title: Symptom Burden and Functional Dependencies Among Cancer Patients in Botswana Suggest a Need for Palliative Care Nursing.
abstract: BACKGROUND
  Palliative care and cancer nursing in sub-Saharan Africa is hampered by inadequate clinical resources and evidence base but is central to symptom management amid the growing cancer burden.
  
  
  OBJECTIVE
  The aim of this study is to describe symptom burden and functional dependencies of cancer patients in Botswana using the Memorial Symptom Assessment Scale-Short Form (MSAS-SF) and Enforced Social Dependency Scale (ESDS).
  
  
  METHODS
  A cross-sectional multisite study was conducted in Gaborone, Botswana, from June to August 2013 using MSAS-SF, ESDS, and Eastern Cooperative Oncology Group (ECOG) performance status at 1 time point. Descriptive statistics, tests of association, correlation, and scale validity were used.
  
  
  RESULTS
  Among the 100 cancer patients, 65 were women, 21 were inpatients, 48 were human immunodeficiency virus-positive, 23 had gynecological malignancies, 34 had stage 4 disease, and 54 received chemotherapy only. Sixty-four reported pain; 54, neuropathies; 51, weight loss; and 51, hunger. Most distressing symptoms were weight loss, body image, skin changes, and pain. Recreational/social role was most affected by cancer. Cronbach's α for both the MSAS-SF and ESDS was .91. Variations in means for MSAS-SF and ESDS were associated with ECOG grade 2 (P < .05); the ECOG moderately correlated (0.35) with MSAS-SF (P < .01). No associations with human immunodeficiency virus status were found.
  
  
  CONCLUSIONS
  Patients reported distressing levels of cancer pain, weight loss, hunger, and dependency in recreational/social activities. The Setswana translations of the MSAS-SF and ESDS were found reliable to assess cancer patients' symptoms and function.
  
  
  CONCLUSIONS
  Nurses trained in palliative care are needed to meet cancer patients' pain and symptom management care needs.
authors.affiliation: Author Affiliations: Yale University School of Nursing, West Haven, Connecticut (Dr Lazenby and Mss Lopez and Peterson); University of Botswana School of Nursing, Gaborone, Botswana (Dr Sebego and Mr Swart); Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio (Mr Swart); MD Anderson Cancer Center, University of Texas, Houston (Ms Lopez); Park Nicollet Methodist Hospice, Park Nicollet Health Services HealthPartners Health System, Minneapolis, Minnesota (Ms Peterson).
authors.forename: Mark
authors.initials: M
authors.lastname: Lazenby
authors.forename: Miriam
authors.initials: M
authors.lastname: Sebego
authors.forename: Norman Carl
authors.initials: NC
authors.lastname: Swart
authors.forename: Lidia
authors.initials: L
authors.lastname: Lopez
authors.forename: Katie
authors.initials: K
authors.lastname: Peterson
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001902:Botswana; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D005260:Female; D006301:Health Services Needs and Demand; D064946:Hospice and Palliative Care Nursing; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000451:nursing; D010146:Pain / Q000209:etiology; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D063189:Symptom Assessment; D014177:Translations; D055815:Young Adult