Psychological distress, quality of life, coping and adjustment: a comparison of Oshiwambo-speaking and Sesotho-speaking patients with breast and/or cervical cancer

English: Psycho-oncology emerged as a formal discipline in the mid-1970s. Much progress has been made in both research and clinical practice, specifically in developed countries. Psycho-oncological research in developing countries, including Africa, remains scant. Cancer has been viewed as a disease of the western world. However, it is estimated that by the year 2020 cancer incidence in developing countries will surpass that of the developed countries. Given this reality and the high mortality from cancer in Africa, the development and progression of psycho-oncology on the continent is essential to provide a basis for research and clinical practice. Against this background, this exploratory and comparative study aimed to investigate psychosocial aspects of cancer patients in two southern African countries. The major objective of the current study was five-fold. Firstly, to provide an overview of psycho-oncology research in Africa, with a brief historical perspective of international psycho-oncology. Secondly, the study explored the presence of psychological morbidity in Oshiwambo-speaking Namibian and Sesotho-speaking South African cancer patients. Additionally, the feasibility of the use of a single-item visual analogue screening instrument of psychological distress was explored. Thirdly, the study explored quality of life (QoL) of cancer patients in these two groups. The association of QoL and psychological distress was also explored. Fourthly, the study explored perceived selfefficacy for coping with cancer in these two countries. Fifthly, adjustment to cancer was explored. By its nature of being a comparative study, Oshiwambo-speaking Namibian and Sesotho-speaking South African patients were compared with regards to psychological morbidity, QoL, self-efficacy for coping and adjustment to cancer. The Distress Thermometer (DT), Hospital Anxiety and Depression Scale (HADS), 26-item World Health Organization Quality of Life measure (WHOQOL-Bref), Cancer Behavior Inventory (CBI) and Mental Adjustment to Cancer (MAC) scale were used. The sample consisted of 103 Namibian and 126 South African patients with a histologicallyconfirmed diagnosis of breast or cervical cancer. Results suggest that a DT cut-off of 3 is the ideal cut-off score for both groups. Using this DT cut-off, approximately half of the patients in both countries reached the case criteria for psychological distress, while a third were identified as distressed on the HADS. About a third scored above the HADS anxiety cut-off. Approximately 30% South African and 20% Namibian patients met the depression case-criteria. With regards to QoL, Namibian and South African patients in this study appeared to have comparable QoL on most domains. However, Namibian patients appeared to fare better on the psychological domain. Psychological distress, anxiety and depression correlated negatively with all facets of QoL. Results suggest overall high self-efficacy for coping with cancer for the entire study sample, and the Namibian group obtaining significantly higher scores. Self-efficacy correlated negatively with psychological morbidity and positively with QoL for both groups of patients. Correlations with psychological morbidity were stronger for South Africa, and comparable for QoL. Namibian and South African patients reported comparable and probably high levels of hopelessness/helplessness responses to a diagnosis of cancer. Fighting spirit correlated negatively with psychological morbidity for both groups, however the magnitude of the correlations were statistically different. Helplessness/hopelessness correlated positively with psychological morbidity. Anxious preoccupation, fatalism and avoidance responses yielded mixed and conflicting results for this study. QoL and self-efficacy correlated positively with a fighting spirit response. This study highlights the presence of psychological morbidity among cancer patients in southern Africa, and supports international research. It further highlights relationships between psychological distress, QoL, self-efficacy for coping and adjustment to cancer. The results could have implications with regard to clinical practice within Namibian and South African oncology settings. However, psychological interventions must take into account geo-socio-cultural differences of cancer patients in the various African oncology settings. Further research in African psycho-oncology research is recommended.