Awareness and Knowledge of Ovarian Cancer Symptoms and Risk

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ovarian cancer, awareness, risk factors, symptoms, women, Jordan, cancer prevention ... tunately, most of the cases are usually detected in late or advanced stages ... early detection improves the prognosis for this disease (Brain et al., 2014).
704749 research-article2017

CNRXXX10.1177/1054773817704749Clinical Nursing ResearchFreij et al.

Article

Awareness and Knowledge of Ovarian Cancer Symptoms and Risk Factors: A Survey of Jordanian Women

Clinical Nursing Research 1­–15 © The Author(s) 2017 Reprints and permissions: sagepub.com/journalsPermissions.nav https://doi.org/10.1177/1054773817704749 DOI: 10.1177/1054773817704749 journals.sagepub.com/home/cnr

Mazen Freij, MD, MRCOG, FICRS1,2, Mohammad Al Qadire, RN, PhD3, Maysa Khadra, MD2, Mohammed ALBashtawy, RN, MPH, PhD3, Wael Tuqan, MD1, Mohammad Al Faqih, MD1, Ayoub Innabi, MD1, Abdul-Monim Batiha, PhD, RN4, Fadwa Alhalaiqa, RN, CNS, PhD4, and Aida Abd El-Razek, RN, PhD4

Abstract Ovarian cancer accounts for 3% of all female cancers and has a high mortality rate among gynecological malignancies. Early diagnosis carries a high survival rate of 93%. So, this study was carried out to assess the knowledge and awareness of Jordanian women about ovarian cancer symptoms and risk factors. A cross-sectional survey design was used; 896 women completed the survey. The mean of total symptoms recognized was low at level of 3.2 (SD = 2.7) out of 10. The three highest known symptoms among women 1Jordan

University Hospital, Amman, Jordan University of Jordan, Amman, Jordan 3Al al-Bayt University, Mafraq, Jordan 4Philadelphia University, Amman, Jordan 2The

Corresponding Author: Mohammad Al Qadire, Faculty of Nursing, Head of Adult Healthcare Nursing Department, Dean Assistant for Students Affairs, Al Al-Bayt University, P.O. Box 130040, Mafraq 25113, Jordan. Email: [email protected]

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were as follows: extreme fatigue (43.2%), back pain (42.4%), and persistent pain in pelvic area (40.7%). The most commonly known risk factor was smoking (68.4%), followed by having ovarian cyst(s) (59.7%). Hence, with the absence of an effective screening program, a national awareness campaign is urgently needed to improve the public’s understanding of symptoms and risk factors and increasing women’s confidence in symptom recognition. Keywords ovarian cancer, awareness, risk factors, symptoms, women, Jordan, cancer prevention

Background Ovarian cancer is one of the most common gynecological malignancies worldwide; it is correlated with a high mortality rate (more than 50%; Bankhead et al., 2008; Karim-Kos et al., 2008). According to the Jordanian Cancer Registry, ovarian cancer represents 3% of the yearly diagnosed cases in the country (Taraweneh & Nimri, 2013). Early detection and diagnosis of ovarian cancer would result in a high 5-year survival rate (up to 93%); unfortunately, most of the cases are usually detected in late or advanced stages (Buys et al., 2011). This underpins the high morbidity and mortality rates among women with ovarian cancer. It is believed that a good knowledge of ovarian cancer warning symptoms would motivate more women to utilize the available early detection programs and seek medical attention (Ott, Ullrich, & Miller, 2009; Sopik, Iqbal, Rosen, & Narod, 2015). There is mounting international interest in assessing the level of women’s knowledge of warning symptoms of ovarian cancer; however, in Jordan the number of ovarian cancer cases is increasing (Ismail, Soubani, Nimri, & Al-Zeer, 2013), and there is a clear need for research to evaluate women’s awareness level of the symptoms and risk factors. Jordan is a small country in the heart of the Middle East with an area of 92,300 km2. It is bounded by Syria on the north, Iraq and Saudi Arabia on the east and south, and Palestine on the west. Most Jordanians are Arab Muslims; Arabic is the official language, but English is well understood and is commonly used in hospitals and universities. In comparison with the other countries in the region, Jordan has a well-developed health care system and services, in both the public and private sectors. The public sector, represented by the Ministry of Health, includes health care centers, maternity and child health centers, and hospitals, distributed throughout the country. However,

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the private clinics, centers, and hospitals are concentrated in the central region (the capital city, Amman).

