Introduction

Cancer is a major public health burden and among the top causes of death worldwide. According to GLOBOCAN (2020), an estimated 19.3 million new cases and 10 million deaths occurred globally [11]. Sub-Saharan Africa faces a dual challenge of rising incidence and limited treatment capacity [5]. In Kenya, the growing number of cancer cases has strained public cancer centers, making quality-of-care assessment increasingly important.

Chemotherapy remains a vital treatment modality for solid and hematologic malignancies [1,3]. Despite its efficacy, it is often associated with fatigue, nausea, vomiting, hair loss, immunosuppression, and emotional distress (Dodd et al., 2001). These side effects can significantly impact patients’ quality of life and perceptions of care. Patient satisfaction—an indicator of perceived quality and effectiveness of services— reflects the gap between expectations and experiences [8]. Satisfied patients are more likely to adhere to treatment, maintain follow-ups, and exhibit improved outcomes [2]. This study therefore aimed to assess patient satisfaction and QoL among outpatients receiving chemotherapy at the Chandaria Cancer Center, MTRH, and to identify associated determinants.

Methods

A hospital-based cross-sectional descriptive design was conducted at the Chandaria Cancer Center, a specialized oncology unit within MTRH in Eldoret, Kenya. The facility serves a large population across Western Kenya and neighboring regions. The study population comprised adult cancer patients (≥18 years) attending the outpatient chemotherapy clinic. A sample of 315 participants was obtained using systematic random sampling. Eligibility included a confirmed cancer diagnosis, receipt of at least one chemotherapy cycle, and informed consent. Patients too ill to participate or on concurrent radiotherapy was excluded.

Data were collected using a structured questionnaire divided into sections: socio-demographics, satisfaction with chemotherapy information, QoL domains, and satisfaction with treating physicians. SPSS v23 was used for data analysis. Descriptive statistics summarized the findings, while multivariable logistic regression determined predictors of QoL. Ethical approval was obtained from MTRH/MU-IREC; all participants provided written informed consent.

Results

Respondents’ characteristics

A total of 315 participants (response rate 100%) completed the study. Most were female (70.2%) with a mean age of 45.8 years. About 53.3% had not attained secondary education, and breast cancer (26.7%) was the leading type. Stage II disease accounted for 41.6%, and 24.1% of patients reported comorbidities. One hundred thirty-one (41.6%) of participants were at stage II of cancer with good performance status (ECOG PS 0) (Table 1).

Patient satisfaction with information on chemotherapy

The study found that only 20% understood the purpose of chemotherapy, and most received limited information from healthcare providers. Only a small proportion were informed about side-effect prevention (28.9%), infection risk (17.8%), impact on daily activities (39%), ability to continue working (14%), expected survival (16.5%), and dietary advice (1.6%), indicating significant gaps in patient education and communication (Table 2).

Table 1: Socio-demographic and clinical characteristics of adult cancer patients under chemotherapy treatment at chandaria, (MTRH) Kenya 2023.

Table 2: Patient satisfaction with information on chemotherapy.

Quality of life among cancer patients receiving chemotherapy

The study reported a mean Quality of Life (QoL) score of 47.63±10.07, with only 43.23% of participants experiencing a good QoL.

Functional and symptom scale scores

The study showed that domain scores ranged from a mean (SD) of 46.73 (23) for physical well-being to 61.07 (21.44) for cognitive well-being. Psychological well-being was the most affected domain, with 61% of participants reporting poor QoL, while cognitive functioning was the least affected, with 77.1% reporting good QoL. Among symptoms, appetite loss was the most prevalent, affecting 77.5% of participants (Table 3).

Table 3: Domain and symptom scale score among adult cancer patient undertaking chemotherapy treatment at chandaria (MTRH).

Table 4: Association between different domains and symptom scales with QoL of adult cancer patients undertaking chemotherapy treatment at chandaria, MTRH.

