Quality of life and associated factors among cancer patients receiving palliative care in Western Uganda: a cross-sectional study

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Our goal therefore, was to assess the level of quality of life and associated factors among cancer patients receiving palliative care in Western Uganda. Methods A cross-sectional study was conducted using a pretested questionnaire that included socio-demographics, clinical information and the MissoulaVitas Quality of Life Index (MVQOLI-15R), a tool that measures quality of life of patients with advanced, incurable and progressive disease such as cancer. It is a 16-item instrument comprising of five subscales of: function, symptom, interpersonal, well-being and transcendence that encompass physical, social, psychological and spiritual dimensions. This tool was previously validated for a similar segment of patients. The above data collection instrument was translated into Runyoro and Runyankore and administered to consecutively enrolled cancer patients at Mobile Hospice Mbarara and Little Hospice Hoima, both of which are found in Western Uganda. Results 204 patients were recruited. They had a mean age of58.8 ± 15.2 years and 154 (75.5%) of them were female. The commonest diagnosis was cancer of the cervix, 101(49.5%). The mean global QoL score was 3.47 ± 0.88 (possible range 0[worst] to 5[best]). The mean total QoL score was 13.44 ± 1.62 (possible range 0[worst] to 30[best]). Patients scored most poorly on symptoms (-6.78±), followed by Interpersonal (-4.01), transcendence (-3.53), function (-2.50) and well-being (1.31). The possible ranges for the subscales is (-30[worst] to 30[best]). With regard to factors associated with QoL, stage of disease, treatment with radiotherapy and pain intensity were found to have statistically significant associations with QoL of cancer patients receiving palliative care in this context. Conclusion QoL of cancer patients under palliative care in Western Uganda was found to be low. Treatment with radiotherapy, pain intensity and stage of disease were established to key predictors of QoL of these patients. Therefore, it is vital for cancer patients to be diagnosed with early stage, have their pin well controlled and get treated with radiotherapy where appropriate in order to harness better outcomes such as QoL for them. Quality of life Palliative care Associated factors Cancer Figures Figure 1 Background Globally, cancer is a leading cause morbidity and mortality, and this burden is increasingly becoming prominent in low- and middle-income nations, especially those in sub-Saharan Africa (SSA) such as Uganda [ 1 , 2 ]. In 2020 SSA had over 800,000 new cases and 520,000 deaths and this public health load is projected to more than double by 2040 [ 3 , 4 ]. Uganda registers over 32,000 new cases and over 21,000 deaths annually [ 5 , 6 ]. In these settings many of these patients present with advanced, incurable and progressive disease characterized by limited management modalities, making palliative care (PC) a pertinent component of cancer care [ 1 , 7 ]. The World Health Organization (WHO) defines palliative care as “an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual”[ 8 – 10 ]. The main focus of palliative care is to ameliorate quality of life (QoL) through addressing multifaceted problems of the patients and their families [ 1 , 11 , 12 ]. QoL is a foundational outcome in cancer care and WHO define it as “ individuals’ perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns” [ 13 – 15 ]. It is a broad spectrum multi-dimensional concept that is influenced by a number of factors; physical, social, psychological as well as spiritual [ 16 , 17 ]. In African palliative care settings, a number of patients are found to have low to moderate QoL, especially in the physical and psychological domains [ 11 , 18 , 19 ]. In Uganda, majority of adult cancer patients experience a decline in physical (79%) and psychological (61%) functioning and hence low QoL levels, highlighting a huge indicator of unmet needs for palliative care[ 18 ]. Additionally, several systematic reviews about QoL for cancer patients in the developing world have shown that it is highly influenced by factors such as; marital status, education levels, symptom burden, depression, social support and age and that these factors can be modified through better clinical, psychological and spiritual care [ 1 , 2 , 20 ]. Unfortunately, QoL and its determinants among cancer patients in Africa including Western Uganda remain largely under-researched, which hinders proper planning and implementation of palliative in the region [ 1 , 2 ]. In view of the above, this study therefore, aimed to assess the level of QoL and associated factors among cancer patients receiving palliative care in Western Uganda. This was justified to quantify the outcome and reveal modifiable determinants and ultimately support evaluation and improvement of palliative care in the region. Methods Setting This study was carried out from Little Hospice Hoima (LHH) and Mobile Hospice Mbarara (MHM), both of which are located in Western Uganda. The two health facilities are branches of Hospice Africa Uganda (HAU), a non-governmental organization (NGO) that provides specialized palliative care at a tertiary level (level 3) as per the African Palliative Care Association (APCA) standards of 2011. to patients with life-limiting illnesses such as cancer. Since their establishment in 1998, both facilities have cared for over 50,000 patients and currently 815 patients are on their program, 80% of whom have a diagnosis of cancer (HAU 2025). HAU provides a spectrum of services that include; pain and symptom management across physical psychosocial and spiritual domains. It also provides bereavement support and daycare services for both patients and their families. This care is offered through home-based care, outreach clinics and at the facilities. Study design and participants This was a facility-based cross-sectional study carried among 204 cancer patients who received care from Mobile Hospice Mbarara and Little Hospice Hoima from September to November 2025 through the above modalities of care. Participants were considered eligible if they had a diagnosis of cancer, were 18 years or older, had been on palliative care program for 30 days or more and were willing to participate in the study. Participants were excluded if they were not willing to take part in the study, were too sick to participate or were unable to communicate verbally. Sample size estimation The above sample size of 204 cancer patients was estimated by use of Yamane’s formula (1967) for finite populations. This formula is widely used is survey studies when the population size is known and a specific margin of error is targeted [ 21 ]. Sampling technique We employed a consecutive sampling technique at the study sites. A database of patients at each of the two facilities was used to identify all the eligible participants who were sequentially consented and enrolled into the study until the required sample size was attained. Data collection Data were collected using a pretested structured questionnaire that was programmed and administered through the Research and Data Capture software (REDCAP) version 5[ 22 ] by 3 trained research assistants at each of the 2 study sites. The data collection tool had 3 sections: 1) Patients’ socio-demographics, 2) medical/clinical information 3) QoL assessment using the Missoula Vitas Quality of Life Index (MVQOLI-15R). This tool, developed by Byock et al at first as a 25-item tool, with five dimensions of: function, symptom, interpersonal (social), well-being (psychological), transcendence (existential and spiritual issues) but was later revised to 15-item tool with similar dimensions/domains [ 23 ]. The MVQOLI-15R is specifically designed to assess the personal experiences of patients in each of the 5 domains and for the very reason, the individual items are phrased in a very subjective way where scores are not awarded to questions seen by the patient. In each of the 5 dimensions, patients provide 3 pieces of information to capture their overall experience: Assessment, which is a subjective measure of the current status or circumstance (rate from − 2 to + 2), Satisfaction, which measures the level of acceptance of the current status or circumstance (rated from-4 to + 4) and Importance, which indicates the extent to which a specific dimension influences the overall quality of life (rated + 1 to + 5). The tool generates both raw/unweighted scores and weighted scores. The unweighted dimensional scores are obtained by adding the Assessment and Satisfaction scores and they range from − 6 to + 6 while the weighted dimensional scores are calculated as the product of the above unweighted scores and the Importance score and they range from − 30 to + 30. The total QoL is derived by summing all the five weighted dimensional scores, dividing them by 10, and then adding 15 to the resultant quotient. This variable ranges from 0 to + 30, as the worst and best QoL levels possible. The instrument includes a single item on quality-of-life status (Global score) for assessing convergent validity purposes and it ranges from + 1 to + 5 for the worst and best possible scores. Additionally, this tool has adequate internal consistency (α = 0.77) and construct validity (r = 0.43) [ 24 ] and it has been validated and used to assess QoL in a number of studies in SSA and Uganda [ 11 , 25 ]. The entire data collection instrument was in English but was translated to Runyankore and Runyoro for application in Mbarara and Hoima respectively. Data Management and analysis Data was exported from REDCAP to excel software as a password protected dataset where its completeness was ascertained and cleaned. It was then exported to SPSS software version 25 for analysis. Descriptive statistics (frequencies, percentages, means, medians and interquartile range) were used to summarize participant characteristics and pertinent study variables including QoL. Also, bivariate and multi-variable analysis was conducted to identify key factors associated with QoL utilizing suitable statistical tests. Ethical considerations Informed consent was sought and obtained from all study participants before they could be enrolled into the study. Ethical approval was sought and granted from the Research and Ethics Committee of Mbarara University of Science and Technology (MUST-2025-351 and Uganda National Council of Science and Technology (UNCST: HS6248ES). Also, administrative clearance was obtained from Hospice Africa Uganda. In order to protect privacy, data were collected and stored in de-identified form, with personal identifiers kept separate from research data and accessible only to authorized study personnel. Additionally, all data collection processes were aligned to the key principles of the Declaration of Helsinki [ 26 ]. Results Socio-demographic characteristics of the study participants. Over a period of 12 weeks, we recruited 204 patients across the 2 study sites. None of the participants requested declined to take part in the study. Slightly less than three-quarters of the participants (147, 72.1%) were recruited from MHM. Table 1 illustrates the participants’ socio-demographic characteristics. The mean and standard deviation of their ages was 58.8 and 15.2 years respectively. Slightly more than three quarters of the number of participants (154, 75.5%) were female. Just over a half the number of participants (112, 59.8%) had attained primary level of education and above. A tad more than half the number of participants (119, 58.3%) were banyankore by tribe and also about half (92, 45.1) were married. Just over three quarters of them (163, 79.9%) reported no history of smoking and slightly more than half of them (131, 64.2%) did not consume alcohol. Just over half of them (107, 52.5%) were of socio-economic class 4 and worse. Only about one eighth of the participants (26, 12.7%) stated that they had total family support. A little more than half of them (117, 57.4%) receive care from hospice sites. Slightly less than one quarter (46, 22.5%) received support from the village health teams (VHTs). Table 1 Demographic Characteristics of Study Participants by Site Variable Site 1 (MHM) (n = 147) Site 2 (LHH) (n = 57) Total (n = 204) Age(years) Mean (Sd) Median (IQR) 59.7(16.2) 60.0(23) 56.5(11.8) 56.0(14.0) 58.8(15.2) 60.0(18.0) Gender: Counts (%) Female Male 103(70.1) 44(29.9) 51(89.5) 6(10.5) 154(75.5) 50(24.5) Education Level: Counts (%) No Formal Education Primary Level Ordinary level secondary Advanced level secondary Tertiary level 59(40.1) 69(46.9) 11(7.5) 2(1.4) 6(4.1) 23(40.4) 24(42.1) 7(12.3) 2(3.5) 1(1.8) 82(40.2) 93(45.6) 18(8.8) 4(2) 7(3.4) Tribe: Counts (%) Banyankore Baganda Banyoro Batooro Bakiga Others 116(78.9) 6(4.1) 1(0.7) 0 18(12.2) 6(4.1) 3(5.3) 5(8.8) 34(59.6) 1(1.8) 6(10.5) 8(14.0) 119(58.3) 11(5.4) 35(17.2) 1(0.5) 24(11.8) 14(6.9) Religion: Counts (%) Christian Muslim Others 141(95.9) 6(4.1) 54(94.7) 3(5.3) 195(95.6) 