Determinants of Health-Related Quality of Life of Patients with Prostate Cancer Attending Cancer Centers in Eastern Kenya

Monicah Kiraki; Catherine Gichunge; Domisiano Impwii

doi:doi:10.11648/j.jctr.20251304.12

Research Article |

| Peer-Reviewed

Determinants of Health-Related Quality of Life of Patients with Prostate Cancer Attending Cancer Centers in Eastern Kenya

Monicah Kiraki^*

, Catherine Gichunge

, Domisiano Impwii

Published in Journal of Cancer Treatment and Research (Volume 13, Issue 4)

Received: 4 September 2025 Accepted: 16 September 2025 Published: 18 October 2025

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Abstract

Introduction: Patients with PCa experience alterations in sexual, genitourinary, and bowel functions, as well as psychological and financial difficulties, which in turn affect their HRQoL. However, there is paucity of data on the HRQoL among of patients with PCa being treated within the rural areas in Kenya. Aim: The aim of this study was to determine determinants of HRQoL among patients with PCa. Methodology: A descriptive cross-sectional design was used. Simple random sampling method was used to recruit 58 participants from two public cancer centers in Eastern Kenya. Data was collected using a researcher developed and administered semi-structured questionnaire. European Organization of Cancer Research and Treatment (EORTC) QLQ - C30 and QLQ – PR25 tools were used to obtain the HRQoL data and data was analyzed with SPSS version 29. Logistic regression tool was used to determine the predictors of HRQoL. A p-value of < 0.05 was considered significant. Ethical clearance and research permit were obtained from relevant authorities. Results: The mean age of the participants was about 73 years (±7.62) with a range of 60 to 90 years. Most participants were diagnosed in the 3^rd stage of disease (39.7%, n=23) and had poor HRQoL (58.6%, n = 34). On the EORTC QLQ - C30, social functioning had the lowest average score of 49.43, while role functioning had the highest average score of 67.529%. On symptom scales/items, financial difficulties, fatigue, pain and insomnia were the most frequently reported. On EORTC QLQ – PR 25, urinary symptoms were the most prevalent (34.84%) while sexual activity domain scored relatively high, with a mean of 71.84%. Poor HRQoL was significantly associated with older age and low income while longer illness duration was associated with better HRQoL (p = < 0.05). The findings highlight age, income, and illness duration as key determinants of HRQoL among the participants, with financial strain and advanced age emerging as critical vulnerabilities. Strengthening financial protection mechanisms, geriatric-focused care, and sustained psychosocial support may help optimize long-term outcomes for patients with PCa in Kenya and similar settings.

Published in	Journal of Cancer Treatment and Research (Volume 13, Issue 4)
DOI	10.11648/j.jctr.20251304.12
Page(s)	96-106
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2025. Published by Science Publishing Group

Keywords

Prostate Cancer, Health-Related Quality of Life, EORTC QLQ - C30, EORTC QLQ – PR 25, Kenya

1. Background

Prostate cancer (PCa) is a leading cause of cancer-related morbidity and mortality among men worldwide with a significant impact on patient’s Health-Related Quality of Life (HRQoL)

[1]

. In 2022, PCa was the fourth most common cancer globally, with over 1.4 million new cases and nearly 400,000 deaths

[1]

. The high incidences of PCa continue to be reported in Africa where PCa was the number one cancer among men in 2022

[2]

. In Kenya, specifically, PCa is the most prevalent male cancer, with 3.582 cases and 2,029 deaths reported in 2022

[2]

. Regional data from Kenya shows PCa accounts for 19.4% of all cancer cases in Meru county

[3]

. The high incidence in Kenya has been associated with poor health-seeking behavior, inadequate awareness of screening, and lack of essential facilities

[4]

HRQoL is a crucial measure of a person’s perceived state in reference to how a disease and its treatment affect a person’s well-being

[5]

. Chronic conditions like cancer including PCa can interfere with a patient’s ability to live a happy and functional life due to both the disease itself and its management

[6]

. The psychological distress and financial burden of cancer therapy can interfere with a patient’s ability to manage their illness, symptoms, and treatment

[7]

. Patients with PCa often experience alterations in sexual, pain, fatigue, genitourinary, and bowel functions, as well as psychological and financial difficulties, all of which negatively impact their HRQoL

[8]

HRQoL has been associated with a number of socioeconomic and clinical characteristics. The relationship between age and HRQoL among patients with PCa remains inconclusive. Some studies report poorer HRQoL in older men

[9-11]

, while others show that younger patients, particularly those post-prostatectomy, experience pain and sexual dysfunction that lower HRQoL

[12]

. At the same time, younger patients often demonstrate better physical and sexual functioning compared to older counterparts