**Significant level at p<.01; *significant level at p<.05

Table 5: Bivariable and multivariable logistic regression of determinant factors with QOL of cancer patients under chemotherapy at chandaria, MTRH

*P value<0.05, significant associated. Cl confidence interval, OR odd ratio

Factors associated with quality of life

The study found that patients with tertiary education were 4.3 times more likely to have good Quality of Life (QoL) compared to those without formal education. Conversely, patients with advanced-stage cancer (stage IV) were 79% less likely to have good QoL than those with early-stage disease. Those without comorbid conditions were 72% less likely to have good QoL compared to those with comorbidities, and patients with depression were 71% less likely to report good QoL than non-depressed individuals (Table 5).

Satisfaction with the treating physician

The study reported an average patient satisfaction score of 48.77 during chemotherapy. Satisfaction was significantly associated with information provision (p=.004), physician availability (p=.003), information exchange (p=.001), and inclusion in decision-making (p=.008) (Table 6).

Table 6: Patients Satisfaction with the treating physician.

M: Arithmetic Mean; SD: Standard Deviation p<0.05 statistically significantly

Discussion

The study highlights that patient satisfaction with chemotherapy information and care at Chandaria Cancer Center was generally low, primarily due to insufficient information provision and poor communication. Many patients reported unmet informational needs regarding side effects, infection risk, treatment impact on daily life, ability to continue working, survival expectations, and dietary guidance. As in previous studies, this lack of clear and continuous information negatively affected satisfaction and adherence to treatment [4].

Over the past decade, research has emphasized that adequate patient education enhances adherence and improves Quality of Life (QoL); however, achieving consistent information delivery remains challenging. Patients are often overwhelmed by complex medical details at diagnosis, leading to low retention and understanding.

The mean QoL score was 47.63, lower than findings from comparable studies in Nepal [13], India [10], and Pakistan [15]. Factors significantly influencing QoL included psychological and social well-being, nausea and vomiting, pain, financial difficulty, education level, cancer stage, comorbidity, and depression. Financial strain and symptom burden were major contributors to poor QoL. Patients with tertiary education had significantly better QoL (AOR=4.3), while those with advanced-stage cancer and depression were much less likely to report good QoL.

Consistent with global evidence, depression and disease progression were strong negative predictors of QoL, likely due to greater symptom distress, uncertainty, and limited psychosocial support [7,9].

Finally, the average satisfaction with treating physicians was 48.77, with significant associations observed for information provision (p=.004), physician availability (p=.003), information exchange (p=.001), and involvement in decision-making (p=.008). The study underscores the urgent need for improved communication, patient education, and psychosocial care to enhance both satisfaction and quality of life among chemotherapy patients.

Conclusion

Adult cancer patients undergoing chemotherapy at MTRH reported moderate satisfaction and poor QoL. Key influencing factors included communication, information adequacy, psychosocial support, and financial stress. To enhance satisfaction and outcomes, the following are recommended: Implement comprehensive patient education sessions before and during chemotherapy, introduce structured psychosocial support and counseling services, conduct routine QoL screenings using standardized tools, strengthen healthcare provider communication training, last but not the list provide financial assistance programs for economically vulnerable patients.

Author declarations

Ethical approval and consent to participate: Ethical approval was granted by the Moi Teaching and Referral Hospital– Moi University ethics and research committee (reference number IREC/236/2022). Informed consent was obtained from all the participants and/or their LAR. The study was conducted in accordance to relevant guidelines and regulations.”

Availability of data and materials: The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Competing interests: The authors declare that they have no competing interests.

Funding: Not Applicable.

Authors’ contributions: Mr. David Lubanga Wamukobole and Mr. Alex Kamau both provided professional writing services or material, analyzed and interpreted the patient data.

Acknowledgment: The authors would like to thank all the participating patients for their willingness in giving us a deeper. view into oncology patient satisfaction and for voicing their opinions on this topic.

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