9(4.4) Marital Status: Counts (%) Married Single Separated Cohabiting Divorced Others Widow/widower 69(46.9) 15(10.2) 19(12.9) 10(6.8) 0 0 34(23.1) 23(40.4) 3(5.3) 11(19.3) 3(5.3) 1(1.8) 0 16(28.1) 92(45.1) 18(8.8) 30(14.7) 13(6.4) 1(0.5) 0 50(24.5) Smoking History: Counts (%) Yes No 36(24.5) 111(75.5) 5(8.80 52(91.2) 41(20.1) 163(79.9) Alcohol Consumption: Counts (%) Yes No 56(61.9) 91(38.1) 17(29.8) 40(70.2) 73(35.8) 131(64.2) Socio-economic Status: Counts (%) Class 1 Class 2 Class 3 Class 4 Class 5 0 7(4.8) 63(42.9) 71(48.3) 6(4.1) 0 4(7) 23(40.4) 25(43.9) 5(8.8) 0 11(5.4) 86((42.2) 96(47.1) 11(5.4) Occupation: Count (%) 1-Professionals with first class jobs, govt officials, prominent business persons etc. with an income of >3m/month 2-Professionals with middle level jobs, senior religious leaders and ordinary business persons (income of <3m/month) 3-Small business owners, junior religious leaders, etc. (income of 0.5-2m/month) 4-Peasant farmers, petty traders (Income of < 0.5m) 5-No income; destitute 0 6(4.1) 13(8.8) 122(83.0) 6(4.1) 0 4(7.0) 8(14.0) 33(57.9) 12(21.1) 0 10(4.9) 21(10.3) 155(76.0) 18(8.8) Family Support (Financial, moral, social and spiritual): Counts (%) Total Support 3 of the above 4 pillars 2 of the above 4 pillars 1 of the above 4 pillars No support at all 21(14.3) 22(15) 40(27.2) 59(40.1) 5(3.4) 5(8.8) 16(28.1) 30(52.6) 6(10.5) 0 26(12.7) 38(18.6) 70(34.3) 65(31.9) 5(2.5) Place of care: Counts (%) Hospice Home Outreach 93(63.3) 23(15.6) 31(21.1) 24(42.1) 1(1.8) 32(56.1) 117(57.4) 24(11.8) 63(30.90 Village Health team involvement: Counts (%) Yes No 11(7.5) 136(92.5) 35(61.5) 22(38.6) 46(22.5) 158(77.5) Cancer disease-related Information of the study participants The most prevalent cancer diagnoses among the study participants were cancer of the cervix (101, 49.5%), cancer o of the breast (20, 9.8%) and cancer of the prostate (19, 9.3%), Fig. 1 . Table 2 describe some of the key variables of the study participants. The mean score of the medication adherence levels as measured by the Morisky medication Adherence Scale (MMAS)[ 27 ], was 5.13 ± 1.77. A tad more than half the number of participants (105,51.5%) had early stage disease. Slightly more than half their number (116, 56.8%) had at least one comorbidity condition such as heart disease, renal disease, hypertension, HIV/AIDS and diabetes. Almost a similar number (113, 55.4%) had been on palliative care program for more than a year. About pain, only (28, 13.7%) were not in any physical pain, with the rest having various levels of pain ranging from mild to overwhelming pain as assessed using the Numerical Rating Scale (NRS)[ 28 ]. In terms of their functional status which was assessed using the Eastern Oncological Group Scale (ECOG) [ 29 ], about three-quarters of them (156, 76.5%) were grade or better. Related to cancer treatment received, 140(68.6%) had received chemotherapy, 91(44.6%) received radiotherapy, 48(23.5%) were done surgery on, 41(20.1%) were treated with herbal medicine while 34(16.7%) did not receive any of the above treatment modalities. Quality of Life levels: The mean total weighted QoL score for the study participants was 13.44 ± 1.62 with a 95 CI of 13.22 to 13.67. The weighted dimensional mean scores were also calculated and they ranged from − 6.78 ± 9.42, 95CI -8.08 to -5.48 for the symptom subscale to 1.31 ± 4.63, 95CI 0.67to 1.95 for the well-being subscale (Table 2 ). Table 2 Quality of Life (QOL) Scores of Participants by Site MVQOLI Mean [95%CI] (Sd) Site 1, MHM, n = 147 Site 2, LHH, n = 57 Total, n = 204 Global Score 3.51[3.35 to 3.67] (0.99) 3.37[3.24 to 3.50] (0.49) 3.47 [3.35 to 3.59] (0.88) Weighted Symptom subscale score -7.21[-8.85 to -5.57] (10.08) -5.68[-7.65 to -3.72] (7.41) -6.78 [-8.08 to-5.48] (9.42) Weighted Function Subscale Score -2.35[-3.00 to -1.70] (3.99) -2.86 [-3.86 to -1.86] (3.77) -2.50 [-3.04 to -1.95] (3.93) Weighted Interpersonal Subscale -3.27[-4.11 to -2.44] (5.12) -5.91 [-7.15 to -4.68] (4.65) -4.01[-4.72 to -3.30] (5.12) Weighted Well-being Subscale score 1.39 [0.74 to 2.05] (4.00) -1.09[-0.5 to 2.68] (5.99) 1.31 [0.67 to 1.95] (4.63) Weighted Transcendence Subscale score -2.99 [-3.87 to -2.12] (5.39) -4.91[-6.27 to -3.55] (5.13) -3.53[-4.27 to -2.79] (5.37) Total QOL Score 13.56 [13.29 to 13.83] (1.66) 13.17 [12.77 to 13.83] (1.52) 13.44 [13.22 to 13.67] (1.62) Predictors of Quality of Life (QoL) With regard to factors associated with QoL, a multivariable analysis revealed three factors that had significant statistical associations with QoL. These were, stage of disease, treatment with radiotherapy and pain levels, all of which were found to have statistically significant relationship with the of quality of life of cancer patients receiving palliative care in Western Uganda. Considering patients with early stage disease as a reference group, patients with advanced stage disease have lower quality of life levels by about 0.6 units ( p = 0.001, 95CI; -0.965 to -0.243) , while those not staged, their quality was lowered by 0.54 units, although it was marginally significant (p = 0.068, 95CI; -1.130 to 0.042). For radiotherapy, the cancer patients who did not received the treatment, their quality of life declined by 0.55 units compared to those who received treatment (p = 0.025, 95CI; -1.033 to -0.071). About pain levels, considering cancer patients with no pain as a reference group, patients with moderate pain tended to have lower quality of life levels by 1.0 units , although this was marginally significant (p = 0.06, 95CI; -2.116 to 0.043 ), those with moderately-severe pain, their quality of life levels declined by 1.6 units (p = 0.04, 95CI; -0.477 to -2.902) , those with severe pain, their quality of life scores reduced by 1.6 units ( p = 0.003, 95CI; -0.474 to -2.999). The most impactful was overwhelming pain where quality of life levels declined by 3.47 units (p < 0.001, 95CI; -4.782 to -2.160). Other variables such as; age, alcohol consumption, socio-economic status, family support, and functional status did not demonstrate statistically significant association with quality of life as their p-values exceeded 0.05 and their 95%Cis included zero (Table 3 ). Table 3 Summary of Multivariable Linear Regression Analysis Results: Predictor B Coefficient 95%CI P value Age -0.001 -0.011 to 0.008 0.773 Alcohol consumption Yes* No -0.029 -0.296 to 0.238 0.830 VHT Yes* No -0.022 -0.354 to 0.310 0.897 Heart disease Yes* No 0.522 -0.335 to 1.378 0.231 Marital status Married* Single Separated Cohabiting Divorced Widow/Widower 0.011 0.220 -0.107 0.317 0.040 -0.464 to 0.486 -0.181 to 0.621 -0.653 to 0.438 -1.423 to 2.053 -0.349 to 0.268 0.962 0.281 0.698 0.720 0.797 Chemotherapy Yes* No -0.363 -0.832 to 0.105 0.128 Radiotherapy Yes* No -0.552 -1.033 to -0.071 0.025 Socioeconomic status Socio-economic class 1* Socio-economic class 2 Socio-economic class 3 Socio-economic class 4 -0.556 -0.540 -0.197 -1.342 to 0.229 -1.141 to 0.060 -0.773 to 0.379 0.164 0.078 0.501 Family support 4 pillars of support* Only 3 pillars of support Only 2 pillars of support Only 1 pillar of support No pillars of support -0.323 -0.360 -0.487 -0.786 -0.892 to 0.246 -1.403 to 0.682 -1.439 to 0.465 -1.771 to 0.199 0.264 0.496 0.314 0.117 Stage of disease Early stage* Advanced stage Not staged -0.604 -0.544 -0.965 to -0.243 -1.130 to 0.042 0.001 0.068 Functional status Grade o* Grade 1 Grade 2 Grade 3 Grade 4 0.060 -0.192 -0.027 0.168 -0.202 to 0.323 -0.896 to 0.512 -0.650 to 0.596 -0.486 to 0.822 0.651 0.591 0.932 0.613 Place of care Hospice* Home Outreach 0.152 -0.140 -0.244 to 0.548 -0.443 to 0.164 0.451 0.366 Pain level No Pain* Mild Pain Moderate Pain Moderate-severe Pain Severe pain Overwhelming Pain -0.538 -1.036 -1.589 -1.618 -3.471 -1.126 to 0.50 -2.116 to 0.043 -2.670 to -0.508 -2.683 to -0.553 -4.782 to -2.160 0.073 0.060 0.004 0.003 0.000 Discussion This is one of the first studies to examine quality of life and its predictors among cancer patients receiving palliative care in Uganda. Our participants were predominantly female 154 (75.5%) and cancer of the cervix was the commonest, followed by cancers of the breast and prostate, which finding is consistent with regional cancer epidemiology in Sub Saharan Africa, including Uganda [ 30 , 31 ]. This study established that adult cancer patients who are under palliative care in Western Uganda suffer from poor quality of life, especially in the symptoms domain but comparatively better in the well-being domain, but still far from optimal. This is consistent with other studies conducted elsewhere in the African setting[ 7 , 11 , 32 ]. The mean QoL in this study is 13.4, which is lower than those reported in the above studies where it was reported at about 17 could be as result of the differences in the study settings and sample sizes. The remarkably low symptom subscale and relatively higher interpersonal/well-being scores mirror patterns across patients receiving palliative care in the developing world, where there is a high physical symptom burden but where interpersonal or relational and spiritual domains are highly valued and sometimes better preserved [ 1 , 11 , 33 ]. With regard to predictors of QoL, three clinical factors; stage of disease, radiotherapy, and pain intensity were the only statistically significant predictors of QoL while socio-demographic factors were not. This can be attributed to the linkage between the three factors and physical and symptom burden of the disease; so they naturally show strong correlations with QoL in palliative and oncological settings [ 34 , 35 ].This finding is consistent with previous studies which showed that clinical severity and symptom burden are key determinants of QoL in cancer disease [ 35 – 40 ]. Advanced or unstaged cancer disease compared to early stage disease leads to a decrease in QoL, with more pain, fatigue, and functional decline. This is because advanced stage disease means higher tumor burden, more metastases, more complications and intensive treatment, all of which heighten the symptom burden and reduce the physical and role function [ 34 , 37 , 41 , 42 ]. It is also reflective of findings of previous studies which showed that QoL declines as the cancer disease progresses [ 37 ]. In Indian and Vietnamese cross-sectional studies, advanced stage disease and poor performance status consistently predict poor QoL, especially across the physical and global domains [ 43 , 44 ]. Patients who did not receive radiotherapy had poorer QoL scores than those who did and this may be explained that cancer-directed treatment including radiotherapy is closely associated with better body function and less symptom burden such as pain and fatigue [ 37 , 43 , 44 ]. Radiotherapy is vital in both early and advanced stages of disease. In early stage, it decimates the tumor size and reduces future symptoms and preserves function [ 45 , 46 ]. In advanced stage disease, this modality of treatment reduces pain and other local symptoms, leading to better physical functioning. This finding is highly collaborated by results from a number of previous studies [ 46 – 48 ]. Patients with higher pain intensity tended to have lower QoL levels. Pain is one of the most frequent and burdensome symptoms in advanced cancer and is negatively correlated with QoL [ 35 ]. Higher pain scores are linked to poor physical functioning, body weakness and limitation in daily activities [ 36 , 39 ] but when pain is well controlled, QoL improves markedly [ 49 ]. This finding is strongly supported by evidence from several studies which show that higher pain severity is a predictor of physical, social, psychological well-being in advanced cancer [ 35 , 36 , 38 , 39 ]. Interventions that reduce pain lead to substantial improvement in QoL scores, even in low-resource settings similar to our study [ 39 , 50 ]. All in all, advanced stage disease diminishes QoL by increasing the disease and symptom burden. Pain intensity directly impacts physical, emotional and social functioning. Radiotherapy affects QoL majorly through its effectiveness in managing tumor-induced symptoms, especially pain. The lack of association between socio-demographic factors such as age, socio-economic status, family support and QoL in this could be as result of having homogeneous samples in which there was an overwhelming symptom burden that overshadowed or attenuated the effect of the socio-demographic factor differences in determining QoL levels. This phenomenon is similar to other studies carried in palliative care settings [ 36 , 38 , 43 ]. Conclusions In this real-world sample of palliative cancer patients attending two specialized care facilities in Western Uganda, overall quality of life (QoL) was significantly poor, primarily due to high symptom burden and advanced disease stages among patients already receiving palliative care. The study found that clinical factors, rather than socio-demographic characteristics, were the main influences on QoL. Specifically, advanced disease stage, higher pain levels, and radiotherapy were significantly linked to QoL outcomes. In contrast, socio-demographic