[10]

. Higher education and income are consistently associated with better physical, social and psychological outcomes, as well as reduced risk of depression enhancing the HRQoL

[9, 2, 13]

. Marital status also plays a role, with studies noting improved HRQoL among married men due to spousal support, though there is mixed evidence

[14]

. Spiritual coping has similarly been associated with enhanced well-being

[12, 13]

. Clinical factors significantly shape HRQoL, as advanced or metastatic disease consistently worsens outcome across regions

[13]

, while comorbidities increase pain, fatigue and psychosocial needs

[10]

. Mental distress, anxiety, and depression impair functioning

[11]

, and memory loss reduces daily performance all of which compromise the HRQoL

[14]

Previous research on PCa in Kenya has largely concentrated on survivors of patients managed in national referral hospitals, with limited attention given to those receiving active treatment in county referral facilities. In Kenya healthcare is a devolved function and county hospitals serve as the first point of specialized cancer care for many patients. Little is known about HRQoL and its determinants in this context, despite potential differences in resources, access, and support systems compared to national centers. This study therefore assessed the determinants of HRQoL among patients with PCa attending two county teaching and referral facilities Eastern Kenya.

2. Materials and Methods

2.1. Study Design and Setting

This was a descriptive cross-sectional study that sought to determine the HRQoL of patients with PCa attending Embu and Meru cancer centers. The study was conducted out in the Embu and Meru Teaching and Referral Hospitals' cancer centers. The study sites were selected since they were the only cancer treatment centers in the Eastern region with high numbers of registered patients with cancer. The communities in the region engage in relatively similar socioeconomic activities. Furthermore, the two hospitals belonged to the same category of county teaching referral hospitals.

2.2. Study Population and Sampling

The study targeted patients with PCa attending cancer centers in Embu and Meru County Teaching and Referral hospitals’ cancer centers. Simple random sampling method was used to recruit 58 patients; 29 participants per facility, with a histologically confirmed diagnosis of PCa. However, the very sick patients and the eligible but unwilling to participate were excluded from the study.

2.3. Data Collection Method

A researcher developed and administered semi-structured questionnaire was used to obtain the socioeconomic (age, marital status, level of education, location, monthly household income, and availability of medical insurance) and clinical (year of cancer diagnosis, staging of the disease at the time of diagnosis, disease management received and comorbidity) characteristics of study participants. The participants' HRQoL was assessed using the European Organization for Research and Treatment of Cancer (EORTC – QLQ-30, EORTC-QLQ-PR25) tools

[15]

2.4. Data Analysis

Data was analyzed using the Statistical Package of Social Sciences (SPSS) version 29. The HRQoL scores were obtained according to the EORTC scoring manual

[16]

. A higher score on a scale measuring functioning and global health status indicated a greater level of functioning

[16]

. In contrast, a higher degree of symptomatology was indicated by a higher score on a symptoms/problems scales

[16]

. The overall HRQoL was classified into two categories, good and poor, as has been transformed by

[17]

. The Cronbach alpha for the EORTC –QLQ –PR25 and EORTC QLQ-C30 for this study was 0.87 and 0.813 respectively. Chi-square test was used to determine the relationship between categorical variables and HRQoL. Variables that showed a statistically significant association, or a p-value of ≤0.3 were included in a logistic model to determine the predictors of HRQoL

[18]

2.5. Ethical Considerations

Ethical clearance and research permit for the study were acquired from Chuka University's Institutional Research Ethics and Review Committee (CUIERC/NACOSTI/586) and National Commission for Science, Technology and Innovation (NACOSTI) (NACOSTI/P/24/39/242) respectively. The researcher obtained approval to use the HRQoL assessment tool from the European Organization for Research and Treatment of Cancer (EORTC). Detailed information on the study was provided before seeking consent from eligible participants. To participate in the study, willing participants gave written consent.

3. Results

The study sample comprised of 58 participants with a mean age of 72.98 years (±7.62), and a median of 73 years ranging from 60 to 90 years. As shown in Table 1, majority of the participants (55.2%, n = 32) were aged 60 – 74 years, were married (81%, n = 47) and had secondary and above (51.7%, n = 30)., Almost half of the participants (46.6%, n = 27) were unemployed and the average estimated household income was Ksh 5071 ($39). Income range was Ksh 500 – 15,000 ($3.8 - $116) with about half of the participants (51.7%, n = 30), earning above Ksh 5,000 ($38.7). All the participants had a medical cover (100%, n = 58) with the majority (79.3%, n = 46) using Social Health Authority (SHA). The participants were from four counties with the majority being from Meru county (39.7%, n = 23) and the least from Kirinyaga County) 12.1%, n = 7). (Table 1)

Table 1. Socioeconomic characteristics of participants.

