 106 (55.21%) male adult cancer patients experienced psychosocial distress. As a result, female cancer patients were nearly twice more likely experiencing psychosocial distress when compared with male (AOR = 1.98, 95% CI: 1.24–3.17). The likelihood of experiencing psychosocial distress was 2.3 times higher among patients living in rural area (AOR = 2.3, 95% CI: 1.49 − 3.54) as compared to those who were living in urban. The odds of developing psychosocial distress were decreased by 66% among patients who utilized community-based health insurance (AOR = 0.34, 95% CI: 0.23–0.51) as compared to patients who did not utilized community-based health insurance. Regarding cancer treatment type, those patients who were on chemotherapy treatment were 2.72 times more likely to develop psychosocial distress as compared to those who did not start cancer treatment after adjusting other variables in the model (AOR = 2.72, 95% CI: 1.38–5.39). Cancer patients who had comorbidity disease were 3.2 times more likely to experience psychosocial distress when compared to patients who had no comorbidity (AOR = 3.2, 95% CI: 1.67–6.10). In this study, 174 (73%) adult cancer patients with severe fatigue developed psychosocial distress, whereas 204 (58.3%) patients without severe fatigue also developed psychosocial distress. In this case, the odds of experiencing psychosocial distress among severely fatigued cancer patients were increased by 1.7 times as compared to patients with no severe fatigue (AOR = 1.65, 95% CI: 1.09–2.39). The level of psychosocial distress among cancer patients with severe nausea was 155 (74.2%), whereas 223 (58.1%) of patients with no severe nausea experienced psychosocial distress. Given that the likelihood of developing psychosocial distress in cancer patients with severe nausea was almost 2 times higher than in cancer patients without severe nausea (AOR = 1.76, 95%CI: 1.10–2.80) (Table 4 ). Table 4 Bivariable and multivarible logistic regression analysis of factors assocated with psychosocial distress among adult cancer patients at oncollogy units in the Amhara regional state, Ethiopia, Aprile 30-June 22/2022 Variables Category Psychosocial distress COR(95% CI) AOR(95% CI) P-value Yes No Sex Male 106 86 1 1 Female 272 129 1.71(1.20–2.44) 1.98(1.24–3.17) 0.004 Age group 18–24 26 13 1 1 25–40 95 74 0.64(0.31–1.33) 0.67(0.30–1.56) 0.354 41–59 168 86 0.98(0.48–1.99) 1.06(0.47–2.39) 0.892 ≥ 60 89 42 1.06(0.49–2.26) 1.03(0.43–2.44) 0.953 Residence Urban 92 79 1 1 Rural 286 136 1.81(1.26–2.60) 2.30(1.49–3.54) < 0.001 Health insurance Yes 185 145 0.46(0.33–0.67) 0.34(0.23–0.51) < 0.001 No 193 70 1 1 Cancer type Breast cancer 98 59 1 1 Gynecological 90 45 1.20(0.74–1.95) 0.87(0.48–1.54) 0.612 GIT 88 59 0.90(0.57–1.42) 1.14(0.64–2.02) 0.654 Hematological 65 28 1.40(0.81–2.45) 1.84(0.93–3.62) 0.080 Others 37 24 0.93(0.51–1.70) 0.81(0.38–1.70) 0.578 Time since diagnosis < 1 year 190 119 1 1 ≥ 1 year 188 96 1.23(0.88–1.77) 1.07(0.72–1.59) 0.741 Cancer stage Stage I 28 20 1 1 Stage II 26 23 0.81(0.36–1.80) 0.67(0.26–1.54) 0.396 Stage III 123 74 1.20(0.62–2.26) 0.80(0.35–1.67) 0.499 Stage IV 201 98 1.47(0.79–2.73) 0.90(0.41–1.98) 0.789 Current Treatment type No treatment received 24 30 1 1 Chemotherapy 234 96 3.05(1.69–5.48) 2.72(1.38–5.39) 0.004 Surgery 12 11 1.36(0.51–3.63) 1.04(0.32–3.40) 0.944 Mixed 108 78 1.73(0.94–3.19) 1.64(0.77–3.51) 0.202 Comorbidity Yes 84 14 4.10(2.27–7.43) 3.20(1.67–6.10) < 0.001 No 294 201 1 1 ECOG PS Poor 194 98 1 1 Good 184 117 0.79(0.60–1.11) 0.92(0.62–1.36) 0.672 Severe fatigue Yes 174 65 1.97(1.38–2.81) 1.65(1.09–2.50) 0.018 No 204 150 1 1 Severe nausea Yes 155 54 2.07(1.43-3.00) 1.76(1.10–2.80) 0.019 No 223 161 1 1 Severe vomiting Yes 59 26 1.34(0.82–2.21) 0.87(0.47–1.62) 0.664 No 319 189 1 Severe numbness Yes 34 10 2.03(0.98–4.19) 1.41(0.61–3.21) 0.420 No 344 205 1 1 Social support Strong 190 104 1 1 Moderate 92 64 0.79(0.53–1.17) 0.80(0.50–1.28) 0.358 Poor 96 47 1.12(0.73–1.71) 1.19(0.72–1.94) 0.498 Note: ⁎ P-value < 0.05 Discussion This study identified the prevalence of psychosocial distress and factors associated with it among adult cancer patients at oncology units in the Amhara regional state, Ethiopia. From the study results, the overall prevalence of psychosocial distress among adult cancer patients was 63.74%. The magnitude of psychosocial distress in this study was relatively consistent with other studies conducted among cancer patients in Doha, Qatar (62%) ( 54 ), Sri Lanka (65%)( 55 ), Iran (67.7%) ( 19 ). This similarity could be explained by the course of physiological (biological) similarities between cancers and their impact on psychosocial and social aspects across the countries. Whereas this figure was to some extent higher when compared with the other previous study findings in Egypt (46%) ( 56 ), Saudi Arabia (46%) ( 57 ), South Korea where the magnitude was ranged from (28.8–33.6%)( 58 ), across fifty five North American cancer centers (46%) ( 59 ), single study in USA (55%) ( 20 ), and multi-center study in Italy (26.6%)( 60 ). This discrepancy could be attributed from the difference of study populations in terms cancer types, the socio demographic variation, study design and setting, time frame, health care inequities and the level of country development. But the prevalence of this study was less than studies conducted in Kenya (72.2%) ( 61 ), Cameroon (69.2%) ( 62 ), republic of China (83.4%) ( 63 ), and Germany (89.3%) ( 64 ). The reason for this could be the studies difference in consideration of severity of psychosocial distress and the tool used for screening and diagnosis of distress with different cut of points. It is noted that these prior studies used different measurement tools other than QSC-R10. For instance, the Brief Symptom Inventory (the BSI-18), which is considered as a more conservative tool, and the NCCN distress thermometer (DT), which has been condemned as providing more false positives and the accuracy in detecting psychosocial distress is limited ( 65 ). In this study, being a female cancer patient was statistically associated with psychosocial distress, in which the likelihood of developing psychosocial distress among female cancer patients was significantly higher when compared to male cancer patients. This finding was similar to studies conducted in two sites in Japan ( 66 , 67 ), Germany ( 68 ), Iran ( 19 ), and China ( 11 ). A possible reason for this finding could be that receiving a cancer diagnosis and its treatment can cause a psychosocial difficulty that can lead to cognitive and emotional crises and persistent distress among the patients ( 5 ). With regard to females, the difficulty may be more problematic for several reasons. First of all, cancer can pose more obstacles for the roles and responsibilities that females carry out than the ones that males do. Females are more likely to be confronted by ongoing household involvements due to family obligations than their male counterparts. Traditionally females are usually regarded as caring, nurturing, and compassionate and are socialized prioritize their families' needs to nurture and care for others before their own needs and accomplishments. Another reason could be when women with various responsibilities manage their illnesses and the physical symptoms of the diseases at the same time, their resources could likely run out, which could ultimately cause distress. Third, females usually tend to be preoccupied with cosmetic issues, which can without any question impact their mental state and personal satisfaction. Because cancer and its treatments has cosmetic issues ( 67 ). This study also revealed that cancer patients living in rural areas have a higher likelihood of developing psychosocial distress when compared with those living in urban areas. This finding is consistent with prior research from Iran ( 19 ) and Greece ( 69 ). This might be a result of cancer patients living in rural areas having a low perception of lifestyle modification, relaxation, and recreation. And lack of access of other luxury enjoyments in order to cope with the disease and treatment burden and lack of access or low seeking behavior to get psychosocial and mental health counseling or consultation. Rural cancer patients face many challenges in receiving care, including problems with public transportation, distance to treatment areas, financial issues, and the availability of support when they need it ( 70 ). According to this study, the likely hood of developing psychosocial distress among community based health insurance utilizers decreased by 66% when compared with cancer patients who did not utilize it. This finding was in line with research conducted in Kenya ( 61 ) and the USA ( 71 ). This could be due to the fact that CBHI provides financial protection against the cost of illness and increase access to needed health care in order to improve access to quality health services for low-income and rural households who are in need. Evidence suggested that cancer Patients who don’t have a medical insurance are more distressed because of the high costs of cancer therapy. At times, they sell their property, including land, to pay for the therapy ( 61 ). Receiving chemotherapy treatment alone was associated with higher odds of developing psychosocial distress when compared to cancer patients who did not start cancer treatment. This finding was consistent with other research carried out in Kenya ( 61 ) and Brazil ( 72 ). This could be due to the fact that even if chemotherapy is one of the treatment modalities for cancer, it can bring troublesome side effects that can impact on daily living activities and can affect the emotional well-being of patients. Side effects such as fatigue, loss of hair, together with skin color changes and loss of weight experienced by patients, lead to a disturbed body image and low self-esteem, which could lead to distress ( 73 ). Chemotherapy forces the patient to adhere to schedules of medical appointments or hospitalizations and to reallocate their roles and responsibilities because the patient usually cannot meet obligations because of fatigue or other side effects. Another reason can be related to emotional chemo-brain, which is emotional disturbances and self-disgust resulting from the adverse drug effects of chemotherapy on the neurobiological level. Chemo-brain is thought to be a factor in the exacerbation of mental, social, and behavioral problems in physically ill people ( 74 ). Cancer patients with comorbidities in this study were more likely to experience psychosocial distress as compared to cancer patients without comorbidities. This finding is equivalent to findings from South Korea ( 75 ) and Taiwan ( 48 ). This could be due to the fact that comorbidities having a big impact on cancer treatment decisions and management. Comorbidities may influence the progression, stage at diagnosis, treatment, and/or prognosis of cancer patients. It can limit access to the most effective and curative treatments, delay their beginning, or reduce adherence, increase toxicities of cancer treatment and regarded as double burden for cancer patients associated with poor quality of life. And also comorbidities resulted higher health care costs ( 49 , 76 ) , In this study, severe fatigue was associated with an increased likelihood of experiencing psychosocial distress. Similarly previous studies conducted in Iran ( 19 ), Korea ( 77 ), and Vietnam( 78 ) also identified that fatigue was a distressing symptom for cancer. This can be because severe fatigue can make performing daily routine activities more difficult, as well as making it more difficult to participate in social activities and deteriorating cognitive functions such as concentrating and remembering things. Fatigue can also decrease motivation, interest and increase frustration, irritability and feelings of sadness. The results of this study also showed that the likelihood of developing psychosocial distress was higher among cancer patients with severe nausea when compared to patients with no severe nausea. This result was consistent with findings from other studies ( 79 ). This could be due to the fact that nausea is still a serious side effect of cancer therapy, frequently resulting in dramatic changes in the patient's emotions, social activities, and work situations. Patients suffering from cancer who develop nausea symptoms find it difficult to socialize and prefer to live alone rather than disrupting others' time and feeling like a burden on their family ( 80 ). Limitation Of The Study Since the study was a cross-sectional study, the temporal relationship between cause and effect could not be ascertained. Secondly, some measurement tools used were self-rating questionnaires. This may have led to some bias. In this study, spiritual and income-related variables that might be considered as associated factors of psychosocial distress were not included. The Amharic version of the MD Anderson Symptom Inventory (MDASI), a valid and reliable multi-symptom assessment tool developed for use in cancer patients which considers only severe core symptoms, was evaluated to identify whether cancer patients with severe symptom burdens had psychosocial distress. As a result, it is difficult to distinguish between mild and moderate levels of the core symptoms. This might understate the level of the potential distressing symptoms. Conclusion In general, the findings of this study showed a relatively high magnitude in which around two- thirds of patients experienced psychosocial distress. The most prevalent cancer type among the participants was breast cancer. Most cancer patients were attending with advanced stages of cancer. Fatigue, nausea and pain were the most common presenting severe symptoms experienced by cancer patients. These symptoms necessitate the prevention, early detection and evidenced based management by the frontline health care workers. Being female cancer patient, rural residents, community-based health insurance utilization, chemotherapy treatment, the presence of comorbidity, and symptom severity such as severe fatigue and nausea