factors did not show a significant impact. This pattern highlights that, in this resource-limited setting, severe symptoms and clinical needs tend to overshadow social factors. Notably, pain intensity emerged as a key modifiable factor affecting QoL, emphasizing the importance of effective pain management and symptom control in palliative care. The association between advanced disease and poorer QoL underscores how disease progression affects physical, psychological, and functional wellbeing. Additionally, access to radiotherapy was linked to better QoL, suggesting that chemo-radiation treatment can still provide symptom relief even in palliative stages. This study provides valuable, context-specific evidence from an under-researched, resource-limited region. By utilizing a standardized QoL measurement and multivariable analysis, it highlights modifiable clinical factors—such as pain, disease stage, and radiotherapy access—that align with regional and global efforts to improve palliative cancer care in low-resource settings. Recommendations Clinical practice Palliative cancer care teams in Western Uganda should focus on proactive control of physical pain and other distressing symptoms. This includes consistent use of WHO stepwise analgesic ladder to ensure that treatment is effective and adjusted as patients’ needs change. Routine assessment for quality of life and common symptoms during clinic visits should become standard practice. This would help clinicians identify patients who are struggling earlier and offer timely, tailored interventions rather than waiting for crises to occur. Radiotherapy should be used earlier and more systematically for symptom relief, for example to manage pain, bleeding, or obstruction. Clear referral pathways and simple eligibility criteria are needed so that patients who could benefit are identified promptly so that they do not miss out due to delays or system barriers. Health system and policy At the health system level, access to essential palliative medicines, particularly opioids, should be strengthened through reliable procurement, robust supply chain management, and supportive regulatory frameworks. There is high need for training, mentorship and supervision of healthcare providers at palliative care facilities to build confidence and skills in assessing QoL, pain and other burdensome symptoms and treating them. Research Future research should include longitudinal studies that track patients over time to observe how QoL evolves with better pain management, earlier palliative care intervention, and improved access to radiotherapy. Strengths This study has several important strengths. It focuses on a real-world group of palliative care cancer patients in Western Uganda, an under-researched setting where evidence is urgently needed. By recruiting patients from routine specialized palliative care services rather than from highly selected trial populations, the study reflects the complex realities of everyday clinical practice in a low-resource context. The use of a standardized, validated quality-of-life tool, together with systematic collection of clinical and socio-demographic data, allows for robust assessment of how different factors relate to patients’ quality of life. Applying multivariable analysis further strengthens the findings by accounting for key confounders. Importantly, the study identifies practical, modifiable clinical predictors—pain, disease stage and access to radiotherapy—that can realistically be targeted within Ugandan and similar health systems. This makes the results directly relevant for guiding improvements in palliative cancer care at both clinical and policy levels. Limitations: This study has some important limitations that should be kept in mind when interpreting the findings. First, its cross-sectional design provides only a single snapshot of patients’ quality of life and clinical status. This means we cannot determine causal relationships or understand how quality of life and symptoms evolve over the course of palliative care, even though the study still offers valuable real-world insight into patients already receiving specialized services. Second, the work was carried out in the only two specialized palliative care facilities in Western Uganda, using a consecutive sample of patients enrolled in these services. While this strengthens the study’s relevance to routine palliative practice in this region, it may limit how far the findings can be generalized to other settings, to people who are not accessing palliative care, or to patients with non-cancer conditions. Finally, although the sample size was sufficient for the main analyses and allowed robust multivariable modeling, it was not large enough to reliably detect smaller differences within subgroups. This underlines the need for larger, longitudinal, multi-center studies—ideally including a broader range of patients and facilities—to confirm and build on these context-specific results and to better track changes in quality of life over time. Abbreviations APCA African Palliative Care Association HAU Hospice Africa Uganda LHH Little Hospice Hoima MHM Mobile Hospice Mbarara MUST Mbarara University of Science and Technology MVQOLI Missoula Vitas Quality of Life Index NGO Non-Governmental Organization QoL Quality of Life REDCAP Research Data Capture WHO World Health Organization Declarations Ethical approval and consent to participate This research was approved by the Research and Ethics Committee of Mbarara University of Science and Technology (MUST-2025-351 and Uganda National Council of Science and Technology (UNCST: HS6248ES). Also, administrative clearance was obtained from Hospice Africa Uganda. Additionally, all data collection processes were aligned to the key principles of the Declaration of Helsinki. Consent for publication Not applicable Availability of data and materials The dataset generated and analyzed for this study are available and can be accessed on request. Please contact [email protected] about the same. Competing interests The authors declare that they have no competing interests. Funding This work was supported by ROAD TO CARE. Authors’ contributions J.B.N lead the research team that conceptualized, executed the study, analyzed the data, wrote and reviewed this manuscript. J.K, E.M and E. N contributed almost equally towards the above facets of this work. Acknowledgements J.B.N acknowledges with gratitude ROAD TO CARE, for supporting his PhD studies including this study . He also appreciates the data collection team of Elizabeth Mbabazi, Francis Nagujja, Miriel Kabigarire, Sheila Kukundakwe, Nahabwe Charlotte, Ivan Kalyango, Rashida Nalule and Kobusinge Mildred for the fabulous work done. Special thanks to Andrew Christopher Wesuta for designing the database of the study and continuous information and technological support to the team throughout the entire process. References Gayatri D, Efremov L, Kantelhardt EJ, Mikolajczyk R. Quality of life of cancer patients at palliative care units in developing countries: systematic review of the published literature. Qual Life Res, 30, pp. 315–43, 2021/02/01 2021. Qan’ir Y, Guan T, Idiagbonya E, Dobias C, Conklin JL, Zimba CC, et al. Quality of life among patients with cancer and their family caregivers in the Sub-Saharan region: A systematic review of quantitative studies. PLOS global public health. 2022;2:e0000098. Bray F, Parkin DM, Gnangnon F, Tshisimogo G, Peko J-F, Adoubi I, et al. 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Anticipated help seeking behaviour and barriers to seeking care for possible breast and cervical cancer symptoms in Uganda and South Africa, ecancermedicalscience , vol. 15, p. 1171, 2021. Musekiwa A, Moyo M, Mohammed M, Matsena-Zingoni Z, Twabi HS, Batidzirai JM, et al. Mapping evidence on the burden of breast, cervical, and prostate cancers in Sub-Saharan Africa: a scoping review. Front Public Health. 2022;10:908302. Orindi O. Ad, amimo fa. socio-demographic characteristics associated with quality of life-scores among palliative care cancer patients in kenya. J Community Med Public Health, 5, 2021. Ahlam A, Hind M, Haddou Rahou B, Rachid R, Hassan E. Quality of life of Moroccan patients on the palliative phase of advanced cancer. BMC Res Notes. 2019;12:351. Chung KC, Muthutantri A, Goldsmith GG, Watts MR, Brown AE, Patrick DL. Symptom impact and health-related quality of life (HRQoL) assessment by cancer stage: a narrative literature review. BMC Cancer. 2024;24:884. Costa MFFD, Bilobran MA, de Oliveira LC, Muniz AHR, Chelles PA, d. SG, Sampaio SM. Correlation between cancer pain and quality of life in patients with advanced cancer admitted to a palliative care unit. Am J Hospice Palliat Medicine®. 2024;41:882–8. Verkissen MN, Hjermstad MJ, Van Belle S, Kaasa S, Deliens L, Pardon K. Quality of life and symptom intensity over time in people with cancer receiving palliative care: Results from the international European Palliative Care Cancer Symptom study. PLoS ONE. 2019;14:e0222988. Dixit J, Gupta N, Kataki A, Roy P, Mehra N, Kumar L, et al. Health-related quality of life and its determinants among cancer patients: evidence from 12,148 patients of Indian database. Health Qual Life Outcomes. 2024;22:26. Gayatri D, Efremov L, Mikolajczyk R, Kantelhardt EJ. Quality of life assessment and pain severity in breast cancer patients prior to palliative oncology treatment in Indonesia: A cross-sectional study. Patient Prefer Adherence, pp. 2017–26, 2021. Sarkar SR, Bhuiyan AMR, Alam A, Chowdhury MK. Impact of pain on the quality of life of advanced cancer patients in a palliative care setup in Bangladesh, Medicine , vol. 104, p. e44176, 2025. Jacob J, Palat G, Verghese N, Chandran P, Rapelli V, Kumari S, et al. Health-related quality of life and its socio-economic and cultural predictors among advanced cancer patients: evidence from the APPROACH cross-sectional survey in Hyderabad-India. BMC Palliat care. 2019;18:94. Shahjalal M, Sultana M, Gow J, Hoque ME, Mistry SK, Hossain A, et al. Assessing health-related quality of life among cancer survivors during systemic and radiation therapy in Bangladesh: a cancer-specific exploration. BMC Cancer. 2023;23:1208. Allner M, Rak A, Balk M, Rupp R, Almajali O, Tamse H, et al. Patient-reported outcomes in head and neck cancer: a cross-sectional analysis of quality of life domains across early and advanced UICC stages. Support Care Cancer. 2025;33:278. Huyen BT, Van Anh PT, Duong LD, The THN, Guo P, Van Thuc P, et al. Quality of life among advanced cancer patients in Vietnam: a multicenter cross-sectional study. Support Care Cancer. 2021;29:4791–8. Lam K, Chow E, Zhang L, Wong E, Bedard G, Fairchild A, et al. Determinants of quality of life in advanced cancer patients with bone metastases undergoing palliative radiation treatment. Support Care Cancer. 2013;21:3021–30. Liao K-C, Chuang H-C, Chien C-Y, Lin Y-T, Tsai M-H, Su Y-Y et al. , ., Quality of life as a mediator between cancer stage and long-term mortality in nasopharyngeal cancer patients treated with intensity-modulated radiotherapy, Cancers, vol. 13, p. 5063, 2021. van der Weijst L, Azria D, Berkovic P, Boisselier P, Briers E, Bultijnck R, et al. The correlation between pre-treatment symptoms, acute and late toxicity and patient-reported health-related quality of life in non-small cell lung cancer patients: Results of the REQUITE study. Radiother Oncol. 2022;176:127–37. Yucel B, Akkaş EA, Okur Y, Eren AA, Eren MF, Karapınar H, et al. The impact of radiotherapy on quality of life for cancer patients: a longitudinal study. Support Care Cancer. 2014;22:2479–87. Cañon V, Gomez-Iturriaga A, Casquero F, Rades D, Navarro A, Del Hoyo O, et al. Quality of life improvement in patients with bone metastases undergoing palliative radiotherapy. Rep practical Oncol radiotherapy. 2022;27:428–39. Shih H-H, Chang H-J, Huang T-W. Effects of early palliative care in advanced cancer patients: a meta-analysis. Am J Hospice Palliat Medicine®. 2022;39:1350–7. Wang M, Ding X. Integrated palliative care improves the quality of life of advanced cancer patients. BMC Palliat Care. 2025;24:162. Additional Declarations No competing interests reported. 