Characteristic		N = 58
Age	Mean (±SD)	72.98 (7.62)
	Median	73
	Range	60 - 90
Age group	60 - 74	32 (55.2)
Age group	75 years and above	26 (44.8)
Marital status	Married	47 (81)
Marital status	Widowed	11 (19)
Highest level of education	Primary and below	28 (48.3)
Highest level of education	Secondary and above	30 (51.7)
Religion	Catholic	18 (31)
Religion	Protestant	40 (69)
Source of income	Unemployed	27 (46.6)
	Formally employed	13 (22.4)
	Self-employed	18 (31)
Estimated family monthly income	Mean (SD)	5071.55 (5535.55)
	Median	3750.00
	Range	500 – 15000.00
	Ksh 500 – 4,999	28 (48.3)
	Ksh 5,000 and above	30 (51.7)
Had a medical cover	Yes	58 (100)
Type of medical cover	SHA	46 (79.3)
Type of medical cover	SHA and a private cover	12 (20.7)
County of Residence	Tharaka Nithi	12 (20.7)
	Embu	16 (27.6)
	Kirinyaga	7 (12.1)
	Meru	23 (39.7)

The mean duration and range of illness was 27.83 (±24,43), (1 – 90). More than half of the participants had been ill for 1 – 24 months (55.2%, n = 32), were diagnosed while in stage III (39.7%, n = 23) and were undergoing chemotherapy (77.6%, n = 45). Slightly less than half of the participants had a comorbid condition (46.6%, n = 27) and hypertension was the most prevalent comorbid (29. 3%, n = 17). (Table 2)

Table 2. Clinical characteristics of participants.

Characteristic		N = 58
Duration of illness	Mean (±SD)	27.83 (24.434)
	Median	22
	Range	1 – 90
	1 – 24 months	32 (55.2)
	More than 24 months	26 (44.8)
Disease stage	Stage II	15 (25.9)
	Stage III	23 (39.7)
	Stage IV	20 (34.5)
Disease management (multiple response)	Radiotherapy	22 (37.9)
	Hormone therapy	27 (46.6)
	Chemotherapy	45 (77.6)
Presence of comorbidity	No	31 (53.4)
Presence of comorbidity	Yes	27 (46.6)
Common comorbidities (n=27, multiple responses)	Diabetes	7 (12.1)
	Hypertension	17 (29.3)
	Renal Failure	1 (1.7)
	Asthma	1 (1.7)
	Arthritis	2 (3.4)

Overall, more than half of the participants (58.6%, n = 34) were classified as having poor HRQoL. In the QLC – C30 of the global QoL scale mean score was 55.17 (±19.80) with a range of 16.67 – 100. Among the functional scales, role functioning had the highest average score (67.53, ±31.75) closely followed by physical functioning (66.12, ±29.369) while the least score was the social functioning scale (49.43, ±34.62). In the symptom scales, financial difficulties had the highest score (63.218, ±37.302) while the least was dyspnea (12.07, ±20.76). PCa specific symptoms, measured using the EORTC QLQ-PR25, showed that urinary symptoms were the most prevalent (34.84, ±28.56). In addition, sexual activity domain scored relatively high, with a mean of 71.84 (± 27.21). (Table 3)

Table 3. Scores of HRQoL of Participants.

Scale/Item	N = 58
Overall HRQoL	n (%)
Poor HRQoL	34 (58.6%)
Good HRQoL	24 (41.8%)
EORTC – QLQ-C30	Mean (±SD)	Median	Range
Quality of life/Global health status	55.17 (19.8)	58.30	16.67 – 100
Functional Scale
Physical Functioning (PF)	66.12 (29.37)	67.00	7 – 100
Role functioning (RF)	67.529 (31.75)	66.67	0 - 100
Emotional Functioning (EF)	65.23 (29.21)	58.33	8.33 – 100
Cognitive functioning (CF)	66.81 (25.1)	66.67	16.67 – 100
Social functioning (SF)	49.43 (34.62)	50.00	0 - 100
Symptom/item
Fatigue	30.26 ((24.51)	22.33	0 – 100
Nausea and Vomiting	25.58 (20.76)	33.333	0 – 66.67
Pain	30.46 (29.31)	25.00	0 – 100
Dyspnea	12.07 (20.76)	0.00	0 – 66.67
Insomnia	28.16 (29.82)	33.33	0 – 100
Appetite loss	19.54 (27.24)	0.00	0 - 100
Constipation	23.56 (27.93)	0.00	0 – 100
Diarrhea	14.94 (21.78)	0.00	0 – 66.67
Financial difficulties	63.22 (37.30)	66.67	0 - 100
EORTC-QLQ-PR25	Mean (±SD)	Median	Range
Symptoms scale/items
Urinary symptoms	34.84 (28.56)	37.50	0 – 83.33
Bowel Symptoms	14.22 (16.89)	8.33	0 – 66.67
Hormone-related symptoms	29.79 (24.90)	22.22	0 – 88.89
Functional scales
Sexual activity (SAC)	71.84 (27.61)	66.67	33.33 – 100

HRQoL was statistically significantly associated with participant’s age group (χ²= 6.508, df = 1 and p = 0.011) and monthly household income (χ² = 4.973, df = 1 and p = 0.026) as shown in Table 4.