had statistically significant association with psychosocial distress. Community based health insurance utilization decreases the likely hood of developing psychosocial distress Abbreviations ACS American cancer society BSI-18 Brief Symptom Inventory CBHI Community based health insurance DRH Dessie referral hospital DT Distress thermometer ECOG PS Eastern Cooperative Oncology Group Performance Status FHCSH Felege Hiwot comprehensive specialized hospital IPOS International Psycho-Oncology Society MDASI MD Anderson symptom inventory NCCN National Comprehensive Cancer Network QSC-R10 Questionnaire on Stress in Cancer Patients revised 10 SSA Sub Saharan Africa TGSH Tibebe Ghion Specialized Hospital UoGCSH University of Gondar comprehensive specialized hospital USA United States of America WHO World Health Organization Declarations Ethics approval and consent to participate All procedures performed in this study involving participants were performed in accordance with relevant guidelines and regulations of the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the ethics committee of Bahir Dar University, College of Medicine and Health Sciences institutional review board with protocol number of 40/2022 and decision number of 003 and signed by Dr. Mulusew Andualem (PhD), director of research and development office. Then, the data were collected after getting consent from each hospital manager. The study's objective was explained to participants, and their written informed consent was obtained. By omitting direct personal identifiers from the questionnaire, employing code numbers, locking data with a password, and not misusing or leaking their information, confidentiality was maintained. Additionally, participants were made aware that their participation was voluntary and that they could terminate the study at any time if they felt uncomfortable about it. The issue of confidentiality and privacy was scrupulously upheld. Every technique was used in compliance with the rules and regulations that were applicable. The study was complying with standard national and international ethical guidelines. Consent for publication Not applicable Availability of data and materials All relevant data are available within the manuscript. Competing interests No competing interest exists in our interpretation of data or presentation of information. Funding Financial support was obtained from Bahir Dar University. This supporting institution has no role in the preparation of the manuscript as well as the decision to publish. Authors' contributions AAB: contributed to the creation of the study's research question and design, helped write the proposal, took part in data gathering, evaluated and interpreted the findings, and wrote the manuscript. AT and SKB approved the designed project with a few adjustments. They contributed to the supervision and training of the data collectors; took part in the data analysis and wrote the manuscript. The work of this project was also critically evaluated by MMF, HAG, MET and MK, who also contributed to its design, participated in the analysis and interpretation of the findings, and wrote the manuscript. The compilation, review, and approval of the final manuscript were done by all authors. Acknowledgements The authors’ sincere thanks go to Bahir Dar University, College of Medicine and Health Sciences. The authors also acknowledged each oncology unit staff, supervisors, data collectors. We also expressed our gratitude to the Amhara region people's memoirs center for providing free internet connection and for the goodwill of the personnel. References Sarfati D, Gurney J. Preventing cancer: the only way forward. The Lancet. 2022;400(10352):540-1. Ngwa W, Addai BW, Adewole I, Ainsworth V, Alaro J, Alatise OI, et al. Cancer in sub-Saharan Africa: a Lancet Oncology Commission. The Lancet Oncology. 2022. Memirie ST, Habtemariam MK, Asefa M, Deressa BT, Abayneh G, Tsegaye B, et al. 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Bioscience Research. 2022;19(2):1176-84. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-2217915\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":153116960,\"identity\":\"a474829b-4010-4c73-ae9e-26ca90fba162\",\"order_by\":0,\"name\":\"Astewle Andargie Baye\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1ElEQVRIiWNgGAWjYNCCAgYGfhCdUECUcmYgNmBgkGwAaTEgRYvBAQYIgyDg7z9/8DGPgY288fnViR8eGDDI84sdwK9F4kYyszGPQZrhthtvN0sAHWY4c3YCAWtuMLNJ5xgcZtx24+wGkJYEg9sEtMifP8z+O8fgv/3mGWc3/yBKi8GBZDbmHIMDiRv4e7cRZ4vhjWRj6T8GyckzbvBus0gwkCDsF7nzBx9+nFFhZ9vff3bzzR8VNvL80gS0IIAEWKUEscpBgP8AKapHwSgYBaNgJAEAFCFDffzIKREAAAAASUVORK5CYII=\",\"orcid\":\"\",\"institution\":\"Debre Tabor University\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Astewle\",\"middleName\":\"Andargie\",\"lastName\":\"Baye\",\"suffix\":\"\"},{\"id\":153116961,\"identity\":\"5f802cab-c31d-4cb8-b8a9-b2dbbff9bff8\",\"order_by\":1,\"name\":\"Sitotaw Kerie Bogale\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Bahir Dar University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Sitotaw\",\"middleName\":\"Kerie\",\"lastName\":\"Bogale\",\"suffix\":\"\"},{\"id\":153116962,\"identity\":\"7ef6a0b5-931e-47aa-963a-db25594c1155\",\"order_by\":2,\"name\":\"Abebu Tegenaw\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Bahir Dar University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Abebu\",\"middleName\":\"\",\"lastName\":\"Tegenaw\",\"suffix\":\"\"},{\"id\":153116963,\"identity\":\"80c10aa4-a536-4d89-9e68-2a87fa4b6cb9\",\"order_by\":3,\"name\":\"Mengistu Melak Fekadie\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Debre Tabor University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Mengistu\",\"middleName\":\"Melak\",\"lastName\":\"Fekadie\",\"suffix\":\"\"},{\"id\":153116965,\"identity\":\"b9bd4de9-5f11-48ae-be5a-8c145737189d\",\"order_by\":4,\"name\":\"Haileyesus Gedamu Wondyifraw\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Bahir Dar University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Haileyesus\",\"middleName\":\"Gedamu\",\"lastName\":\"Wondyifraw\",\"suffix\":\"\"},{\"id\":153116968,\"identity\":\"6b691962-51c5-4e33-9f73-b28df5b33f23\",\"order_by\":5,\"name\":\"Mengistu Ewunetu Tigabu\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Debre Tabor University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Mengistu\",\"middleName\":\"Ewunetu\",\"lastName\":\"Tigabu\",\"suffix\":\"\"},{\"id\":153116972,\"identity\":\"ce661a85-81c4-473f-9cb9-2d9b4c0fc395\",\"order_by\":6,\"name\":\"Mulu Kebede\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Debre Tabor University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Mulu\",\"middleName\":\"\",\"lastName\":\"Kebede\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2022-10-30 07:44:03\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-2217915/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-2217915/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":29404006,\"identity\":\"26ff6858-b752-49f1-90ee-d958565d8bdf\",\"added_by\":\"auto\",\"created_at\":\"2022-11-22 18:34:15\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":32949,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003ePrevalence of psychosocial distress among adult cancer patients at oncology units in the Amhara regional state, Ethiopia, April 30-June 22/2022\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Prevalenceofpsychosocialdistress.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-2217915/v1/05640de34151f6e7dda18855.png\"},{\"id\":37221776,\"identity\":\"e31b2dcb-8b30-406c-a911-d9b759d4cb6f\",\"added_by\":\"auto\",\"created_at\":\"2023-05-19 04:59:25\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":603820,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-2217915/v1/d9929983-21d9-47f5-b9fe-d48ceec644b2.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Psychosocial distress and associated factors among adult cancer patients at oncology units in the Amhara regional state, Ethiopia, 2022\",\"fulltext\":[{\"header\":\"Background\",\"content\":\"\\u003cp\\u003eThe global burden of cancer is increasing rapidly and is exceeding the current cancer control capacity (\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e). In sub-Saharan Africa, cancer is increasingly posing a serious threat to public health, and Ethiopia is no exception (\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e). It is commonly perceived as a life-threatening and potentially traumatic illness (\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e). Moreover, receiving a diagnosis of cancer and undergoing its treatment together comprises an extremely stressful experience (\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e). Throughout cancer survivorship, they could render individuals more vulnerable to long-lasting negative psychosocial outcomes (\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e). Recognizing that cancer survivorship is not a single event; it is a multistage process that begins at the moment of diagnosis and continues throughout one's life(\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e). During this continuum, cancer survivors experience a variety of dreadful issues and comorbidities that involve medical, physical, and emotional aspects that can have an impact on their overall health and well-being(\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e). One of the most prevalent comorbidity is cancer related psychosocial distress which is the leading comorbidity problem in cancer patients(\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eThe National Comprehensive Cancer Network (NCCN) defined distress in cancer as \\u0026ldquo;a multifactorial unpleasant experience of a psychological (i.e., cognitive, behavioral, emotional), social, spiritual, and/or physical nature that may interfere with one's ability to cope effectively with cancer, its physical symptoms, and its treatment (\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e). It extends along a continuum, ranging from common normal feelings of vulnerability, sadness, and fears to problems that can become disabling, such as depression, anxiety, panic, social isolation, and existential and spiritual crisis (\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e). This implies that psychosocial distress exists along spectrum that extends from normal adjustment issues to syndromes that meet the full diagnostic criteria for a mental disorder (\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e). Psychosocial distress is a long-term burden for cancer survivors, with implications for their quality of life and oncologic prognosis (\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e). The magnitude of psychosocial distress in the cancer survivorship cohort is reported as between 20\\u0026ndash;52% (\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e). About 50% of cancer patients have clinically significant unrecognized or untreated psychosocial distress during the cancer trajectory (\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e). It varies between economically developed and economically underdeveloped countries, with developing countries having the greatest magnitude (\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e). Regarding factors of distress, previous studies have revealed that estimates of the magnitude of distress vary based on the type and stage of cancer (\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e). High magnitudes of clinically significant level of distress were found among patients with hematologic, lung, and head and neck cancer (\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e). Several factors contribute to psychosocial distress in cancer patients, including advanced stages of cancer, treatment options with a variety and number of uncontrolled symptom burdens such as fatigue, pain, anxiety, difficulty in transportation, changes in role relationships, physical limitation, and fear of recurrence (\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e). Psychosocial distress has also been observed to vary by patient demographics, in which female gender (\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e) and older age were associated with higher distress (\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e). Moderate to severe levels of distress have resulted from being rural residents, patients with low educational status, and divorced patients (\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e). Evidence from the NCCN reveals that inadequate social support, living alone, severe co-morbid illnesses, financial problems, and spiritual/religious concerns put cancer patients at an increased risk of psychosocial distress (\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eDistress in patients with cancer is associated with various negative outcomes, like reduced adherence to treatment (\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e), increased treatment toxicities (\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e), trouble making decisions about treatment (\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e) and increased morbidity (\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e). Furthermore, cancer patients suffering from psychosocial distress have a poor quality of life and may have a lower chance of surviving (\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e). It also associated with increased cancer-specific mortality (\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e). Significant numbers of death were recorded among United States of Americas psychosocially distressed cancer patients and even at lower levels of psychosocial distress, an increased mortality was observed (\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e). Given that risk of death among cancer patients with psychosocial distress was higher than non-distressed individuals (\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e). Long-term distress can have additional significant financial toxicity (\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e). In comparison to patients without a history of distress, cancer survivors with distress reported higher annual medical expenses (\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e). As the burden of psychosocial distress among patients is on the rise, it affects a significantly higher number of families or primary caregivers (\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e). Approximately two-thirds of all caregivers of distressed cancer patients who accessing a support line were severely distressed (\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e) .