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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-9427937","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":633594299,"identity":"e1e6f781-a967-431a-b2a8-55e681eb145e","order_by":0,"name":"John Bosco Ndinawe","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA4ElEQVRIiWNgGAWjYFCCxAYQaWB/vPkAkJaQIV4Lw5ljCSAtPERoSWCAaLmRYwBiENZizp7c9uBnm40xY8+Zz69u1FjwMLAfProBnxbLnofthr1taWbM7L3brHOOAR3Gk5Z2A58WgxuJbRK82w7bsPGc3WacwwbUIsFjRlCL5N9t/214JHKeGef8I1KLNO+2A2YSEjnMj3PbiNFy5mGbtOy/ZGMDnmNmzLl9EjxsBP1yPP2Z5JszdoYb2Jsff875VifHz374GF4tyIBNAkwSqxwEmD+QonoUjIJRMApGDgAAQRBKCOf+AZwAAAAASUVORK5CYII=","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":true,"prefix":"","firstName":"John","middleName":"Bosco","lastName":"Ndinawe","suffix":""},{"id":633594300,"identity":"93028aed-60da-4a22-8126-2f875db388e9","order_by":1,"name":"Jerome Kabakyenga","email":"","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Jerome","middleName":"","lastName":"Kabakyenga","suffix":""},{"id":633594301,"identity":"64f95de4-0482-48d7-93ff-fef3bbb71ed1","order_by":2,"name":"Elizabeth Namukwaya","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"prefix":"","firstName":"Elizabeth","middleName":"","lastName":"Namukwaya","suffix":""},{"id":633594302,"identity":"d3e65602-e7fa-4f60-9675-13a6baa0c35f","order_by":3,"name":"Edgar Mugema Mulogo","email":"","orcid":"","institution":"Mbarara University of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Edgar","middleName":"Mugema","lastName":"Mulogo","suffix":""}],"badges":[],"createdAt":"2026-04-15 13:53:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9427937/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9427937/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108734679,"identity":"66325aec-c409-40f4-aaa4-5aa5154975d9","added_by":"auto","created_at":"2026-05-07 19:55:02","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":62948,"visible":true,"origin":"","legend":"\u003cp\u003eCancer Diagnosis\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9427937/v1/5bd6c92cf365a0803a9dca48.png"},{"id":108806569,"identity":"33ae3e0a-1c1b-4f70-a724-1eedce68132d","added_by":"auto","created_at":"2026-05-08 15:28:56","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":528672,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9427937/v1/ef6a13f8-94ef-496e-bde7-93b608f10515.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Quality of life and associated factors among cancer patients receiving palliative care in Western Uganda: a cross-sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003eGlobally, cancer is a leading cause morbidity and mortality, and this burden is increasingly becoming prominent in low- and middle-income nations, especially those in sub-Saharan Africa (SSA) such as Uganda [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In 2020 SSA had over 800,000 new cases and 520,000 deaths and this public health load is projected to more than double by 2040 [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Uganda registers over 32,000 new cases and over 21,000 deaths annually [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. In these settings many of these patients present with advanced, incurable and progressive disease characterized by limited management modalities, making palliative care (PC) a pertinent component of cancer care [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe World Health Organization (WHO) defines palliative care as \u0026ldquo;an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual\u0026rdquo;[\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe main focus of palliative care is to ameliorate quality of life (QoL) through addressing multifaceted problems of the patients and their families [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. QoL is a foundational outcome in cancer care and WHO define it as \u003cem\u003e\u0026ldquo;\u003c/em\u003eindividuals\u0026rsquo; perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns\u0026rdquo; [\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. It is a broad spectrum multi-dimensional concept that is influenced by a number of factors; physical, social, psychological as well as spiritual [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn African palliative care settings, a number of patients are found to have low to moderate QoL, especially in the physical and psychological domains [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In Uganda, majority of adult cancer patients experience a decline in physical (79%) and psychological (61%) functioning and hence low QoL levels, highlighting a huge indicator of unmet needs for palliative care[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdditionally, several systematic reviews about QoL for cancer patients in the developing world have shown that it is highly influenced by factors such as; marital status, education levels, symptom burden, depression, social support and age and that these factors can be modified through better clinical, psychological and spiritual care [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Unfortunately, QoL and its determinants among cancer patients in Africa including Western Uganda remain largely under-researched, which hinders proper planning and implementation of palliative in the region [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn view of the above, this study therefore, aimed to assess the level of QoL and associated factors among cancer patients receiving palliative care in Western Uganda. This was justified to quantify the outcome and reveal modifiable determinants and ultimately support evaluation and improvement of palliative care in the region.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eSetting\u003c/p\u003e \u003cp\u003eThis study was carried out from Little Hospice Hoima (LHH) and Mobile Hospice Mbarara (MHM), both of which are located in Western Uganda. The two health facilities are branches of Hospice Africa Uganda (HAU), a non-governmental organization (NGO) that provides specialized palliative care at a tertiary level (level 3) as per the African Palliative Care Association (APCA) standards of 2011. to patients with life-limiting illnesses such as cancer. Since their establishment in 1998, both facilities have cared for over 50,000 patients and currently 815 patients are on their program, 80% of whom have a diagnosis of cancer (HAU 2025). HAU provides a spectrum of services that include; pain and symptom management across physical psychosocial and spiritual domains. It also provides bereavement support and daycare services for both patients and their families. This care is offered through home-based care, outreach clinics and at the facilities.\u003c/p\u003e \u003cp\u003eStudy design and participants\u003c/p\u003e \u003cp\u003eThis was a facility-based cross-sectional study carried among 204 cancer patients who received care from Mobile Hospice Mbarara and Little Hospice Hoima from September to November 2025 through the above modalities of care. Participants were considered eligible if they had a diagnosis of cancer, were 18 years or older, had been on palliative care program for 30 days or more and were willing to participate in the study. Participants were excluded if they were not willing to take part in the study, were too sick to participate or were unable to communicate verbally.\u003c/p\u003e \u003cp\u003eSample size estimation\u003c/p\u003e \u003cp\u003eThe above sample size of 204 cancer patients was estimated by use of Yamane\u0026rsquo;s formula (1967) for finite populations. This formula is widely used is survey studies when the population size is known and a specific margin of error is targeted [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSampling technique\u003c/p\u003e \u003cp\u003eWe employed a consecutive sampling technique at the study sites. A database of patients at each of the two facilities was used to identify all the eligible participants who were sequentially consented and enrolled into the study until the required sample size was attained.\u003c/p\u003e \u003cp\u003eData collection\u003c/p\u003e \u003cp\u003eData were collected using a pretested structured questionnaire that was programmed and administered through the Research and Data Capture software (REDCAP) version 5[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] by 3 trained research assistants at each of the 2 study sites. The data collection tool had 3 sections: 1) Patients\u0026rsquo; socio-demographics, 2) medical/clinical information 3) QoL assessment using the Missoula Vitas Quality of Life Index (MVQOLI-15R). This tool, developed by Byock et al at first as a 25-item tool, with five dimensions of: function, symptom, interpersonal (social), well-being (psychological), transcendence (existential and spiritual issues) but was later revised to 15-item tool with similar dimensions/domains [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The MVQOLI-15R is specifically designed to assess the personal experiences of patients in each of the 5 domains and for the very reason, the individual items are phrased in a very subjective way where scores are not awarded to questions seen by the patient. In each of the 5 dimensions, patients provide 3 pieces of information to capture their overall experience: Assessment, which is a subjective measure of the current status or circumstance (rate from \u0026minus;\u0026thinsp;2 to +\u0026thinsp;2), Satisfaction, which measures the level of acceptance of the current status or circumstance (rated from-4 to +\u0026thinsp;4) and Importance, which indicates the extent to which a specific dimension influences the overall quality of life (rated\u0026thinsp;+\u0026thinsp;1 to +\u0026thinsp;5). The tool generates both raw/unweighted scores and weighted scores. The unweighted dimensional scores are obtained by adding the Assessment and Satisfaction scores and they range from \u0026minus;\u0026thinsp;6 to +\u0026thinsp;6 while the weighted dimensional scores are calculated as the product of the above unweighted scores and the Importance score and they range from \u0026minus;\u0026thinsp;30 to +\u0026thinsp;30. The total QoL is derived by summing all the five weighted dimensional scores, dividing them by 10, and then adding 15 to the resultant quotient. This variable ranges from 0 to +\u0026thinsp;30, as the worst and best QoL levels possible. The instrument includes a single item on quality-of-life status (Global score) for assessing convergent validity purposes and it ranges from +\u0026thinsp;1 to +\u0026thinsp;5 for the worst and best possible scores. Additionally, this tool has adequate internal consistency (α\u0026thinsp;=\u0026thinsp;0.77) and construct validity (r\u0026thinsp;=\u0026thinsp;0.43) [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] and it has been validated and used to assess QoL in a number of studies in SSA and Uganda [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The entire data collection instrument was in English but was translated to Runyankore and Runyoro for application in Mbarara and Hoima respectively.\u003c/p\u003e \u003cp\u003eData Management and analysis\u003c/p\u003e \u003cp\u003eData was exported from REDCAP to excel software as a password protected dataset where its completeness was ascertained and cleaned. It was then exported to SPSS software version 25 for analysis. Descriptive statistics (frequencies, percentages, means, medians and interquartile range) were used to summarize participant characteristics and pertinent study variables including QoL. Also, bivariate and multi-variable analysis was conducted to identify key factors associated with QoL utilizing suitable statistical tests.\u003c/p\u003e \u003cp\u003eEthical considerations\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eInformed consent\u003c/strong\u003e \u003cp\u003ewas sought and obtained from all study participants before they could be enrolled into the study. Ethical approval was sought and granted from the Research and Ethics Committee of Mbarara University of Science and Technology (MUST-2025-351 and Uganda National Council of Science and Technology (UNCST: HS6248ES). Also, administrative clearance was obtained from Hospice Africa Uganda. In order to protect privacy, data were collected and stored in de-identified form, with personal identifiers kept separate from research data and accessible only to authorized study personnel. Additionally, all data collection processes were aligned to the key principles of the Declaration of Helsinki [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eSocio-demographic characteristics of the study participants.\u003c/p\u003e\n\u003cp\u003eOver a period of 12 weeks, we recruited 204 patients across the 2 study sites. None of the participants requested declined to take part in the study. Slightly less than three-quarters of the participants (147, 72.1%) were recruited from MHM.\u003c/p\u003e\n\u003cp\u003eTable \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the participants\u0026rsquo; socio-demographic characteristics. The mean and standard deviation of their ages was 58.8 and 15.2 years respectively. Slightly more than three quarters of the number of participants (154, 75.5%) were female. Just over a half the number of participants (112, 59.8%) had attained primary level of education and above. A tad more than half the number of participants (119, 58.3%) were banyankore by tribe and also about half (92, 45.1) were married. Just over three quarters of them (163, 79.9%) reported no history of smoking and slightly more than half of them (131, 64.2%) did not consume alcohol. Just over half of them (107, 52.5%) were of socio-economic class 4 and worse. Only about one eighth of the participants (26, 12.7%) stated that they had total family support. A little more than half of them (117, 57.4%) receive care from hospice sites. Slightly less than one quarter (46, 22.5%) received support from the village health teams (VHTs).