Literature Review In the United States, the majority of ovarian cancer cases diagnosed were in the age group 50 to 69 years, according to the U.S. Surveillance, Epidemiology, and End Results (SEER) database (Freedman, Edwards, Ries, & Young, 2006). On the contrary, the majority of Jordanian cases were diagnosed in women below the age of 50 years (Freedman et al., 2006). The risk of ovarian, fallopian tubal, and peritoneal carcinoma increases with age. Postmenopausal women are particularly at risk of ovarian cancer, the risk increasing by 2% for each additional year of age in women below 50 years and by 11% in women 50 years or older (Gates, Rosner, Hecht, & Tworoger, 2010). Single women are at a higher risk of ovarian cancer (Holschneider & Berek, 2000). Epidemiological evidence from large-cohort studies confirms endometriosis as an independent risk factor for ovarian cancer (Vercellini, Somigliana, Buggio, Bolis, & Fedele, 2012). About 95% of patients have symptoms prior to diagnosis. These symptoms include abdominal distension, pelvic and low back pain, gastrointestinal related symptoms (e.g., loss of appetite, feeling full), and urine frequency (Bankhead et al., 2008; Hamilton, Peters, Bankhead, & Sharp, 2009). It is known that these symptoms can be presented at both early and late stages; early detection improves the prognosis for this disease (Brain et al., 2014). Women with inadequate knowledge of these symptoms may underestimate the importance of following up or seeking medical care. Also, as these symptoms are not necessarily specific to ovarian cancer, women may attribute them to other gastrointestinal or urinary system disorders (Brain et al., 2014). This results in delayed detection of advanced ovarian cancer cases and indirectly increases the mortality rate. Previous studies have found that most women have inadequate knowledge of ovarian cancer symptoms in general and those related to gastrointestinal problems in particular (Brain et al., 2014; Low et al., 2013). For example, a study conducted in Wales (Brain et al., 2014) explored awareness of ovarian cancer symptoms in women of 50 years or over, and the expected waiting time before seeking medical care (Brain et al., 2014). A random sample of 1,043 women was interviewed using a computer-assisted approach. The results showed that the most frequently recognized symptoms were as follows: postmenopause bleeding (87.4%), abdominal pain (85%), and pelvic pain (79%). The least identified symptoms were changes in bowel habits (49%), feeling full (36.3%), difficulty in eating (36.3%), and change in

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bladder habits (32%). The mean of the total number of symptoms recognized was 6.85 out of 11 (Brain et al., 2014). Also, it was concluded that women who were highly educated (degree or above), with high levels of practical and emotional barriers, tended to wait more than 3 weeks before seeking medical advice (Brain et al., 2014). Nevertheless, another study conducted in the United Kingdom (Low et al., 2013) revealed that 58% of the sample (n = 1,000), of higher economic status, were unable to recall one or more symptoms of ovarian cancer (Low et al., 2013). There are consistent findings in regard to low awareness of ovarian cancer symptoms and long anticipated delays for women before seeking medical care from different parts of the world, including the United Kingdom (Brain et al., 2014; Gajjar, Ogden, Mujahid, & Razvi, 2012; Low et al., 2013), Australia (Jones et al., 2010), the United States (Cooper, Polonec, & Gelb, 2011), Denmark, Canada, Norway, and Sweden (Forbes et al., 2013). However, to the authors’ knowledge, no previous study has been conducted on this subject in Jordan.

Aims The aims of this study are as follows: 1. To assess Jordanian women’s awareness of ovarian cancer symptoms. 2. To assess Jordanian women’s knowledge of ovarian cancer risk factors.

Method Design This study was conducted using descriptive cross-sectional survey.

Sample The sample of 896 participants consisted of women aged 18 years or older, who had not been diagnosed with, or treated for, ovarian cancer, and who agreed to participate in the study. All female patients and their family caregivers, and visitors in all outpatients’ clinics (except gynecology and obstetrics) were targeted. During the data collection period, 1,000 women were approached and questionnaires were distributed. Of these, 80 were not returned (decline to participate) and 24 were not answered fully. Hence, the response rate was 89.6%. Data were collected in the period January 15 to August 13, 2015.

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Setting This study was conducted in the outpatients’ clinics affiliated to a referral university hospital in Amman. Only gynecology and obstetrics clinics were excluded. The patients who come to this hospital are referred from different parts of the country, not only the capital city.

Measures The tool used in this study was adopted from a validated ovarian cancer awareness measure (CAM; Simon et al., 2012; Stubbings et al., 2009). It is based on a generic CAM developed by Cancer Research UK, University College London, and Oxford University. It consists of three parts containing a total of 42 questions. The first part collects sociodemographic data and consists of seven questions: age (in years), marital status (single, married, divorced, widow, or prefer not to disclose), education level (low, i.e., secondary school and below; or high, i.e., diploma and above), family income (2 weeks Family monthly income   Low (≤1000 JD)   High (>1000 JD Aware of the presence of the national breast cancer screening program  Yes  No

M (SD)

t

p value

−3.96