\\u003c/p\\u003e \\u003cp\\u003eDespite the fact that distress is significant among cancer patients, it frequently remains under-recognized and under-treated, and interventions that can be helpful are not always delivered (\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e). The prevention, early detection, and proper management of distress are important for improving patients' quality of life and survival (\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e). Potential interventions targeting exercise intensity, character strengths, medical coping, and social support could all be used to reduce the burden of psychosocial distress (\\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e). Pharmacologic interventions, social work and counseling services, supportive psychotherapy, cognitive behavioral therapy, and spiritual care are all important aspects of the therapeutic management of cancer patients who are distressed (\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e). Management of psychosocial distress should be recognized as a universal human right, according to the IPOS, International Standard of Quality Cancer Care, and high-quality cancer care must include the psychosocial domain in regular care (\\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e). The NCCN also suggested psychosocial distress as the sixth vital sign, recommending its assessment after checking temperature, pulse, respiration, blood pressure, and pain (\\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR41\\\" class=\\\"CitationRef\\\"\\u003e41\\u003c/span\\u003e). As a result, various countries throughout the world are implementing psychosocial distress screening programs by incorporating psychosocial-oncology services (\\u003cspan additionalcitationids=\\\"CR43\\\" citationid=\\\"CR42\\\" class=\\\"CitationRef\\\"\\u003e42\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR44\\\" class=\\\"CitationRef\\\"\\u003e44\\u003c/span\\u003e). But the recognition of distress and the implementation of psychosocial-oncology program are fragmented and undeveloped, particularly in African countries (\\u003cspan citationid=\\\"CR45\\\" class=\\\"CitationRef\\\"\\u003e45\\u003c/span\\u003e). Although the national cancer prevention and control program in Ethiopia has made efforts in cancer prevention, control, and management by implementing the national cancer control plan 2016\\u0026ndash;2020 in order to achieve the long-term goal of reducing cancer morbidity and mortality through early detection and screening, diagnosis, and provision of comprehensive intervention (\\u003cspan citationid=\\\"CR46\\\" class=\\\"CitationRef\\\"\\u003e46\\u003c/span\\u003e), no enough evidence about psychosocial distress among cancer patients. So it is critical to understand the magnitude of psychosocial distress and the factors that contribute to it in order to screen and treat it as soon as possible. No study was conducted on the prevalence of psychosocial distress and associated factors in adult cancer patients in our sample. Therefore, this study is intended to identify the prevalence of psychosocial distress among adult cancer patients. And to identify factors associated with psychosocial distress.\\u003c/p\\u003e\"},{\"header\":\"Study Design\",\"content\":\"\\u003cp\\u003e Multi-centered institutional-based cross-sectional study was conducted to identify the prevalence of psychosocial distress and associated factors among adult cancer patients attending at oncology units in the Amhara regional state, Ethiopia.\\u003c/p\\u003e\\n\\u003ch3\\u003eStudy Area And Period\\u003c/h3\\u003e\\n\\u003cp\\u003e The study was conducted at public health facilities with oncology units in the Amhara regional state from April 30 to June 22/2022 among cancer patients who were attending for treatment and follow-up. Currently, the Amhara regional state has four specialized referral hospitals that provide comprehensive and integrated cancer care. The four institutions are Felege Hiwot comprehensive specialized hospital (FHCSH), University of Gondar comprehensive specialized hospital (UOGCSH), Dessie referral hospital (DRH), and Tibebe Ghion Specialized Hospital (TGSH). Both FHCSH and TGSH found in Bahir dar city, the capital of Amhara regional state which are 565 kilometers apart from Addis Ababa, Ethiopia. UOGCSH and DRH, on the other hand, are 738 and 396.8 kilometers from Ethiopia's capital, respectively. These oncological care facilities have been operating since 2015, with the help of a few devoted individuals, and provide comprehensive oncology care for a variety of cancer patients. Currently, region\\u0026rsquo;s oncology units, such as FHCSH, UOGCSH, DRH, and TGSH have 22, 32, 16 and 8 inpatient beds for the treatment of cancer patients respectively.\\u003c/p\\u003e\\n\\u003ch3\\u003eSource Population\\u003c/h3\\u003e\\n\\u003cp\\u003eAll adult cancer patients attending at oncology units in the Amhara regional state\\u003c/p\\u003e \\u003cdiv id=\\\"Sec5\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStudy population\\u003c/h2\\u003e \\u003cp\\u003e All adult cancer patients attending at oncology units in the Amhara Regional state during the study period (April 30 - June 22/2022)\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec6\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStudy unit\\u003c/h2\\u003e \\u003cp\\u003eEach adult cancer patient at oncology units in the Amhara regional state that fulfilled the inclusion criteria was participated in this study.\\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003eInclusion Criteria\\u003c/h3\\u003e\\n\\u003cp\\u003eAll cancer patients who were \\u0026ge;\\u0026thinsp;18 years old who were attending at oncology units were included into the study.\\u003c/p\\u003e\\n\\u003ch3\\u003eSample Size Determination And Sampling Procedure\\u003c/h3\\u003e\\n\\u003cp\\u003eFirst, oncology units which are located in the Amhara regional state were identified. According to the unit\\u0026rsquo;s cancer registry of patients with cancer, each hospital, such as FHCSH, UoGCSH, DRH, and TGSH, treated about 420, 392, 224, and 70 cancer patients on average every month, respectively. And averagely the overall number of cancer patients who have been followed up on each month at the region's oncology units was 1,106. The sample was determined by using a single population proportion formula by considering the following statistical assumptions: P\\u0026thinsp;=\\u0026thinsp;proportion of patients with cancer, who experience psychosocial distress (50%), (Z /2\\u0026thinsp;=\\u0026thinsp;95% CI Z score, d\\u0026thinsp;=\\u0026thinsp;margin of error (5%). The final sample size was 605 considering 1.5 design effect and 10% non-respondent rate. An independent and representative sample was determined for each oncology unit by using a stratified sampling technique based on the above information. And the final sample size was determined after being proportionally assigned to each oncology unit, with 230 from FHCSH, 214 from UOGCSH, 123 from DRH, and 38 from TGSH. A systematic random sampling technique was employed to select the final actual participant samples. The k\\u003csup\\u003eth\\u003c/sup\\u003e value in the systematic random sampling procedure was calculated by dividing the source population by the total sample size. Based on the monthly attending adult cancer patients at oncology units the K\\u003csup\\u003eth\\u003c/sup\\u003e value became 2. Finally, the actual study participants were selected with every 2nd cancer patient who came to the oncologic unit for treatment and follow-up during the data collection period and met the inclusion criteria. The first study participant was selected by using the lottery method and then data was collected from every 2nd patient, starting with the first study participant selected randomly and continuing until the desired sample size was obtained.\\u003c/p\\u003e\\n\\u003ch3\\u003eStudy Variables\\u003c/h3\\u003e\\n\\u003cp\\u003e \\u003cstrong\\u003eDependent variable\\u003c/strong\\u003e \\u003cp\\u003ePsychosocial distress\\u003c/p\\u003e \\u003c/p\\u003e\\n\\u003ch3\\u003eIndependent Variables\\u003c/h3\\u003e\\n\\u003cp\\u003e \\u003cstrong\\u003eSocio demographic factors\\u003c/strong\\u003e \\u003cp\\u003e(age, sex, marital status, religion, residence, educational status, occupation, and health insurance).\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eSymptom burden variables\\u003c/strong\\u003e \\u003cp\\u003ePain, fatigue(tiredness), nausea, disturbed sleep, upset, shortness of breath, problems of remembering things, lack of appetite, drowsy(sleepy), dry mouth, sadness, vomiting, and numbness\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eClinical and treatment factors\\u003c/strong\\u003e \\u003cp\\u003e(Cancers type, cancer stages, cancer treatment, duration of time since diagnosis, Co-morbid disease, and performance status).\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003ePsychosocial related factors\\u003c/strong\\u003e \\u003cp\\u003eSocial support.\\u003c/p\\u003e \\u003c/p\\u003e\\n\\u003ch3\\u003eOperational Definitions\\u003c/h3\\u003e\\n\\u003cp\\u003e \\u003cstrong\\u003ePsychosocial distress\\u003c/strong\\u003e \\u003cp\\u003ePsychosocial distress refers to a specific co-morbid and clinically significant condition that is experienced by cancer patients. It is identified and measured by using the Questionnaire on Distress in Cancer Patients (QSC-R10), which is a validated measurement scale with psychometric properties specific to cancer. An individual with a score of \\u0026gt;\\u0026thinsp;14 is recognized as having psychosocial distress and a score of \\u0026le;\\u0026thinsp;14 is recognized as not experiencing psychosocial distress (\\u003cspan citationid=\\\"CR47\\\" class=\\\"CitationRef\\\"\\u003e47\\u003c/span\\u003e).\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eCo-morbid disease\\u003c/strong\\u003e \\u003cp\\u003eThe \\\"coexistence of non-communicable and co-infectious diseases in addition to a primary disease of interest (cancer disease) like diabetes mellitus, hypertension, heart failure, HIV/AIDS...\\\"(\\u003cspan citationid=\\\"CR48\\\" class=\\\"CitationRef\\\"\\u003e48\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR49\\\" class=\\\"CitationRef\\\"\\u003e49\\u003c/span\\u003e).\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eSymptoms burden\\u003c/strong\\u003e \\u003cp\\u003eSeverity of symptoms experienced by cancer patients measured by using M. D. Anderson Symptom Inventory measurement tool. Each symptom lists considered as severe if the score rated as greater or equal to seven from a scale from 0\\u0026ndash;10 in which 0 (no symptom) and 10 (as bad as you can imagine) (\\u003cspan citationid=\\\"CR50\\\" class=\\\"CitationRef\\\"\\u003e50\\u003c/span\\u003e).\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003ePerceived social support\\u003c/strong\\u003e \\u003cp\\u003eHow cancer patients perceive friends, family members and others as sources available to provide material, psychosocial and overall support during times of need. Measured by using Oslo 3-item social support scale and considered as poor, moderate, and strong social support if scores become 3\\u0026ndash;8, 9\\u0026ndash;11, and 12\\u0026ndash;14 respectively(\\u003cspan citationid=\\\"CR51\\\" class=\\\"CitationRef\\\"\\u003e51\\u003c/span\\u003e)\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003ePerformance status\\u003c/strong\\u003e \\u003cp\\u003eIt describes a patient\\u0026rsquo;s level of functioning in terms of their ability to care for themselves. Eastern Cooperative Oncology Group performance status (ECOG PS) measurement scale is used which has six grades ranging from 0 to 5. Patients with grades of ECOG PS of 0 and 1 labeled as having good performance status whereas grades of ECOG PS 2, 3, and 4 is considered as having poor performance status(\\u003cspan citationid=\\\"CR52\\\" class=\\\"CitationRef\\\"\\u003e52\\u003c/span\\u003e).\\u003c/p\\u003e \\u003c/p\\u003e \\u003cdiv id=\\\"Sec12\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eData collection tools and procedure\\u003c/h2\\u003e \\u003cp\\u003eA structured written questionnaire was used to collect the data. It consisted of socio-demographic factors of the respondents, clinical and treatment factors, Questionnaire on psychosocial distress in Cancer Patients-Short Form (QSC-R10); the core symptom burden list experienced by cancer patients, perceived social support and Eastern Cooperative Oncology Group performance status (ECOG PS). Level of psychosocial distress was measured by using the Amharic version of QSC-R10. The QSC-R10 is a 10-item psycho-oncological screening instrument for self-assessment of psychosocial distress specific to cancer disease and its treatment. It comprises the following items: fear of disease progression, feeling tired and weak, reduced work and recreation activities, feeling tense and/or nervous, disturbed sleep, feeling physically imperfect, pain, missing partner's empathy, few opportunities to speak with psycho-oncological professionals, and not feeling well informed about disease/treatment. Patients indicate whether each item applies to them, and if so, how severely. Thus, each item is rated on a six-point scale ranging from 0 (the problem does not apply to me) to 5 (the problem applies to me and is a very serious problem). A total distress score is calculated by adding each item ratings. This questionnaire shows good psychometric properties; from the previous study Cronbach\\u0026rsquo;s Alpha for the total score is 0.85. A validated cutoff score\\u0026thinsp;\\u0026gt;\\u0026thinsp;14 was used to identify patients with clinical significant level of psychosocial distress, possibly requiring psychosocial-oncological treatment (\\u003cspan citationid=\\\"CR47\\\" class=\\\"CitationRef\\\"\\u003e47\\u003c/span\\u003e). The content validity index and the Cronbach\\u0026rsquo;s alpha for this tool in this study were 0.91 and 0.89, respectively.