FAMILY FUNCTIONING, COPING STRATEGIES AND SEXUAL DYSFUNCTION AMONG CERVICAL CANCER PATIENTS IN THE KUMASI METROPOLIS, GHANA

Abstract

Introduction: Cervical cancer is arguably the most common cancer among women in Ghana, and it is associated with 16% of mortality due to cancer. In the Kumasi metropolis, it is the second most diagnosed gynecological cancer after breast cancer. This study assessed the extent of sexual dysfunction in women diagnosed with cervical cancer in the Kumasi metropolis; and explored the role of family functioning and coping strategies in dealing with the diagnosis of cervical cancer.

Methods: The study was conducted from June to December 2020 among women who had a confirmed diagnosis of cervical cancer at the Komfo Anokye Teaching Hospital, Kumasi, by employing a concurrent triangulation design where both qualitative and quantitative data was collected at the same time. In all, 181 and 15 women were included in the quantitative and qualitative aspects, respectively. Data was collected using a structured questionnaire and in-depth interview guides. Sexual dysfunction, coping strategies and family functioning were measured using the Female Sexual Functional Index (FSFI), the brief-COPE and the Family APGAR scale respectively. Data was analyzed using STATA (version 16.0) statistical software package. Bivariate associations were tested using the chi-square test and fisher exact tests. The relationship between family functioning, sexual dysfunction and coping strategies was assessed using logistic and linear regression models where appropriate. Inferences were made with 95% confidence interval with 5% error margin and a p-value of <0.05. Data from the in-depth interviews were analyzed thematically using variable matrix, flow charts, and relevant quotes to highlight result.

Results: The mean age of the women was 58 years (±12.85). More than two-thirds (124; 68.5%) had between 2 – 3 sexual partners and about two-thirds (119; 65.7%) had their first sexual intercourse at age 18. Participants frequently engaged in adaptive coping strategies with religious coping being the most adopted (mean =7.81, SD =0.60). Almost all (96.1%) the respondents had sexual dysfunction. Nearly two-thirds (65.7%) had highly dysfunctional families and nearly one-third (31.5%) had moderately dysfunctional families. Women with parity of 4 – 7 [OR=2.14, 95% CI: 1.12 – 4.07] and 8-13 children [OR=5.52, 95% CI: 1.50 – 20.4] had higher odds of having a functional family compared to those with 0 – 3 children. Having dysfunctional family was associated with a higher mean active coping [β=5.99; 95% CI: 4.54 – 7.46] and lower mean avoidant coping [β= -1.49; 95% CI: -2.60 – -0.38], compared with women who had functional families. There was no significant association between sexual functioning and family functioning. In the qualitative study, the women recounted difficulties with sexual intercourse due to bleeding, pain, fear and advice from doctors. Most of the women coped with their conditions by praying about it. Social support was mainly received from the husbands and children of women with cervical cancer. Almost all the women however disclosed having financial challenges because of the high cost of treatment.

Conclusions: This research provides evidence of the prevalence and lived realities of sexual-related challenges and coping strategies among women diagnosed with cervical cancer. Majority of the respondents frequently engaged in adaptive coping strategies, with religious coping being the most engaged coping strategy among the women. There was high prevalence of sexual dysfunction and dysfunctional families among the women studied. Family function was positively associated with adaptive coping and negative associated with maladaptive coping strategies. Health campaigns on cervical cancer should be intensified to demystify the disease and its effects on patients, and also to harness support for women with cervical cancer.