Impact of uncertainty, anxiety, and depression on oncology patients’ quality of life: some evidence from Bulgaria and Italy

Abstract

The objective of the present paper is to assess health-related quality of life (HQOL) of oncological patients. The treatment of cancer and of other invalidating and chronic pathologies cannot neglect the patients’ personal dimensions, let alone the uncertainty surrounding therapies and their effectiveness. Simultaneous consideration of all these factors makes it possible to identify the patients’ needs concerning their hospital experience, together with self-perceived health status, and to isolate crucial factors that improve patients’ satisfaction. For this purpose, health related quality of life (HQOL) was measured through the Visual Analogue Scale (VAS) and the EuroQOL-5D questionnaire for the sample of 600 cancer patients who live in two countries (300 in Italy and 306 in Bulgaria). Another validated scale employed in the research explored uncertainty through the Mishel Uncertainty in Illness Scale – MUIS, while other aspects related to cancer were measured through a tool developed by the European Organization for Research and Treatment of Cancer (EORTC). In the estimated Tobit model, a dummy variable was included among the regressors to control for the place of residence. The econometric analysis highlighted the need to account for relational and uncertainty-in-illness factors in the management of oncological diseases. Since both national sub-groups were not representative of the whole sample, we re-ran the same analysis for colorectal cancer, i.e., the most frequent type of cancer in Italy and Bulgaria both. The results of this second model only partially confirmed the main regression results, while the national effect lost its statistical significance. This suggests that the nature of the face-to-face relationships and the type of cancer under consideration matter more than the national institutional setting in providing a person-centered care.