\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u0026nbsp;\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eDemographic Characteristics of Study Participants by Site\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\" style=\"width: 61.3122%;\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003eSite 1 (MHM) (n\u0026thinsp;=\u0026thinsp;147)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eSite 2 (LHH) (n\u0026thinsp;=\u0026thinsp;57)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eTotal (n\u0026thinsp;=\u0026thinsp;204)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" style=\"width: 61.3122%;\"\u003e\n \u003cp\u003eAge(years) Mean (Sd)\u003c/p\u003e\n \u003cp\u003eMedian (IQR)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e59.7(16.2)\u003c/p\u003e\n \u003cp\u003e60.0(23)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e56.5(11.8)\u003c/p\u003e\n \u003cp\u003e56.0(14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e58.8(15.2)\u003c/p\u003e\n \u003cp\u003e60.0(18.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" style=\"width: 61.3122%;\"\u003e\n \u003cp\u003eGender: Counts (%)\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e103(70.1)\u003c/p\u003e\n \u003cp\u003e44(29.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e51(89.5)\u003c/p\u003e\n \u003cp\u003e6(10.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e154(75.5)\u003c/p\u003e\n \u003cp\u003e50(24.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" style=\"width: 61.3122%;\"\u003e\n \u003cp\u003eEducation Level: Counts (%)\u003c/p\u003e\n \u003cp\u003eNo Formal Education\u003c/p\u003e\n \u003cp\u003ePrimary Level\u003c/p\u003e\n \u003cp\u003eOrdinary level secondary\u003c/p\u003e\n \u003cp\u003eAdvanced level secondary\u003c/p\u003e\n \u003cp\u003eTertiary level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e59(40.1)\u003c/p\u003e\n \u003cp\u003e69(46.9)\u003c/p\u003e\n \u003cp\u003e11(7.5)\u003c/p\u003e\n \u003cp\u003e2(1.4)\u003c/p\u003e\n \u003cp\u003e6(4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e23(40.4)\u003c/p\u003e\n \u003cp\u003e24(42.1)\u003c/p\u003e\n \u003cp\u003e7(12.3)\u003c/p\u003e\n \u003cp\u003e2(3.5)\u003c/p\u003e\n \u003cp\u003e1(1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e82(40.2)\u003c/p\u003e\n \u003cp\u003e93(45.6)\u003c/p\u003e\n \u003cp\u003e18(8.8)\u003c/p\u003e\n \u003cp\u003e4(2)\u003c/p\u003e\n \u003cp\u003e7(3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" style=\"width: 61.3122%;\"\u003e\n \u003cp\u003eTribe: Counts (%)\u003c/p\u003e\n \u003cp\u003eBanyankore\u003c/p\u003e\n \u003cp\u003eBaganda\u003c/p\u003e\n \u003cp\u003eBanyoro\u003c/p\u003e\n \u003cp\u003eBatooro\u003c/p\u003e\n \u003cp\u003eBakiga\u003c/p\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e116(78.9)\u003c/p\u003e\n \u003cp\u003e6(4.1)\u003c/p\u003e\n \u003cp\u003e1(0.7)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e18(12.2)\u003c/p\u003e\n \u003cp\u003e6(4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e3(5.3)\u003c/p\u003e\n \u003cp\u003e5(8.8)\u003c/p\u003e\n \u003cp\u003e34(59.6)\u003c/p\u003e\n \u003cp\u003e1(1.8)\u003c/p\u003e\n \u003cp\u003e6(10.5)\u003c/p\u003e\n \u003cp\u003e8(14.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e119(58.3)\u003c/p\u003e\n \u003cp\u003e11(5.4)\u003c/p\u003e\n \u003cp\u003e35(17.2)\u003c/p\u003e\n \u003cp\u003e1(0.5)\u003c/p\u003e\n \u003cp\u003e24(11.8)\u003c/p\u003e\n \u003cp\u003e14(6.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" style=\"width: 61.3122%;\"\u003e\n \u003cp\u003eReligion: Counts (%)\u003c/p\u003e\n \u003cp\u003eChristian\u003c/p\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e141(95.9)\u003c/p\u003e\n \u003cp\u003e6(4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e54(94.7)\u003c/p\u003e\n \u003cp\u003e3(5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e195(95.6)\u003c/p\u003e\n \u003cp\u003e9(4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" style=\"width: 61.3122%;\"\u003e\n \u003cp\u003eMarital Status: Counts (%)\u003c/p\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003cp\u003eSeparated\u003c/p\u003e\n \u003cp\u003eCohabiting\u003c/p\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003cp\u003eWidow/widower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e69(46.9)\u003c/p\u003e\n \u003cp\u003e15(10.2)\u003c/p\u003e\n \u003cp\u003e19(12.9)\u003c/p\u003e\n \u003cp\u003e10(6.8)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e34(23.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e23(40.4)\u003c/p\u003e\n \u003cp\u003e3(5.3)\u003c/p\u003e\n \u003cp\u003e11(19.3)\u003c/p\u003e\n \u003cp\u003e3(5.3)\u003c/p\u003e\n \u003cp\u003e1(1.8)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e16(28.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e92(45.1)\u003c/p\u003e\n \u003cp\u003e18(8.8)\u003c/p\u003e\n \u003cp\u003e30(14.7)\u003c/p\u003e\n \u003cp\u003e13(6.4)\u003c/p\u003e\n \u003cp\u003e1(0.5)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e50(24.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" style=\"width: 61.3122%;\"\u003e\n \u003cp\u003eSmoking History: Counts (%)\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e36(24.5)\u003c/p\u003e\n \u003cp\u003e111(75.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e5(8.80\u003c/p\u003e\n \u003cp\u003e52(91.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e41(20.1)\u003c/p\u003e\n \u003cp\u003e163(79.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" style=\"width: 61.3122%;\"\u003e\n \u003cp\u003eAlcohol Consumption: Counts (%)\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e56(61.9)\u003c/p\u003e\n \u003cp\u003e91(38.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e17(29.8)\u003c/p\u003e\n \u003cp\u003e40(70.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e73(35.8)\u003c/p\u003e\n \u003cp\u003e131(64.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" style=\"width: 61.3122%;\"\u003e\n \u003cp\u003eSocio-economic Status: Counts (%)\u003c/p\u003e\n \u003cp\u003eClass 1\u003c/p\u003e\n \u003cp\u003eClass 2\u003c/p\u003e\n \u003cp\u003eClass 3\u003c/p\u003e\n \u003cp\u003eClass 4\u003c/p\u003e\n \u003cp\u003eClass 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e7(4.8)\u003c/p\u003e\n \u003cp\u003e63(42.9)\u003c/p\u003e\n \u003cp\u003e71(48.3)\u003c/p\u003e\n \u003cp\u003e6(4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e4(7)\u003c/p\u003e\n \u003cp\u003e23(40.4)\u003c/p\u003e\n \u003cp\u003e25(43.9)\u003c/p\u003e\n \u003cp\u003e5(8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e11(5.4)\u003c/p\u003e\n \u003cp\u003e86((42.2)\u003c/p\u003e\n \u003cp\u003e96(47.1)\u003c/p\u003e\n \u003cp\u003e11(5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" style=\"width: 61.3122%;\"\u003e\n \u003cp\u003eOccupation: Count (%)\u003c/p\u003e\n \u003cp\u003e1-Professionals with first class jobs, govt officials, prominent business persons etc. with an income of \u0026gt;3m/month\u003c/p\u003e\n \u003cp\u003e2-Professionals with middle level jobs, senior religious leaders and ordinary business persons (income of \u0026lt;3m/month)\u003c/p\u003e\n \u003cp\u003e3-Small business owners, junior religious leaders, etc. (income of 0.5-2m/month)\u003c/p\u003e\n \u003cp\u003e4-Peasant farmers, petty traders (Income of \u0026lt;\u0026thinsp;0.5m)\u003c/p\u003e\n \u003cp\u003e5-No income; destitute\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e6(4.1)\u003c/p\u003e\n \u003cp\u003e13(8.8)\u003c/p\u003e\n \u003cp\u003e122(83.0)\u003c/p\u003e\n \u003cp\u003e6(4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e4(7.0)\u003c/p\u003e\n \u003cp\u003e8(14.0)\u003c/p\u003e\n \u003cp\u003e33(57.9)\u003c/p\u003e\n \u003cp\u003e12(21.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003cp\u003e10(4.9)\u003c/p\u003e\n \u003cp\u003e21(10.3)\u003c/p\u003e\n \u003cp\u003e155(76.0)\u003c/p\u003e\n \u003cp\u003e18(8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" style=\"width: 61.3122%;\"\u003e\n \u003cp\u003eFamily Support (Financial, moral, social and spiritual): Counts (%)\u003c/p\u003e\n \u003cp\u003eTotal Support\u003c/p\u003e\n \u003cp\u003e3 of the above 4 pillars\u003c/p\u003e\n \u003cp\u003e2 of the above 4 pillars\u003c/p\u003e\n \u003cp\u003e1 of the above 4 pillars\u003c/p\u003e\n \u003cp\u003eNo support at all\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e21(14.3)\u003c/p\u003e\n \u003cp\u003e22(15)\u003c/p\u003e\n \u003cp\u003e40(27.2)\u003c/p\u003e\n \u003cp\u003e59(40.1)\u003c/p\u003e\n \u003cp\u003e5(3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e5(8.8)\u003c/p\u003e\n \u003cp\u003e16(28.1)\u003c/p\u003e\n \u003cp\u003e30(52.6)\u003c/p\u003e\n \u003cp\u003e6(10.5)\u003c/p\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e26(12.7)\u003c/p\u003e\n \u003cp\u003e38(18.6)\u003c/p\u003e\n \u003cp\u003e70(34.3)\u003c/p\u003e\n \u003cp\u003e65(31.9)\u003c/p\u003e\n \u003cp\u003e5(2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" style=\"width: 61.3122%;\"\u003e\n \u003cp\u003ePlace of care: Counts (%)\u003c/p\u003e\n \u003cp\u003eHospice\u003c/p\u003e\n \u003cp\u003eHome\u003c/p\u003e\n \u003cp\u003eOutreach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e93(63.3)\u003c/p\u003e\n \u003cp\u003e23(15.6)\u003c/p\u003e\n \u003cp\u003e31(21.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e24(42.1)\u003c/p\u003e\n \u003cp\u003e1(1.8)\u003c/p\u003e\n \u003cp\u003e32(56.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e117(57.4)\u003c/p\u003e\n \u003cp\u003e24(11.8)\u003c/p\u003e\n \u003cp\u003e63(30.90\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" style=\"width: 61.3122%;\"\u003e\n \u003cp\u003eVillage Health team involvement: Counts (%)\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\" style=\"width: 14.7059%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e11(7.5)\u003c/p\u003e\n \u003cp\u003e136(92.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e35(61.5)\u003c/p\u003e\n \u003cp\u003e22(38.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e46(22.5)\u003c/p\u003e\n \u003cp\u003e158(77.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eCancer disease-related Information of the study participants\u003c/p\u003e\n\u003cp\u003eThe most prevalent cancer diagnoses among the study participants were cancer of the cervix (101, 49.5%), cancer o of the breast (20, 9.8%) and cancer of the prostate (19, 9.3%), Fig. \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003eTable \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e describe some of the key variables of the study participants. The mean score of the medication adherence levels as measured by the Morisky medication Adherence Scale (MMAS)[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e], was 5.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.77. A tad more than half the number of participants (105,51.5%) had early stage disease. Slightly more than half their number (116, 56.8%) had at least one comorbidity condition such as heart disease, renal disease, hypertension, HIV/AIDS and diabetes. Almost a similar number (113, 55.4%) had been on palliative care program for more than a year. About pain, only (28, 13.7%) were not in any physical pain, with the rest having various levels of pain ranging from mild to overwhelming pain as assessed using the Numerical Rating Scale (NRS)[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. In terms of their functional status which was assessed using the Eastern Oncological Group Scale (ECOG) [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], about three-quarters of them (156, 76.5%) were grade or better. Related to cancer treatment received, 140(68.6%) had received chemotherapy, 91(44.6%) received radiotherapy, 48(23.5%) were done surgery on, 41(20.1%) were treated with herbal medicine while 34(16.7%) did not receive any of the above treatment modalities.\u003c/p\u003e\n\u003cp\u003eQuality of Life levels:\u003c/p\u003e\n\u003cp\u003eThe mean total weighted QoL score for the study participants was 13.44\u0026thinsp;\u0026plusmn;\u0026thinsp;1.62 with a 95 CI of 13.22 to 13.67. The weighted dimensional mean scores were also calculated and they ranged from \u0026minus;\u0026thinsp;6.78\u0026thinsp;\u0026plusmn;\u0026thinsp;9.42, 95CI -8.08 to -5.48 for the symptom subscale to 1.31\u0026thinsp;\u0026plusmn;\u0026thinsp;4.63, 95CI 0.67to 1.95 for the well-being subscale (Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u0026nbsp;\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eQuality of Life (QOL) Scores of Participants by Site\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003eMVQOLI Mean [95%CI] (Sd)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003eSite 1, MHM, n\u0026thinsp;=\u0026thinsp;147\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003eSite 2, LHH, n\u0026thinsp;=\u0026thinsp;57\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eTotal, n\u0026thinsp;=\u0026thinsp;204\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eGlobal Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e3.51[3.35 to 3.67] (0.