\\u003c/p\\u003e \\u003cp\\u003eThe core symptom burden experienced by cancer patients was assessed by using the Amharic version of the MD Anderson Symptom Inventory (MDASI) tool. The Amharic version of MD Anderson Symptom Inventory (MDASI) is a valid and reliable multi-symptom assessment tool developed for use in cancer patients. It contains 13 core symptom items rated at their severest level in the past 24 hours, including pain, fatigue, nausea, disturbed sleep, feeling upset, shortness of breath, difficulty remembering, lack of appetite, drowsiness, dry mouth, sadness, vomiting, and numbness or tingling. Each symptom is rated on an 11-point scale ranging from 0 to 10, with 0\\u0026thinsp;=\\u0026thinsp;no presence of the symptom and 10\\u0026thinsp;=\\u0026thinsp;the symptom at its highest severity level.\\u003c/p\\u003e \\u003cp\\u003eA symptom was severe if it was rated greater than or equal to 7 on a scale of 0\\u0026ndash;10. And the cut of score is reliable with alpha coefficient of 0.83(\\u003cspan citationid=\\\"CR50\\\" class=\\\"CitationRef\\\"\\u003e50\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eTo measure level of social support among patients with cancer, the valid and reliable tool such as Amharic version of Oslo 3-item Social Support Scale (OSS-3) was used. The three items cover different fields of social support, and the OSS-3 sum score ranges from 3 to 14 and is calculated by summarizing the raw scores of the items. Scores 3\\u0026ndash;8, 9\\u0026ndash;11, and 12\\u0026ndash;14 indicate poor, moderate, and strong social support respectively (\\u003cspan citationid=\\\"CR51\\\" class=\\\"CitationRef\\\"\\u003e51\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR53\\\" class=\\\"CitationRef\\\"\\u003e53\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eTo measure cancer patients' level of performance status, the Eastern Cooperative Oncology Group Performance Status (ECOG PS) was used. The Eastern Cooperative Oncology Group Performance Status (ECOG PS) is a simple tool that is accepted and recognized by world health organization (WHO) and used by nurses and physicians in everyday practice to assess the functional status of patients, with a range from 0 (fully active) to 5 (dead) (\\u003cspan citationid=\\\"CR52\\\" class=\\\"CitationRef\\\"\\u003e52\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eThe Amharic versions of a written questionnaire were used to collect the data for the current research. After obtaining permission from the appropriate authorities, the data were collected by four BSC nurses and four supervisors with BSC in nursing chosen by the researchers. All the necessary data from the sample was collected by using face-to-face interviews using structured questionnaires. Information regarding some variables which are not known by the respondents, like cancer stage, was collected from their follow-up chart on the oncology unit\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec13\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eData entry, processing and analysis\\u003c/h2\\u003e \\u003cp\\u003eFirst the collected data were checked for completeness by the principal investigator. Then the data was coded and entered using Epi Data statistical software version 3.1 and then exported to stata statistical software version-15 for final analysis. The outcome variable was identified as a categorical variable of psychosocial distress \\u0026ldquo;caseness,\\u0026rdquo; where scores\\u0026thinsp;\\u0026gt;\\u0026thinsp;14 were coded as 1 (distressed) and scores\\u0026thinsp;\\u0026le;\\u0026thinsp;14 were coded as 0 (not distressed). Before analysis, missing values were checked by the principal investigator. Basic descriptive and summary statistics was used to describe results and computed by using frequencies, percentages, means, and standard deviation. And the findings were described in the form of tables, and graphs as appropriate. Binary logistic regression was used to determine statistical association between the independent and the dependent variables at 95% confidence level. All variables associated with the dependent variable with \\u003cem\\u003ep\\u003c/em\\u003e-value less than 0.25 in the bivariable logistic regression analyses were entered into multivariable logistic regression model in order to identify the association between the dependent and independent variables and to control for potential confounders. Multicollinearity was checked between independent variables through variance inflation factor for continuous independent variables and spearman\\u0026rsquo;s rank correlation for categorical independent variables. Model fitness was checked by using the Hosmer and Lemeshow\\u0026rsquo;s goodness of fit test. The p-value for the test was 0.52 which was greater than 0.05 indicating that the model fitted the data. Variables with \\u003cem\\u003ep\\u003c/em\\u003e-value\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05 in the multivariable logistic regression analyses were considered as statistically significant associated factors of psychosocial distress.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec14\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eData quality assurance\\u003c/h2\\u003e \\u003cp\\u003eFor the assurance of data quality, an appropriate data collection tool was designed and evaluated by experienced researchers. Amharic versions of the structured questionnaire were used for data collection. First the questionnaire was prepared in English, and then it was translated to Amharic and back to English. A pretest on 5% of the total sample size was conducted at Tikur Anbassa Specialized Hospital oncology unit prior to three week before the commencement of the actual data collection. The pretest aimed to assess whether the checklist items are easily understood by the data collector and the study participants and to evaluate the appropriateness of the tool for the planned study. Careful modification of the checklist was done before the main study began to improve data quality. After pretest data collectors and supervisors were trained for a couple of days before the data collection on the roles, tasks, and how to ensure the confidentiality of the study participants. Close monitoring and evaluation were carried out by the supervisors and principal investigators. The collected data were reviewed and checked for completeness before data entry. The principal investigators recoded the collected data.\\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003eEthical Considerations\\u003c/h3\\u003e\\n\\u003cp\\u003e The study was carried out after letter of approval was obtained from ethical review committee of Bahir Dar University, college of medicine and health sciences with protocol internal review board\\u0026rsquo;s decisions protocol number (CMHS/IRB 01\\u0026ndash;008). Written official letter was submitted to quality and research coordinator offices of each study areas and permission letter was also submitted for each respective oncologic unit coordinators. Objectives and purpose of the study were explained for the study participants and confirmation of the consent by the participant was obtained by signing on a consent form attached to the data collection tool. The privacy of the participants was kept during the interview. For confidentiality purposes, respondent\\u0026rsquo;s personal identifier details were not required and these were made known to them. Further, all information generated from the participants were treated with confidentiality and only be reported as a group data summary without disclosing any potentiality of identifying information for any research participant.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cdiv id=\\\"Sec17\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eSocio-demographic characteristics\\u003c/h2\\u003e \\u003cp\\u003eA total of 593 adult cancer patients participated in this study, yielding a response rate of 98.02%. Among those, 401(67.62%) were females. The mean age of the participants was 46.86\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;14.5 years. In terms of marital status, more than two-third (70.15%) of the participants were married. Nearly three-quarters of the respondents (81.28%) were Orthodox Christianity. The majority, 422(71.16%) were rural residents. More than half (54.13%) could not write and read. The majority, 338 (57%) of the respondents were farmers. Considering the respondent\\u0026rsquo;s community-based health insurance utilization, more than half (55.65%) cancer patients utilized community-based health insurance (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eSocio-demographic characteristics of adult cancer patients at oncology units, in the Amhara regional state, Ethiopia, April 30-June22/2022 (n\\u0026thinsp;=\\u0026thinsp;593).\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVariables\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCategory\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003efrequency\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003ePercent\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eSex\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e192\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e32.38\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFemale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e401\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e67.62\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"3\\\" rowspan=\\\"4\\\"\\u003e \\u003cp\\u003eAge\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e18\\u0026ndash;24\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e39\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e6.58\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e25\\u0026ndash;40\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e169\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e28.50\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e41\\u0026ndash;59\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e254\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e42.83\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026ge;\\u0026thinsp;60\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e131\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e22.09\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"3\\\" rowspan=\\\"4\\\"\\u003e \\u003cp\\u003eMarital status\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eSingle\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e81\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e13.66\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMarried\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e416\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e70.15\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eDivorced\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e65\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e10.96\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eWidowed\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e31\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e5.23\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eReligion\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eOrthodox\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e482\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e81.28\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMuslim\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e108\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e18.21\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eProtestant\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.51\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eResidence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUrban\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e171\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e28.84\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eRural\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e422\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e71.16\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"4\\\" rowspan=\\\"5\\\"\\u003e \\u003cp\\u003eEducational status\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUnable to write and read\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e321\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e54.13\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAble to write and read\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e102\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e17.20\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePrimary school level\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e49\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e8.26\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eSecondary school level\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e56\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e9.44\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCollege and above\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e65\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e10.96\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"4\\\" rowspan=\\\"5\\\"\\u003e \\u003cp\\u003eOccupation\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eEmployed\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e62\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e10.46\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUn employed\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e87\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e14.67\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMerchant\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e89\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e15.01\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFarmer\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e338\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e57.00\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eStudent\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e17\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2.87\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eHealth insurance\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e263\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e44.35\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e330\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e55.65\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec18\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eClinical and treatment related characteristics\\u003c/h2\\u003e \\u003cp\\u003eAmong 593 participants, the leading type of cancer was breast cancer, accounting for 157(26.48%). Regarding the length of time since the diagnosis of their cancer, more than half (52.11%) had a history of cancer diagnosis of less than one year duration. The majority of the participants were presented with advanced stages of cancer. Considering the current cancer treatment, around 330 (55.65%) patients received chemotherapy treatment alone. About 98 (16.53%) cancer patients had comorbid diseases. The majority (50.76%) of the patients had a good performance status (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eClinical and treatment related characteristics of adult cancer patients at oncology units, in the Amahra regional state, Ethiopia, April 30-June 22/2022 (n\\u0026thinsp;=\\u0026thinsp;593).\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVariables\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCategory\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eFrequency\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003ePercent\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"4\\\" rowspan=\\\"5\\\"\\u003e \\u003cp\\u003eCancer type\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eBreast cancer\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e157\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e26.48\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eGynecological cancer\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e135\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e22.77\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eGIT cancer\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e147\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e24.79\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eHematological cancer\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e93\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e15.68\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eOthers\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e61\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e10.29\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eTime since diagnosis\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;1 year\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e309\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e52.11\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026ge;\\u0026thinsp;1 year\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e284\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e47.89\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"3\\\" rowspan=\\\"4\\\"\\u003e \\u003cp\\u003eCancer stage\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eStage I\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e48\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e8.09\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eStage II\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e49\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e8.26\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eStage III\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e197\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e33.22\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eStage IV\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e299\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e50.42\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"3\\\" rowspan=\\\"4\\\"\\u003e \\u003cp\\u003eCurrent treatment type\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo treatment received\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e54\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e9.11\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eChemotherapy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e330\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e55.65\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eSurgery\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e23\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3.88\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMixed\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e186\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e31.37\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eComorbidity\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e495\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e83.47\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e98\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e16.53\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eECOG PS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePoor\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e292\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e49.24\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eGood\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e301\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e50.76\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec19\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eCore symptoms burden and psychosocial issues\\u003c/h2\\u003e \\u003cp\\u003eThe most frequently reported severe symptoms by the participants were fatigue, nausea, and pain, which accounted for (40.30%), (35.24%), and (29.17%) respectively. Nearly half (49.58%) of the patients had a history of strong social support (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eCore symptom burden and psychosocial issue characteristics of adult cancer patients at oncology units in the Amhara regional state, Ethiopia, April 30-June 22/2022 (n\\u0026thinsp;=\\u0026thinsp;593).\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVariables\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCategory\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eFrequency\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003ePercent\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eSevere pain\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e420\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e70.83\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e173\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e29.17\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eSevere fatigue\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e354\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e59.70\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e239\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e40.30\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eSevere nausea\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e384\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e64.76\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e209\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e35.24\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eSever disturbed sleep\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e445\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e75.04\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e148\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e24.96\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eSevere feeling of upset\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e478\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e80.61\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e115\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e19.39\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eSevere shortness of breath\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e551\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e92.92\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e42\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e7.08\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eSevere problem on remembering things\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e553\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e93.25\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e40\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e6.75\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eSevere lack of appetite\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e436\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e73.52\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e157\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e26.48\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eSevere feeling of drowsy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e557\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e93.93\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e36\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e6.07\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eSevere dry mouth\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e548\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e92.41\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e45\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e7.59\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eSevere feeling of sad\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e544\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e91.74\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e49\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e8.26\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eSevere vomiting\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e508\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e85.67\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e85\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e14.33\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eSevere numbness\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e549\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e92.58\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e44\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e7.42\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eSocial support\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eStrong\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e294\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e49.58\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eModerate\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e156\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e26.31\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePoor\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e143\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e24.11\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec20\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003ePrevalence of psychosocial distress\\u003c/h2\\u003e \\u003cp\\u003eThe prevalence of psychosocial distress among adult cancer patients attending at oncology units in the Amhara regional state was found to be 63.74% (95% CI: 59.86\\u0026ndash;67.62) (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec21\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eFactors associated with psychosocial distress\\u003c/h2\\u003e \\u003cp\\u003eA total of twenty-eight possibly factor variables such as sex, age group, marital status, religion, residence, educational status, occupational status, status on community-based health insurance utilization, cancer type, length of time since diagnosis of cancer, stage of cancer, treatment type, comorbidity, ECOG performance status, thirteen severe symptom burdens, and level of social support to be associated with psychosocial distress were entered into the binary logistic regression model. In bivariable logistic regression, those variables such as sex, age group, residence, community based health insurance utilization, cancer type, cancer stage, time since diagnosis, treatment type, comorbidity, performance status, fatigue, nausea, vomiting, numbness, and level of social support were significant at 0.25 significant level. And those variables with a P-value of \\u0026le;\\u0026thinsp;0.25 in the binary logistic analysis were entered into multivariable logistic analysis to identify the independent variables associated with psychosocial distress. In multivariable logistic regression analysis, seven variables such as sex, residence, health insurance, treatment type, comorbidity, fatigue, and nausea were significant at a p-value of less than 0.05 and 95% confidence interval.\\u003c/p\\u003e \\u003cp\\u003eIn this study, 272 (67.83%) female and 106 (55.21%) male adult cancer patients experienced psychosocial distress. As a result, female cancer patients were nearly twice more likely experiencing psychosocial distress when compared with male (AOR\\u0026thinsp;=\\u0026thinsp;1.98, 95% CI: 1.24\\u0026ndash;3.17).\\u003c/p\\u003e \\u003cp\\u003eThe likelihood of experiencing psychosocial distress was 2.3 times higher among patients living in rural area (AOR\\u0026thinsp;=\\u0026thinsp;2.3, 95% CI: 1.49 \\u0026minus;\\u0026thinsp;3.54) as compared to those who were living in urban. The odds of developing psychosocial distress were decreased by 66% among patients who utilized community-based health insurance (AOR\\u0026thinsp;=\\u0026thinsp;0.34, 95% CI: 0.23\\u0026ndash;0.51) as compared to patients who did not utilized community-based health insurance.