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e3.37[3.24 to 3.50] (0.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e3.47 [3.35 to 3.59] (0.88)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeighted Symptom subscale score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e-7.21[-8.85 to -5.57] (10.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e-5.68[-7.65 to -3.72] (7.41)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e-6.78 [-8.08 to-5.48] (9.42)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeighted Function Subscale Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e-2.35[-3.00 to -1.70] (3.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e-2.86 [-3.86 to -1.86] (3.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e-2.50 [-3.04 to -1.95] (3.93)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeighted Interpersonal Subscale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e-3.27[-4.11 to -2.44] (5.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e-5.91 [-7.15 to -4.68] (4.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e-4.01[-4.72 to -3.30] (5.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeighted Well-being Subscale score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e1.39 [0.74 to 2.05] (4.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e-1.09[-0.5 to 2.68] (5.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e1.31 [0.67 to 1.95] (4.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eWeighted Transcendence Subscale score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e-2.99 [-3.87 to -2.12] (5.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e-4.91[-6.27 to -3.55] (5.13)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e-3.53[-4.27 to -2.79] (5.37)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal QOL Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\"\u003e\n \u003cp\u003e13.56 [13.29 to 13.83] (1.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e13.17 [12.77 to 13.83] (1.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e13.44 [13.22 to 13.67] (1.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003ePredictors of Quality of Life (QoL)\u003c/p\u003e\n\u003cp\u003eWith regard to factors associated with QoL, a multivariable analysis revealed three factors that had significant statistical associations with QoL. These were, stage of disease, treatment with radiotherapy and pain levels, all of which were found to have statistically significant relationship with the of quality of life of cancer patients receiving palliative care in Western Uganda.\u003c/p\u003e\n\u003cp\u003eConsidering patients with early stage disease as a reference group, patients with advanced stage disease have lower quality of life levels by about 0.6 units (\u003cstrong\u003ep\u0026thinsp;=\u0026thinsp;0.001, 95CI; -0.965 to -0.243)\u003c/strong\u003e, while those not staged, their quality was lowered by 0.54 units, although it was marginally significant \u003cstrong\u003e(p\u0026thinsp;=\u0026thinsp;0.068, 95CI; -1.130 to 0.042).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor radiotherapy, the cancer patients who did not received the treatment, their quality of life declined by 0.55 units compared to those who received treatment \u003cstrong\u003e(p\u0026thinsp;=\u0026thinsp;0.025, 95CI; -1.033 to -0.071).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAbout pain levels, considering cancer patients with no pain as a reference group, patients with moderate pain tended to have lower quality of life levels by \u003cstrong\u003e1.0 units\u003c/strong\u003e, although this was marginally significant \u003cstrong\u003e(p\u0026thinsp;=\u0026thinsp;0.06, 95CI; -2.116 to 0.043\u003c/strong\u003e), those with moderately-severe pain, their quality of life levels declined by \u003cstrong\u003e1.6 units (p\u0026thinsp;=\u0026thinsp;0.04, 95CI; -0.477 to -2.902)\u003c/strong\u003e, those with severe pain, their quality of life scores reduced by \u003cstrong\u003e1.6 units ( p\u0026thinsp;=\u0026thinsp;0.003, 95CI; -0.474 to -2.999).\u003c/strong\u003e The most impactful was overwhelming pain where quality of life levels declined by \u003cstrong\u003e3.47 units (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001, 95CI; -4.782 to -2.160).\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOther variables such as; age, alcohol consumption, socio-economic status, family support, and functional status did not demonstrate statistically significant association with quality of life as their p-values exceeded 0.05 and their 95%Cis included zero (Table \u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003cbr\u003e\u003c/div\u003e\u0026nbsp;\u0026nbsp;\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSummary of Multivariable Linear Regression Analysis Results:\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colname=\"c1\" style=\"width: 38.9424%;\"\u003e\n \u003cp\u003ePredictor\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c2\" style=\"width: 22.1153%;\"\u003e\n \u003cp\u003eB Coefficient\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e95%CI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" style=\"width: 38.9424%;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c2\" style=\"width: 22.1153%;\"\u003e\n \u003cp\u003e-0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e-0.011 to 0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\n \u003cp\u003e0.773\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" style=\"width: 38.9424%;\"\u003e\n \u003cp\u003eAlcohol consumption\u003c/p\u003e\n \u003cp\u003eYes*\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\" style=\"width: 22.1153%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e-0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e-0.296 to 0.238\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e0.830\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" style=\"width: 38.9424%;\"\u003e\n \u003cp\u003eVHT\u003c/p\u003e\n \u003cp\u003eYes*\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\" style=\"width: 22.1153%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e-0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e-0.354 to 0.310\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e0.897\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" style=\"width: 38.9424%;\"\u003e\n \u003cp\u003eHeart disease\u003c/p\u003e\n \u003cp\u003eYes*\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\" style=\"width: 22.1153%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e0.522\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e-0.335 to 1.378\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e0.231\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" style=\"width: 38.9424%;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003cp\u003eMarried*\u003c/p\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003cp\u003eSeparated\u003c/p\u003e\n \u003cp\u003eCohabiting\u003c/p\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003cp\u003eWidow/Widower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\" style=\"width: 22.1153%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e0.011\u003c/p\u003e\n \u003cp\u003e0.220\u003c/p\u003e\n \u003cp\u003e-0.107\u003c/p\u003e\n \u003cp\u003e0.317\u003c/p\u003e\n \u003cp\u003e0.040\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e-0.464 to 0.486\u003c/p\u003e\n \u003cp\u003e-0.181 to 0.621\u003c/p\u003e\n \u003cp\u003e-0.653 to 0.438\u003c/p\u003e\n \u003cp\u003e-1.423 to 2.053\u003c/p\u003e\n \u003cp\u003e-0.349 to 0.268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e0.962\u003c/p\u003e\n \u003cp\u003e0.281\u003c/p\u003e\n \u003cp\u003e0.698\u003c/p\u003e\n \u003cp\u003e0.720\u003c/p\u003e\n \u003cp\u003e0.797\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" style=\"width: 38.9424%;\"\u003e\n \u003cp\u003eChemotherapy\u003c/p\u003e\n \u003cp\u003eYes*\u003c/p\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\" style=\"width: 22.1153%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e-0.363\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e-0.832 to 0.105\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e0.128\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" style=\"width: 38.9424%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRadiotherapy\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eYes*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\" style=\"width: 22.1153%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-0.552\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-1.033 to -0.071\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.025\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" style=\"width: 38.9424%;\"\u003e\n \u003cp\u003eSocioeconomic status\u003c/p\u003e\n \u003cp\u003eSocio-economic class 1*\u003c/p\u003e\n \u003cp\u003eSocio-economic class 2\u003c/p\u003e\n \u003cp\u003eSocio-economic class 3\u003c/p\u003e\n \u003cp\u003eSocio-economic class 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\" style=\"width: 22.1153%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e-0.556\u003c/p\u003e\n \u003cp\u003e-0.540\u003c/p\u003e\n \u003cp\u003e-0.197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e-1.342 to 0.229\u003c/p\u003e\n \u003cp\u003e-1.141 to 0.060\u003c/p\u003e\n \u003cp\u003e-0.773 to 0.379\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e0.164\u003c/p\u003e\n \u003cp\u003e0.078\u003c/p\u003e\n \u003cp\u003e0.501\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" style=\"width: 38.9424%;\"\u003e\n \u003cp\u003eFamily support\u003c/p\u003e\n \u003cp\u003e4 pillars of support*\u003c/p\u003e\n \u003cp\u003eOnly 3 pillars of support\u003c/p\u003e\n \u003cp\u003eOnly 2 pillars of support\u003c/p\u003e\n \u003cp\u003eOnly 1 pillar of support\u003c/p\u003e\n \u003cp\u003eNo pillars of support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\" style=\"width: 22.1153%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e-0.323\u003c/p\u003e\n \u003cp\u003e-0.360\u003c/p\u003e\n \u003cp\u003e-0.487\u003c/p\u003e\n \u003cp\u003e-0.786\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e-0.892 to 0.246\u003c/p\u003e\n \u003cp\u003e-1.403 to 0.682\u003c/p\u003e\n \u003cp\u003e-1.439 to 0.465\u003c/p\u003e\n \u003cp\u003e-1.771 to 0.199\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e0.264\u003c/p\u003e\n \u003cp\u003e0.496\u003c/p\u003e\n \u003cp\u003e0.314\u003c/p\u003e\n \u003cp\u003e0.117\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" style=\"width: 38.9424%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStage of disease\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eEarly stage*\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAdvanced stage\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNot staged\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\" style=\"width: 22.1153%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-0.604\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-0.544\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-0.965 to -0.243\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-1.130 to 0.042\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.068\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" style=\"width: 38.9424%;\"\u003e\n \u003cp\u003eFunctional status\u003c/p\u003e\n \u003cp\u003eGrade o*\u003c/p\u003e\n \u003cp\u003eGrade 1\u003c/p\u003e\n \u003cp\u003eGrade 2\u003c/p\u003e\n \u003cp\u003eGrade 3\u003c/p\u003e\n \u003cp\u003eGrade 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\" style=\"width: 22.1153%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e0.060\u003c/p\u003e\n \u003cp\u003e-0.192\u003c/p\u003e\n \u003cp\u003e-0.027\u003c/p\u003e\n \u003cp\u003e0.168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e-0.202 to 0.323\u003c/p\u003e\n \u003cp\u003e-0.896 to 0.512\u003c/p\u003e\n \u003cp\u003e-0.650 to 0.596\u003c/p\u003e\n \u003cp\u003e-0.486 to 0.822\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e0.651\u003c/p\u003e\n \u003cp\u003e0.591\u003c/p\u003e\n \u003cp\u003e0.932\u003c/p\u003e\n \u003cp\u003e0.613\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" style=\"width: 38.9424%;\"\u003e\n \u003cp\u003ePlace of care\u003c/p\u003e\n \u003cp\u003eHospice*\u003c/p\u003e\n \u003cp\u003eHome\u003c/p\u003e\n \u003cp\u003eOutreach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\" style=\"width: 22.1153%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e0.152\u003c/p\u003e\n \u003cp\u003e-0.140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e-0.244 to 0.548\u003c/p\u003e\n \u003cp\u003e-0.443 to 0.164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e0.451\u003c/p\u003e\n \u003cp\u003e0.366\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colname=\"c1\" style=\"width: 38.9424%;\"\u003e\n \u003cp\u003ePain level\u003c/p\u003e\n \u003cp\u003eNo Pain*\u003c/p\u003e\n \u003cp\u003eMild Pain\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eModerate