\\u003c/p\\u003e \\u003cp\\u003eRegarding cancer treatment type, those patients who were on chemotherapy treatment were 2.72 times more likely to develop psychosocial distress as compared to those who did not start cancer treatment after adjusting other variables in the model (AOR\\u0026thinsp;=\\u0026thinsp;2.72, 95% CI: 1.38\\u0026ndash;5.39). Cancer patients who had comorbidity disease were 3.2 times more likely to experience psychosocial distress when compared to patients who had no comorbidity (AOR\\u0026thinsp;=\\u0026thinsp;3.2, 95% CI: 1.67\\u0026ndash;6.10). In this study, 174 (73%) adult cancer patients with severe fatigue developed psychosocial distress, whereas 204 (58.3%) patients without severe fatigue also developed psychosocial distress. In this case, the odds of experiencing psychosocial distress among severely fatigued cancer patients were increased by 1.7 times as compared to patients with no severe fatigue (AOR\\u0026thinsp;=\\u0026thinsp;1.65, 95% CI: 1.09\\u0026ndash;2.39). The level of psychosocial distress among cancer patients with severe nausea was 155 (74.2%), whereas 223 (58.1%) of patients with no severe nausea experienced psychosocial distress. Given that the likelihood of developing psychosocial distress in cancer patients with severe nausea was almost 2 times higher than in cancer patients without severe nausea (AOR\\u0026thinsp;=\\u0026thinsp;1.76, 95%CI: 1.10\\u0026ndash;2.80) (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eBivariable and multivarible logistic regression analysis of factors assocated with psychosocial distress among adult cancer patients at oncollogy units in the Amhara regional state, Ethiopia, Aprile 30-June 22/2022\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"7\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c7\\\" colnum=\\\"7\\\"\\u003e\\u003c/div\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eVariables\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eCategory\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colspan=\\\"2\\\" nameend=\\\"c4\\\" namest=\\\"c3\\\"\\u003e \\u003cp\\u003ePsychosocial\\u003c/p\\u003e \\u003cp\\u003edistress\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eCOR(95% CI)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eAOR(95% CI)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eP-value\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eSex\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e106\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e86\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFemale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e272\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e129\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.71(1.20\\u0026ndash;2.44)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.98(1.24\\u0026ndash;3.17)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e0.004\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"3\\\" rowspan=\\\"4\\\"\\u003e \\u003cp\\u003eAge group\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e18\\u0026ndash;24\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e26\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e13\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e25\\u0026ndash;40\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e95\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e74\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.64(0.31\\u0026ndash;1.33)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.67(0.30\\u0026ndash;1.56)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.354\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e41\\u0026ndash;59\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e168\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e86\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.98(0.48\\u0026ndash;1.99)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.06(0.47\\u0026ndash;2.39)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.892\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026ge;\\u0026thinsp;60\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e89\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e42\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.06(0.49\\u0026ndash;2.26)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.03(0.43\\u0026ndash;2.44)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.953\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eResidence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUrban\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e92\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e79\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eRural\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e286\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e136\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.81(1.26\\u0026ndash;2.60)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e2.30(1.49\\u0026ndash;3.54)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eHealth insurance\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e185\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e145\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.46(0.33\\u0026ndash;0.67)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.34(0.23\\u0026ndash;0.51)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e193\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e70\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"4\\\" rowspan=\\\"5\\\"\\u003e \\u003cp\\u003eCancer type\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eBreast cancer\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e98\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e59\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eGynecological\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e90\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e45\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.20(0.74\\u0026ndash;1.95)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.87(0.48\\u0026ndash;1.54)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.612\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eGIT\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e88\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e59\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.90(0.57\\u0026ndash;1.42)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.14(0.64\\u0026ndash;2.02)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.654\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eHematological\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e65\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e28\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.40(0.81\\u0026ndash;2.45)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.84(0.93\\u0026ndash;3.62)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.080\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eOthers\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e37\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e24\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.93(0.51\\u0026ndash;1.70)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.81(0.38\\u0026ndash;1.70)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.578\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eTime since diagnosis\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;1 year\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e190\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e119\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026ge;\\u0026thinsp;1 year\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e188\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e96\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.23(0.88\\u0026ndash;1.77)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.07(0.72\\u0026ndash;1.59)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.741\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"3\\\" rowspan=\\\"4\\\"\\u003e \\u003cp\\u003eCancer stage\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eStage I\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e28\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e20\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eStage II\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e26\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e23\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.81(0.36\\u0026ndash;1.80)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.67(0.26\\u0026ndash;1.54)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.396\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eStage III\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e123\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e74\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.20(0.62\\u0026ndash;2.26)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.80(0.35\\u0026ndash;1.67)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.499\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eStage IV\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e201\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e98\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.47(0.79\\u0026ndash;2.73)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.90(0.41\\u0026ndash;1.98)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.789\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"3\\\" rowspan=\\\"4\\\"\\u003e \\u003cp\\u003eCurrent Treatment type\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo treatment received\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e24\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e30\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eChemotherapy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e234\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e96\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e3.05(1.69\\u0026ndash;5.48)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e2.72(1.38\\u0026ndash;5.39)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e0.004\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eSurgery\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e12\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e11\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.36(0.51\\u0026ndash;3.63)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.04(0.32\\u0026ndash;3.40)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.944\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMixed\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e108\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e78\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.73(0.94\\u0026ndash;3.19)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.64(0.77\\u0026ndash;3.51)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.202\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eComorbidity\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e84\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e14\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e4.10(2.27\\u0026ndash;7.43)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e3.20(1.67\\u0026ndash;6.10)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e294\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e201\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eECOG PS\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePoor\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e194\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e98\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eGood\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e184\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e117\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.79(0.60\\u0026ndash;1.11)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.92(0.62\\u0026ndash;1.36)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.672\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eSevere fatigue\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e174\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e65\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.97(1.38\\u0026ndash;2.81)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.65(1.09\\u0026ndash;2.50)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e0.018\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e204\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e150\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eSevere nausea\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e155\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e54\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2.07(1.43-3.00)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.76(1.10\\u0026ndash;2.80)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e0.019\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e223\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e161\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eSevere vomiting\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e59\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e26\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.34(0.82\\u0026ndash;2.21)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.87(0.47\\u0026ndash;1.62)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.664\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e319\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e189\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eSevere numbness\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e34\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e10\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2.03(0.98\\u0026ndash;4.19)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.41(0.61\\u0026ndash;3.21)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.420\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e344\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e205\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"2\\\" rowspan=\\\"3\\\"\\u003e \\u003cp\\u003eSocial support\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eStrong\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e190\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e104\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eModerate\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e92\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e64\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e0.79(0.53\\u0026ndash;1.17)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e0.80(0.50\\u0026ndash;1.28)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.358\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePoor\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e96\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e47\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1.12(0.73\\u0026ndash;1.71)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.19(0.72\\u0026ndash;1.94)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c7\\\"\\u003e \\u003cp\\u003e0.498\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"7\\\"\\u003eNote: \\u003csup\\u003e⁎\\u003c/sup\\u003eP-value\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eThis study identified the prevalence of psychosocial distress and factors associated with it among adult cancer patients at oncology units in the Amhara regional state, Ethiopia. From the study results, the overall prevalence of psychosocial distress among adult cancer patients was 63.74%. The magnitude of psychosocial distress in this study was relatively consistent with other studies conducted among cancer patients in Doha, Qatar (62%) (\\u003cspan citationid=\\\"CR54\\\" class=\\\"CitationRef\\\"\\u003e54\\u003c/span\\u003e), Sri Lanka (65%)(\\u003cspan citationid=\\\"CR55\\\" class=\\\"CitationRef\\\"\\u003e55\\u003c/span\\u003e), Iran (67.7%) (\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e). This similarity could be explained by the course of physiological (biological) similarities between cancers and their impact on psychosocial and social aspects across the countries. Whereas this figure was to some extent higher when compared with the other previous study findings in Egypt (46%) (\\u003cspan citationid=\\\"CR56\\\" class=\\\"CitationRef\\\"\\u003e56\\u003c/span\\u003e), Saudi Arabia (46%) (\\u003cspan citationid=\\\"CR57\\\" class=\\\"CitationRef\\\"\\u003e57\\u003c/span\\u003e), South Korea where the magnitude was ranged from (28.8\\u0026ndash;33.6%)(\\u003cspan citationid=\\\"CR58\\\" class=\\\"CitationRef\\\"\\u003e58\\u003c/span\\u003e), across fifty five North American cancer centers (46%) (\\u003cspan citationid=\\\"CR59\\\" class=\\\"CitationRef\\\"\\u003e59\\u003c/span\\u003e), single study in USA (55%) (\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e), and multi-center study in Italy (26.6%)(\\u003cspan citationid=\\\"CR60\\\" class=\\\"CitationRef\\\"\\u003e60\\u003c/span\\u003e). This discrepancy could be attributed from the difference of study populations in terms cancer types, the socio demographic variation, study design and setting, time frame, health care inequities and the level of country development. But the prevalence of this study was less than studies conducted in Kenya (72.2%) (\\u003cspan citationid=\\\"CR61\\\" class=\\\"CitationRef\\\"\\u003e61\\u003c/span\\u003e), Cameroon (69.2%) (\\u003cspan citationid=\\\"CR62\\\" class=\\\"CitationRef\\\"\\u003e62\\u003c/span\\u003e), republic of China (83.4%) (\\u003cspan citationid=\\\"CR63\\\" class=\\\"CitationRef\\\"\\u003e63\\u003c/span\\u003e), and Germany (89.3%) (\\u003cspan citationid=\\\"CR64\\\" class=\\\"CitationRef\\\"\\u003e64\\u003c/span\\u003e). The reason for this could be the studies difference in consideration of severity of psychosocial distress and the tool used for screening and diagnosis of distress with different cut of points. It is noted that these prior studies used different measurement tools other than QSC-R10. For instance, the Brief Symptom Inventory (the BSI-18), which is considered as a more conservative tool, and the NCCN distress thermometer (DT), which has been condemned as providing more false positives and the accuracy in detecting psychosocial distress is limited (\\u003cspan citationid=\\\"CR65\\\" class=\\\"CitationRef\\\"\\u003e65\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eIn this study, being a female cancer patient was statistically associated with psychosocial distress, in which the likelihood of developing psychosocial distress among female cancer patients was significantly higher when compared to male cancer patients. This finding was similar to studies conducted in two sites in Japan (\\u003cspan citationid=\\\"CR66\\\" class=\\\"CitationRef\\\"\\u003e66\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR67\\\" class=\\\"CitationRef\\\"\\u003e67\\u003c/span\\u003e), Germany (\\u003cspan citationid=\\\"CR68\\\" class=\\\"CitationRef\\\"\\u003e68\\u003c/span\\u003e), Iran (\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e), and China (\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e). A possible reason for this finding could be that receiving a cancer diagnosis and its treatment can cause a psychosocial difficulty that can lead to cognitive and emotional crises and persistent distress among the patients (\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e). With regard to females, the difficulty may be more problematic for several reasons. First of all, cancer can pose more obstacles for the roles and responsibilities that females carry out than the ones that males do. Females are more likely to be confronted by ongoing household involvements due to family obligations than their male counterparts. Traditionally females are usually regarded as caring, nurturing, and compassionate and are socialized prioritize their families' needs to nurture and care for others before their own needs and accomplishments. Another reason could be when women with various responsibilities manage their illnesses and the physical symptoms of the diseases at the same time, their resources could likely run out, which could ultimately cause distress. Third, females usually tend to be preoccupied with cosmetic issues, which can without any question impact their mental state and personal satisfaction. Because cancer and its treatments has cosmetic issues (\\u003cspan citationid=\\\"CR67\\\" class=\\\"CitationRef\\\"\\u003e67\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eThis study also revealed that cancer patients living in rural areas have a higher likelihood of developing psychosocial distress when compared with those living in urban areas. This finding is consistent with prior research from Iran (\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e) and Greece (\\u003cspan citationid=\\\"CR69\\\" class=\\\"CitationRef\\\"\\u003e69\\u003c/span\\u003e). This might be a result of cancer patients living in rural areas having a low perception of lifestyle modification, relaxation, and recreation. And lack of access of other luxury enjoyments in order to cope with the disease and treatment burden and lack of access or low seeking behavior to get psychosocial and mental health counseling or consultation. Rural cancer patients face many challenges in receiving care, including problems with public transportation, distance to treatment areas, financial issues, and the availability of support when they need it (\\u003cspan citationid=\\\"CR70\\\" class=\\\"CitationRef\\\"\\u003e70\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eAccording to this study, the likely hood of developing psychosocial distress among community based health insurance utilizers decreased by 66% when compared with cancer patients who did not utilize it. This finding was in line with research conducted in Kenya (\\u003cspan citationid=\\\"CR61\\\" class=\\\"CitationRef\\\"\\u003e61\\u003c/span\\u003e) and the USA (\\u003cspan citationid=\\\"CR71\\\" class=\\\"CitationRef\\\"\\u003e71\\u003c/span\\u003e). This could be due to the fact that CBHI provides financial protection against the cost of illness and increase access to needed health care in order to improve access to quality health services for low-income and rural households who are in need. Evidence suggested that cancer Patients who don\\u0026rsquo;t have a medical insurance are more distressed because of the high costs of cancer therapy. At times, they sell their property, including land, to pay for the therapy (\\u003cspan citationid=\\\"CR61\\\" class=\\\"CitationRef\\\"\\u003e61\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eReceiving chemotherapy treatment alone was associated with higher odds of developing psychosocial distress when compared to cancer patients who did not start cancer treatment. This finding was consistent with other research carried out in Kenya (\\u003cspan citationid=\\\"CR61\\\" class=\\\"CitationRef\\\"\\u003e61\\u003c/span\\u003e) and Brazil (\\u003cspan citationid=\\\"CR72\\\" class=\\\"CitationRef\\\"\\u003e72\\u003c/span\\u003e). This could be due to the fact that even if chemotherapy is one of the treatment modalities for cancer, it can bring troublesome side effects that can impact on daily living activities and can affect the emotional well-being of patients. Side effects such as fatigue, loss of hair, together with skin color changes and loss of weight experienced by patients, lead to a disturbed body image and low self-esteem, which could lead to distress (\\u003cspan citationid=\\\"CR73\\\" class=\\\"CitationRef\\\"\\u003e73\\u003c/span\\u003e). Chemotherapy forces the patient to adhere to schedules of medical appointments or hospitalizations and to reallocate their roles and responsibilities because the patient usually cannot meet obligations because of fatigue or other side effects. Another reason can be related to emotional chemo-brain, which is emotional disturbances and self-disgust resulting from the adverse drug effects of chemotherapy on the neurobiological level. Chemo-brain is thought to be a factor in the exacerbation of mental, social, and behavioral problems in physically ill people (\\u003cspan citationid=\\\"CR74\\\" class=\\\"CitationRef\\\"\\u003e74\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003eCancer patients with comorbidities in this study were more likely to experience psychosocial distress as compared to cancer patients without comorbidities. This finding is equivalent to findings from South Korea (\\u003cspan citationid=\\\"CR75\\\" class=\\\"CitationRef\\\"\\u003e75\\u003c/span\\u003e) and Taiwan (\\u003cspan citationid=\\\"CR48\\\" class=\\\"CitationRef\\\"\\u003e48\\u003c/span\\u003e). This could be due to the fact that comorbidities having a big impact on cancer treatment decisions and management. Comorbidities may influence the progression, stage at diagnosis, treatment, and/or prognosis of cancer patients. It can limit access to the most effective and curative treatments, delay their beginning, or reduce adherence, increase toxicities of cancer treatment and regarded as double burden for cancer patients associated with poor quality of life. And also comorbidities resulted higher health care costs (\\u003cspan citationid=\\\"CR49\\\" class=\\\"CitationRef\\\"\\u003e49\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR76\\\" class=\\\"CitationRef\\\"\\u003e76\\u003c/span\\u003e) ,\\u003c/p\\u003e \\u003cp\\u003eIn this study, severe fatigue was associated with an increased likelihood of experiencing psychosocial distress. Similarly previous studies conducted in Iran (\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e), Korea (\\u003cspan citationid=\\\"CR77\\\" class=\\\"CitationRef\\\"\\u003e77\\u003c/span\\u003e), and Vietnam(\\u003cspan citationid=\\\"CR78\\\" class=\\\"CitationRef\\\"\\u003e78\\u003c/span\\u003e) also identified that fatigue was a distressing symptom for cancer. This can be because severe fatigue can make performing daily routine activities more difficult, as well as making it more difficult to participate in social activities and deteriorating cognitive functions such as concentrating and remembering things. Fatigue can also decrease motivation, interest and increase frustration, irritability and feelings of sadness.\\u003c/p\\u003e \\u003cp\\u003eThe results of this study also showed that the likelihood of developing psychosocial distress was higher among cancer patients with severe nausea when compared to patients with no severe nausea. This result was consistent with findings from other studies (\\u003cspan citationid=\\\"CR79\\\" class=\\\"CitationRef\\\"\\u003e79\\u003c/span\\u003e). This could be due to the fact that nausea is still a serious side effect of cancer therapy, frequently resulting in dramatic changes in the patient's emotions, social activities, and work situations. Patients suffering from cancer who develop nausea symptoms find it difficult to socialize and prefer to live alone rather than disrupting others' time and feeling like a burden on their family (\\u003cspan citationid=\\\"CR80\\\" class=\\\"CitationRef\\\"\\u003e80\\u003c/span\\u003e).\\u003c/p\\u003e\\n\\u003ch3\\u003eLimitation Of The Study\\u003c/h3\\u003e\\n\\u003cp\\u003eSince the study was a cross-sectional study, the temporal relationship between cause and effect could not be ascertained.\\u003c/p\\u003e \\u003cp\\u003eSecondly, some measurement tools used were self-rating questionnaires. This may have led to some bias.\\u003c/p\\u003e \\u003cp\\u003eIn this study, spiritual and income-related variables that might be considered as associated factors of psychosocial distress were not included. The Amharic version of the MD Anderson Symptom Inventory (MDASI), a valid and reliable multi-symptom assessment tool developed for use in cancer patients which considers only severe core symptoms, was evaluated to identify whether cancer patients with severe symptom burdens had psychosocial distress. As a result, it is difficult to distinguish between mild and moderate levels of the core symptoms. This might understate the level of the potential distressing symptoms.