Pain\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eModerate-severe Pain\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSevere pain\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eOverwhelming Pain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c2\" style=\"width: 22.1153%;\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e-0.538\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-1.036\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-1.589\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-1.618\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-3.471\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c3\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e-1.126 to 0.50\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-2.116 to 0.043\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-2.670 to -0.508\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-2.683 to -0.553\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e-4.782 to -2.160\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colname=\"c4\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e0.073\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.060\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.003\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0.000\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis is one of the first studies to examine quality of life and its predictors among cancer patients receiving palliative care in Uganda. Our participants were predominantly female 154 (75.5%) and cancer of the cervix was the commonest, followed by cancers of the breast and prostate, which finding is consistent with regional cancer epidemiology in Sub Saharan Africa, including Uganda [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. This study established that adult cancer patients who are under palliative care in Western Uganda suffer from poor quality of life, especially in the symptoms domain but comparatively better in the well-being domain, but still far from optimal. This is consistent with other studies conducted elsewhere in the African setting[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe mean QoL in this study is 13.4, which is lower than those reported in the above studies where it was reported at about 17 could be as result of the differences in the study settings and sample sizes.\u003c/p\u003e \u003cp\u003eThe remarkably low symptom subscale and relatively higher interpersonal/well-being scores mirror patterns across patients receiving palliative care in the developing world, where there is a high physical symptom burden but where interpersonal or relational and spiritual domains are highly valued and sometimes better preserved [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWith regard to predictors of QoL, three clinical factors; stage of disease, radiotherapy, and pain intensity were the only statistically significant predictors of QoL while socio-demographic factors were not. This can be attributed to the linkage between the three factors and physical and symptom burden of the disease; so they naturally show strong correlations with QoL in palliative and oncological settings [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].This finding is consistent with previous studies which showed that clinical severity and symptom burden are key determinants of QoL in cancer disease [\u003cspan additionalcitationids=\"CR36 CR37 CR38 CR39\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAdvanced or unstaged cancer disease compared to early stage disease leads to a decrease in QoL, with more pain, fatigue, and functional decline. This is because advanced stage disease means higher tumor burden, more metastases, more complications and intensive treatment, all of which heighten the symptom burden and reduce the physical and role function [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. It is also reflective of findings of previous studies which showed that QoL declines as the cancer disease progresses [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. In Indian and Vietnamese cross-sectional studies, advanced stage disease and poor performance status consistently predict poor QoL, especially across the physical and global domains [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePatients who did not receive radiotherapy had poorer QoL scores than those who did and this may be explained that cancer-directed treatment including radiotherapy is closely associated with better body function and less symptom burden such as pain and fatigue [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e, \u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Radiotherapy is vital in both early and advanced stages of disease. In early stage, it decimates the tumor size and reduces future symptoms and preserves function [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. In advanced stage disease, this modality of treatment reduces pain and other local symptoms, leading to better physical functioning. This finding is highly collaborated by results from a number of previous studies [\u003cspan additionalcitationids=\"CR47\" citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePatients with higher pain intensity tended to have lower QoL levels. Pain is one of the most frequent and burdensome symptoms in advanced cancer and is negatively correlated with QoL [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Higher pain scores are linked to poor physical functioning, body weakness and limitation in daily activities [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e] but when pain is well controlled, QoL improves markedly [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. This finding is strongly supported by evidence from several studies which show that higher pain severity is a predictor of physical, social, psychological well-being in advanced cancer [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Interventions that reduce pain lead to substantial improvement in QoL scores, even in low-resource settings similar to our study [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAll in all, advanced stage disease diminishes QoL by increasing the disease and symptom burden. Pain intensity directly impacts physical, emotional and social functioning. Radiotherapy affects QoL majorly through its effectiveness in managing tumor-induced symptoms, especially pain.\u003c/p\u003e \u003cp\u003eThe lack of association between socio-demographic factors such as age, socio-economic status, family support and QoL in this could be as result of having homogeneous samples in which there was an overwhelming symptom burden that overshadowed or attenuated the effect of the socio-demographic factor differences in determining QoL levels. This phenomenon is similar to other studies carried in palliative care settings [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn this real-world sample of palliative cancer patients attending two specialized care facilities in Western Uganda, overall quality of life (QoL) was significantly poor, primarily due to high symptom burden and advanced disease stages among patients already receiving palliative care.\u003c/p\u003e \u003cp\u003eThe study found that clinical factors, rather than socio-demographic characteristics, were the main influences on QoL. Specifically, advanced disease stage, higher pain levels, and radiotherapy were significantly linked to QoL outcomes. In contrast, socio-demographic factors did not show a significant impact. This pattern highlights that, in this resource-limited setting, severe symptoms and clinical needs tend to overshadow social factors. Notably, pain intensity emerged as a key modifiable factor affecting QoL, emphasizing the importance of effective pain management and symptom control in palliative care. The association between advanced disease and poorer QoL underscores how disease progression affects physical, psychological, and functional wellbeing. Additionally, access to radiotherapy was linked to better QoL, suggesting that chemo-radiation treatment can still provide symptom relief even in palliative stages.\u003c/p\u003e \u003cp\u003eThis study provides valuable, context-specific evidence from an under-researched, resource-limited region. By utilizing a standardized QoL measurement and multivariable analysis, it highlights modifiable clinical factors\u0026mdash;such as pain, disease stage, and radiotherapy access\u0026mdash;that align with regional and global efforts to improve palliative cancer care in low-resource settings.\u003c/p\u003e\n\u003ch3\u003eRecommendations\u003c/h3\u003e\n\u003cp\u003eClinical practice\u003c/p\u003e \u003cp\u003ePalliative cancer care teams in Western Uganda should focus on proactive control of physical pain and other distressing symptoms. This includes consistent use of WHO stepwise analgesic ladder to ensure that treatment is effective and adjusted as patients\u0026rsquo; needs change.\u003c/p\u003e \u003cp\u003eRoutine assessment for quality of life and common symptoms during clinic visits should become standard practice. This would help clinicians identify patients who are struggling earlier and offer timely, tailored interventions rather than waiting for crises to occur.\u003c/p\u003e \u003cp\u003eRadiotherapy should be used earlier and more systematically for symptom relief, for example to manage pain, bleeding, or obstruction. Clear referral pathways and simple eligibility criteria are needed so that patients who could benefit are identified promptly so that they do not miss out due to delays or system barriers.\u003c/p\u003e \u003cp\u003eHealth system and policy\u003c/p\u003e \u003cp\u003eAt the health system level, access to essential palliative medicines, particularly opioids, should be strengthened through reliable procurement, robust supply chain management, and supportive regulatory frameworks.\u003c/p\u003e \u003cp\u003eThere is high need for training, mentorship and supervision of healthcare providers at palliative care facilities to build confidence and skills in assessing QoL, pain and other burdensome symptoms and treating them.\u003c/p\u003e \u003cp\u003eResearch\u003c/p\u003e \u003cp\u003eFuture research should include longitudinal studies that track patients over time to observe how QoL evolves with better pain management, earlier palliative care intervention, and improved access to radiotherapy.\u003c/p\u003e\n\u003ch3\u003eStrengths\u003c/h3\u003e\n\u003cp\u003eThis study has several important strengths. It focuses on a real-world group of palliative care cancer patients in\u003c/p\u003e \u003cp\u003eWestern Uganda, an under-researched setting where evidence is urgently needed. By recruiting patients from routine specialized palliative care services rather than from highly selected trial populations, the study reflects the complex realities of everyday clinical practice in a low-resource context.\u003c/p\u003e \u003cp\u003eThe use of a standardized, validated quality-of-life tool, together with systematic collection of clinical and socio-demographic data, allows for robust assessment of how different factors relate to patients\u0026rsquo; quality of life. Applying multivariable analysis further strengthens the findings by accounting for key confounders.\u003c/p\u003e \u003cp\u003eImportantly, the study identifies practical, modifiable clinical predictors\u0026mdash;pain, disease stage and access to radiotherapy\u0026mdash;that can realistically be targeted within Ugandan and similar health systems. This makes the results directly relevant for guiding improvements in palliative cancer care at both clinical and policy levels.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eLimitations:\u003c/h2\u003e \u003cp\u003eThis study has some important limitations that should be kept in mind when interpreting the findings. First, its cross-sectional design provides only a single snapshot of patients\u0026rsquo; quality of life and clinical status. This means we cannot determine causal relationships or understand how quality of life and symptoms evolve over the course of palliative care, even though the study still offers valuable real-world insight into patients already receiving specialized services.\u003c/p\u003e \u003cp\u003e Second, the work was carried out in the only two specialized palliative care facilities in Western Uganda, using a consecutive sample of patients enrolled in these services. While this strengthens the study\u0026rsquo;s relevance to routine palliative practice in this region, it may limit how far the findings can be generalized to other settings, to people who are not accessing palliative care, or to patients with non-cancer conditions.\u003c/p\u003e \u003cp\u003eFinally, although the sample size was sufficient for the main analyses and allowed robust multivariable modeling, it was not large enough to reliably detect smaller differences within subgroups. This underlines the need for larger, longitudinal, multi-center studies\u0026mdash;ideally including a broader range of patients and facilities\u0026mdash;to confirm and build on these context-specific results and to better track changes in quality of life over time.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAPCA African Palliative Care Association\u003c/p\u003e\u003cp\u003eHAU Hospice Africa Uganda\u003c/p\u003e\u003cp\u003eLHH Little Hospice Hoima\u003c/p\u003e\u003cp\u003eMHM Mobile Hospice Mbarara\u003c/p\u003e\u003cp\u003eMUST Mbarara University of Science and Technology\u003c/p\u003e\u003cp\u003eMVQOLI Missoula Vitas Quality of Life Index\u003c/p\u003e\u003cp\u003eNGO Non-Governmental Organization\u003c/p\u003e\u003cp\u003eQoL Quality of Life\u003c/p\u003e\u003cp\u003eREDCAP Research Data Capture\u003c/p\u003e\u003cp\u003eWHO World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was approved by the Research and Ethics Committee of Mbarara University of Science and Technology (MUST-2025-351 and Uganda National Council of Science and Technology (UNCST: HS6248ES). Also, administrative clearance was obtained from Hospice Africa Uganda.\u0026nbsp; Additionally, all data collection processes were aligned to the key principles of the Declaration of Helsinki.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset generated and analyzed for this study are available and can be accessed on request. Please contact [email protected] about the same.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by ROAD TO CARE.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJ.B.N lead the research team that conceptualized, executed the study, analyzed the data, wrote and reviewed this manuscript.\u003c/p\u003e\n\u003cp\u003eJ.K, E.M and E. N contributed almost equally towards the above facets of this work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJ.B.N acknowledges with gratitude ROAD TO CARE, for supporting his PhD studies including this study\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eHe also appreciates the data collection team of Elizabeth Mbabazi, Francis Nagujja, Miriel Kabigarire, Sheila Kukundakwe, Nahabwe Charlotte, Ivan Kalyango, Rashida Nalule and Kobusinge Mildred for the fabulous work done. Special thanks to Andrew Christopher Wesuta for designing the database of the study and continuous information and technological support to the team throughout the entire process.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGayatri D, Efremov L, Kantelhardt EJ, Mikolajczyk R. 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Ad, amimo fa. socio-demographic characteristics associated with quality of life-scores among palliative care cancer patients in kenya. J Community Med Public Health, 5, 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhlam A, Hind M, Haddou Rahou B, Rachid R, Hassan E. Quality of life of Moroccan patients on the palliative phase of advanced cancer. BMC Res Notes. 2019;12:351.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChung KC, Muthutantri A, Goldsmith GG, Watts MR, Brown AE, Patrick DL. Symptom impact and health-related quality of life (HRQoL) assessment by cancer stage: a narrative literature review. BMC Cancer. 2024;24:884.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCosta MFFD, Bilobran MA, de Oliveira LC, Muniz AHR, Chelles PA, d. SG, Sampaio SM. Correlation between cancer pain and quality of life in patients with advanced cancer admitted to a palliative care unit. Am J Hospice Palliat Medicine\u0026reg;. 2024;41:882\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVerkissen MN, Hjermstad MJ, Van Belle S, Kaasa S, Deliens L, Pardon K. Quality of life and symptom intensity over time in people with cancer receiving palliative care: Results from the international European Palliative Care Cancer Symptom study. PLoS ONE. 2019;14:e0222988.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDixit J, Gupta N, Kataki A, Roy P, Mehra N, Kumar L, et al. Health-related quality of life and its determinants among cancer patients: evidence from 12,148 patients of Indian database. Health Qual Life Outcomes. 2024;22:26.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGayatri D, Efremov L, Mikolajczyk R, Kantelhardt EJ. Quality of life assessment and pain severity in breast cancer patients prior to palliative oncology treatment in Indonesia: A cross-sectional study. Patient Prefer Adherence, pp. 2017\u0026ndash;26, 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSarkar SR, Bhuiyan AMR, Alam A, Chowdhury MK. Impact of pain on the quality of life of advanced cancer patients in a palliative care setup in Bangladesh, \u003cem\u003eMedicine\u003c/em\u003e, vol. 104, p. e44176, 2025.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJacob J, Palat G, Verghese N, Chandran P, Rapelli V, Kumari S, et al. Health-related quality of life and its socio-economic and cultural predictors among advanced cancer patients: evidence from the APPROACH cross-sectional survey in Hyderabad-India. BMC Palliat care. 2019;18:94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShahjalal M, Sultana M, Gow J, Hoque ME, Mistry SK, Hossain A, et al. Assessing health-related quality of life among cancer survivors during systemic and radiation therapy in Bangladesh: a cancer-specific exploration. BMC Cancer. 2023;23:1208.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAllner M, Rak A, Balk M, Rupp R, Almajali O, Tamse H, et al. Patient-reported outcomes in head and neck cancer: a cross-sectional analysis of quality of life domains across early and advanced UICC stages. Support Care Cancer. 2025;33:278.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuyen BT, Van Anh PT, Duong LD, The THN, Guo P, Van Thuc P, et al. Quality of life among advanced cancer patients in Vietnam: a multicenter cross-sectional study. Support Care Cancer. 2021;29:4791\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLam K, Chow E, Zhang L, Wong E, Bedard G, Fairchild A, et al. Determinants of quality of life in advanced cancer patients with bone metastases undergoing palliative radiation treatment. Support Care Cancer. 2013;21:3021\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiao K-C, Chuang H-C, Chien C-Y, Lin Y-T, Tsai M-H, Su Y-Y et al. ,\u003cem\u003e., Quality of life as a mediator between cancer stage and long-term mortality in nasopharyngeal cancer patients treated with intensity-modulated radiotherapy, Cancers, vol. 13, p. 5063, 2021.\u003c/em\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan der Weijst L, Azria D, Berkovic P, Boisselier P, Briers E, Bultijnck R, et al. The correlation between pre-treatment symptoms, acute and late toxicity and patient-reported health-related quality of life in non-small cell lung cancer patients: Results of the REQUITE study. Radiother Oncol. 2022;176:127\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYucel B, Akkaş EA, Okur Y, Eren AA, Eren MF, Karapınar H, et al. The impact of radiotherapy on quality of life for cancer patients: a longitudinal study. Support Care Cancer. 2014;22:2479\u0026ndash;87.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCa\u0026ntilde;on V, Gomez-Iturriaga A, Casquero F, Rades D, Navarro A, Del Hoyo O, et al. Quality of life improvement in patients with bone metastases undergoing palliative radiotherapy. Rep practical Oncol radiotherapy. 2022;27:428\u0026ndash;39.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShih H-H, Chang H-J, Huang T-W. Effects of early palliative care in advanced cancer patients: a meta-analysis. Am J Hospice Palliat Medicine\u0026reg;. 2022;39:1350\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang M, Ding X. Integrated palliative care improves the quality of life of advanced cancer patients. BMC Palliat Care. 2025;24:162.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-palliative-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pcar","sideBox":"Learn more about [BMC Palliative Care](http://bmcpalliatcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pcar/default.aspx","title":"BMC Palliative Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Quality of life, Palliative care, Associated factors, Cancer","lastPublishedDoi":"10.21203/rs.3.rs-9427937/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9427937/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground\u003c/b\u003e\u003c/p\u003e \u003cp\u003eQuality of life (QoL) is a vital outcome of palliative care for cancer patients, yet in a number of Sub-Saharan settings, including Western Uganda, there is a dearth of evidence on the level of quality of life and its correlates. Our goal therefore, was to assess the level of quality of life and associated factors among cancer patients receiving palliative care in Western Uganda.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA cross-sectional study was conducted using a pretested questionnaire that included socio-demographics, clinical information and the MissoulaVitas Quality of Life Index (MVQOLI-15R), a tool that measures quality of life of patients with advanced, incurable and progressive disease such as cancer. It is a 16-item instrument comprising of five subscales of: function, symptom, interpersonal, well-being and transcendence that encompass physical, social, psychological and spiritual dimensions. This tool was previously validated for a similar segment of patients. The above data collection instrument was translated into Runyoro and Runyankore and administered to consecutively enrolled cancer patients at Mobile Hospice Mbarara and Little Hospice Hoima, both of which are found in Western Uganda.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003e204 patients were recruited. They had a mean age of58.8\u0026thinsp;\u0026plusmn;\u0026thinsp;15.2 years and 154 (75.5%) of them were female. The commonest diagnosis was cancer of the cervix, 101(49.5%). The mean global QoL score was 3.47\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88 (possible range 0[worst] to 5[best]). The mean total QoL score was 13.44\u0026thinsp;\u0026plusmn;\u0026thinsp;1.62 (possible range 0[worst] to 30[best]). Patients scored most poorly on symptoms (-6.78\u0026plusmn;), followed by Interpersonal (-4.01), transcendence (-3.53), function (-2.50) and well-being (1.31). The possible ranges for the subscales is (-30[worst] to 30[best]). With regard to factors associated with QoL, stage of disease, treatment with radiotherapy and pain intensity were found to have statistically significant associations with QoL of cancer patients receiving palliative care in this context.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eQoL of cancer patients under palliative care in Western Uganda was found to be low. Treatment with radiotherapy, pain intensity and stage of disease were established to key predictors of QoL of these patients. Therefore, it is vital for cancer patients to be diagnosed with early stage, have their pin well controlled and get treated with radiotherapy where appropriate in order to harness better outcomes such as QoL for them.\u003c/p\u003e","manuscriptTitle":"Quality of life and associated factors among cancer patients receiving palliative care in Western Uganda: a cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-07 19:54:59","doi":"10.21203/rs.3.rs-9427937/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-18T10:20:26+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-04T08:10:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"109126064334396312360858712922466483924","date":"2026-05-01T14:02:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"95549013240804760202783876244343371534","date":"2026-04-27T14:44:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-24T13:22:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"26969750450314968881809373907923258209","date":"2026-04-23T14:14:50+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-23T11:09:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-23T11:05:14+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-20T18:26:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-18T13:50:41+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Palliative Care","date":"2026-04-18T13:46:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-palliative-care","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pcar","sideBox":"Learn more about [BMC Palliative Care](http://bmcpalliatcare.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pcar/default.aspx","title":"BMC Palliative Care","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ba59d504-a6d4-4793-8f65-b44160271f3c","owner":[],"postedDate":"May 7th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-18T10:20:26+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-04T08:10:16+00:00","index":35,"fulltext":""},{"type":"reviewerAgreed","content":"109126064334396312360858712922466483924","date":"2026-05-01T14:02:52+00:00","index":34,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-18T10:24:58+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-07 19:54:59","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9427937","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9427937","identity":"rs-9427937","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}