\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eIn general, the findings of this study showed a relatively high magnitude in which around two- thirds of patients experienced psychosocial distress. The most prevalent cancer type among the participants was breast cancer. Most cancer patients were attending with advanced stages of cancer. Fatigue, nausea and pain were the most common presenting severe symptoms experienced by cancer patients. These symptoms necessitate the prevention, early detection and evidenced based management by the frontline health care workers. Being female cancer patient, rural residents, community-based health insurance utilization, chemotherapy treatment, the presence of comorbidity, and symptom severity such as severe fatigue and nausea had statistically significant association with psychosocial distress. Community based health insurance utilization decreases the likely hood of developing psychosocial distress\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cp\\u003eACS\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;American cancer society\\u003c/p\\u003e\\n\\u003cp\\u003eBSI-18\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;Brief Symptom Inventory\\u003c/p\\u003e\\n\\u003cp\\u003eCBHI\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;Community based health insurance\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eDRH\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;Dessie referral hospital\\u003c/p\\u003e\\n\\u003cp\\u003eDT\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;Distress thermometer\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eECOG PS\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;Eastern Cooperative Oncology Group Performance Status\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eFHCSH\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;Felege Hiwot comprehensive specialized hospital\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eIPOS\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;International Psycho-Oncology Society\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eMDASI \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;MD Anderson symptom inventory\\u003c/p\\u003e\\n\\u003cp\\u003eNCCN\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;National Comprehensive Cancer Network\\u003c/p\\u003e\\n\\u003cp\\u003eQSC-R10\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;Questionnaire on Stress in Cancer Patients revised 10\\u003c/p\\u003e\\n\\u003cp\\u003eSSA\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;Sub Saharan Africa\\u003c/p\\u003e\\n\\u003cp\\u003eTGSH\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;Tibebe Ghion Specialized Hospital\\u003c/p\\u003e\\n\\u003cp\\u003eUoGCSH\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;University of Gondar comprehensive specialized hospital\\u003c/p\\u003e\\n\\u003cp\\u003eUSA\\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;\\u0026nbsp;United States of America\\u003c/p\\u003e\\n\\u003cp\\u003eWHO \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp; \\u0026nbsp;World Health Organization\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003e\\u0026nbsp;Ethics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAll procedures performed in this study involving participants were performed in accordance with\\u0026nbsp;relevant guidelines and regulations of\\u0026nbsp;the 1964 Helsinki declaration and its later amendments or comparable ethical standards.\\u0026nbsp;The study was approved by the ethics committee of\\u0026nbsp;Bahir Dar University, College of Medicine and Health Sciences institutional review board with protocol number of 40/2022 and decision number of\\u0026nbsp;003 and signed by Dr. Mulusew Andualem (PhD), director of research and development office. Then, the data were collected after getting consent from each hospital manager. The study\\u0026apos;s objective was explained to participants, and their written informed consent was obtained. By omitting direct personal identifiers from the questionnaire, employing code numbers, locking data with a password, and not misusing or leaking their information, confidentiality was maintained. Additionally, participants were made aware that their participation was voluntary and that they could terminate the study at any time if they felt uncomfortable about it. The issue of confidentiality and privacy was scrupulously upheld. Every technique was used in compliance with the rules and regulations that were applicable. The study was complying with standard national and international ethical guidelines.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNot applicable\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAll relevant data are available within the manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests\\u0026nbsp;\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eNo competing interest exists in our interpretation of data or presentation of information.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eFinancial support was obtained from Bahir Dar University. This supporting institution has no role in the preparation of the manuscript as well as the decision to publish.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026apos; contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eAAB: contributed to the creation of the study\\u0026apos;s research question and design, helped write the proposal, took part in data gathering, evaluated and interpreted the findings, and wrote the manuscript. AT and SKB approved the designed project with a few adjustments. They contributed to the supervision and training of the data collectors; took part in the data analysis and wrote the manuscript. The work of this project was also critically evaluated by MMF, HAG, MET and MK, who also contributed to its design, participated in the analysis and interpretation of the findings, and wrote the manuscript.\\u0026nbsp;The compilation, review, and approval of the final manuscript were done by all authors.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors\\u0026rsquo; sincere thanks go to Bahir Dar University, College of Medicine and Health Sciences. The authors also acknowledged each oncology unit staff, supervisors, data collectors. We also expressed our gratitude to the Amhara region people\\u0026apos;s memoirs center for providing free internet connection and for the goodwill of the personnel.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n\\u003cli\\u003eSarfati D, Gurney J. Preventing cancer: the only way forward. 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Prevalence and predictors of psychosocial problems in informal caregivers of older cancer survivors\\u0026ndash;A systematic review: Still major gaps in current research. European journal of cancer care. 2018;27(6):e12899.\\u003c/li\\u003e\\n\\u003cli\\u003eTraversa P. 36th Annual CAPO Conference: Advocating for All: Psychosocial Oncology at the Intersections of Equity, Diversity, and Inclusion, 8\\u0026ndash;10 June 2021. Current Oncology. 2021;28(4):2579-698.\\u003c/li\\u003e\\n\\u003cli\\u003eGrassi L, Fujisawa D, Odyio P, Asuzu C, Ashley L, Bultz B, et al. Disparities in psychosocial cancer care: a report from the International Federation of Psycho‐oncology Societies. Psycho‐Oncology. 2016;25(10):1127-36.\\u003c/li\\u003e\\n\\u003cli\\u003eAdeme Tsegaye AA, Baharu Zewdie, Genet Negusie. NATIONAL CANCER CONTROL PLAN OF ETHIOPIA - 2016-2020. 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Current Oncology. 2022;29(4):2575-82.\\u003c/li\\u003e\\n\\u003cli\\u003eBraga Mendon\\u0026ccedil;a A, Ramos Pereira E, Magnago C, Andrade Silva RMCR, das Gra\\u0026ccedil;as Gazel de Souza M, de Lima Cury Cunha MA. Distress in the context of cancer and chemotherapy: A mixed‐method study. International Journal of Nursing Practice. 2021:e12949.\\u003c/li\\u003e\\n\\u003cli\\u003eBosire AM. Biopsychosocial Effects of Chemotherapy Among Breast and Cervical Cancer Patients Attending Kenyatta National Hospital Cancer Treatment Center: University of Nairobi; 2019.\\u003c/li\\u003e\\n\\u003cli\\u003eBou Khalil R. \\u0026quot;Emotional Chemobrain\\u0026quot;: A new concept for chemotherapy adverse drug effect? L\\u0026apos;Encephale. 2021;47(6):613-5.\\u003c/li\\u003e\\n\\u003cli\\u003eChoi K-H, Park SM. Psychological status and associated factors among Korean cancer survivors: a cross-sectional analysis of the fourth \\u0026amp; fifth Korea National Health and Nutrition Examination Surveys. Journal of Korean Medical Science. 2016;31(7):1105-13.\\u003c/li\\u003e\\n\\u003cli\\u003eSarfati D, Koczwara B, Jackson C. The impact of comorbidity on cancer and its treatment. CA: a cancer journal for clinicians. 2016;66(4):337-50.\\u003c/li\\u003e\\n\\u003cli\\u003ePark J-H, Chun M, Jung Y-S, Bae SH. Predictors of psychological distress trajectories in the first year after a breast cancer diagnosis. Asian nursing research. 2017;11(4):268-75.\\u003c/li\\u003e\\n\\u003cli\\u003eNguyen TQ, Do TM, Pham TA. Screening for Psychological Distress in Vietnamese Cancer Patients: An Evaluation of the Distress Thermometer. Cancer Medicine. 2021;10(21):7793-803.\\u003c/li\\u003e\\n\\u003cli\\u003eLeach C. Nausea and vomiting in palliative care. Clinical medicine. 2019;19(4):299.\\u003c/li\\u003e\\n\\u003cli\\u003eAdeelaQayyum FS, Tahira Nazir, Shazia Arooj,Saima Parveen and Samia iqbal. Quality of life in breast cancer women in south punjab intertiary care hospital Multan,Pakistan. Bioscience Research. 2022;19(2):1176-84.\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Amhara region, cancer, prevalence, psychosocial distress\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-2217915/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-2217915/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e \\u003cp\\u003ePsychosocial distress is a long-term burden for cancer survivors, which has an impact on their quality of life and oncologic prognosis. Although the national cancer prevention and control program in Ethiopia has made efforts in cancer prevention, control, and management by implementing the national cancer control plan 2016\\u0026ndash;2020, no enough evidence about psychosocial distress among adult cancer patients. So it is critical to understand the magnitude of psychosocial distress and the factors that contribute to it.\\u003c/p\\u003e\\u003ch2\\u003eObjective\\u003c/h2\\u003e \\u003cp\\u003eTo assess the prevalence of psychosocial distress and associated factors among adult cancer patients at oncology units in the Amhara regional state, Ethiopia. 2022.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eA multi-center institutional based cross-sectional study was conducted among a sample of 605 adult cancer patients from April 30-June 22, 2022. A systematic random sampling technique was employed to select the study units. And data were collected through interviewers administered questionnaires by using the validated and pretested tools. Distress was assessed using the Questionnaire on Stress in Cancer Patients Revised 10. Both bivariable and multivariable logistic regression was used to describe the association between dependent and independent variables. Independent variable with \\u003cem\\u003ep\\u003c/em\\u003e-value less than 0.25 in the bivariable logistic regression analyses were entered into multivariable logistic regression model. Variables with \\u003cem\\u003ep\\u003c/em\\u003e-value\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.05 in the multivariable logistic regression analyses were considered as statistically significant associated factors of psychosocial distress.\\u003c/p\\u003e\\u003ch2\\u003eResult\\u003c/h2\\u003e \\u003cp\\u003eA total of 593 adult cancer patients took part in this study with mean age of 46.86\\u0026thinsp;\\u0026plusmn;\\u0026thinsp;14.5 years. The overall prevalence of psychosocial distress was 63.74%. Variables such as being female (AOR\\u0026thinsp;=\\u0026thinsp;1.98, 95% CI: 1.24\\u0026ndash;3.17), patients who lives in rural areas (AOR\\u0026thinsp;=\\u0026thinsp;2.3, 95% CI: 1.49\\u0026ndash;3.54), community based health insurance utilization (AOR\\u0026thinsp;=\\u0026thinsp;0.34, 95% CI: 0.23\\u0026ndash;0.51), patients on chemotherapy treatment (AOR\\u0026thinsp;=\\u0026thinsp;2.72, 95% CI: 1.38\\u0026ndash;5.39), patients with comorbidity (AOR\\u0026thinsp;=\\u0026thinsp;3.2, 95% CI: 1.67\\u0026ndash;6.10), and symptom burdens such as severe fatigue (AOR\\u0026thinsp;=\\u0026thinsp;1.65, 95% CI:1.09\\u0026ndash;2.39) and severe nausea (AOR\\u0026thinsp;=\\u0026thinsp;2.07, 95%CI: 1.43-3.00) were statistically associated with psychosocial distress.\\u003c/p\\u003e\\u003ch2\\u003eConclusion and recommendation:\\u003c/h2\\u003e \\u003cp\\u003eIn general, the findings of this study showed a relatively high magnitude in which around two-thirds of patients experienced psychosocial distress. It is better to establish and enforce the integration and coordination of psychosocial-oncology service programs at national level with parallel guidelines and policies.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Psychosocial distress and associated factors among adult cancer patients at oncology units in the Amhara regional state, Ethiopia, 2022\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2022-11-22 18:34:08\",\"doi\":\"10.21203/rs.3.rs-2217915/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"ccd5cda4-d213-418b-8cf9-d9f5f194f368\",\"owner\":[],\"postedDate\":\"November 22nd, 2022\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2023-05-19T04:59:13+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2022-11-22 18:34:08\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-2217915\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-2217915\",\"identity\":\"rs-2217915\",\"version\":[\"v1\"]},\"buildId\":\"_2-kVJe1T_tPrBINL-cwx\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}