Table 4. Association between overall HRQoL and socioeconomic characteristics.

Characteristic		Poor HRQoL n (%)	Good HRQoL n (%)	χ²	df	p-value
		n=58
Age group	60 – 74 years	14 (24.1)	18 (31)	6.508	1	0.011^a
Age group	≥ 75 years	20 (34.5)	6 (10.3)	6.508	1	0.011^a
Marital status	Married	26 (44.8)	21 (36.2)	1.114	1	0.291*
Marital status	Widowed	8 (13.8)	3 (5.2)	1.114	1	0.291*
Level of education	Primary and below	17 (29.3)	11 (19)	0.098	1	0.754
Level of education	Secondary and above	17 (29.3)	13 (22.4)	0.098	1	0.754
Religion	Catholic	9 (15.5)	9 (15.5)	0.800	1	0.371
Religion	Protestant	25 (43.1)	15 (25.9)	0.800	1	0.371
Source of income	Unemployed	14 (24.1)	13 (22.4)	3.203	2	0.202
	Formally employed	7 (12.1)	6 (10.3)
	Self employed	13 (22.4)	5 (8.6)
Monthly household income	Ksh 500 – 4,999 ($4 – 39)	13 (22.4)	15 (25.9)	4.973	1	0.026^a
Monthly household income	Ksh ≥ 5,000 (>$39)	21 (36.2)	9 (15.5)	4.973	1	0.026^a
Type of medical cover	SHA	27 (46.6)	19 (32.8)	0.001	1	0.982
Type of medical cover	SHA and a private cover	7 (12.1)	5 (8.6)	0.001	1	0.982
County of residence	Tharaka Nithi	10 (17.2)	2 (3.4)	6.479	3	0.091*
	Embu	6 (10.3)	10 (17.2)
	Kirinyaga	5 (8.6)	2 (3.4)
	Meru	13 (22.4)	10 (17.2)

*Fisher’s exact test; a-statistically significant at 95%

Table 5 shows that individuals aged ≥75 years had 7.4 times higher odds of experiencing poor HRQoL compared to those aged 60–74 years (AOR = 7.41, 95% CI [1.48–37.20], p=0.02). In addition, those earning low income (Ksh 500–4,999) were 7.1 more likely to have poor HRQoL compared to higher income (≥5,000) (AOR = 7.13, 95% CI [1.24–40.91], p = 0.03).

Table 5. Multivariate logistic regression showing association between HRQoL and Socioeconomic Characteristics.

Variable		COR (95% CI)	AOR (95% CI)	p-value
Age group	≥ 75 years	4.29 (1.36 – 13.52)	7.41 (1.48 – 37.20)	0.02^a
Age group	60 – 74 years	1	1	0.02^a
Marital status	Married	2.15 (0.51 – 9.15)	1.795 (0.27 – 11.79)	0.54
Marital status	Widowed	1	1	0.54
Source of income	Unemployed	2.01 (0.65 – 6.19)	3.14 (0.63 – 15.59)	0.16
	Formally employed	0.38 (0.04 – 3.79)	0.49 (0.03 – 8.13)	0.62
	Self employed	1	1	-
Monthly household income	500 – 4,999	3.47 (1.14 – 10.57)	7.13 (1.24 – 40.91)	0.03^a
Monthly household income	≥ 5,000	1	1	0.03^a
County of residence	Tharaka Nithi	0.26 (0.05 – 1.46)	0.33 (0.04 – 2.56)	0.29
	Embu	2.17 (0.59 – 7.99)	4.05 (0.57 – 28.54)	0.16
	Kirinyaga	0.52 (0.08 – 3.26)	1.07 (0.08 – 14.62)	0.96
	Meru	1	1	1

a-statistically significant at 95%; 1 – reference category

As shown in Table 6, HRQoL was significantly associated with duration if illness, (χ² = 6.51, df = 1 and p = 0.01). There were no significant relationships with other clinical characteristics of the study participants.

Table 6. Association between HRQoL and clinical characteristics.

Characteristic		Poor HRQoL n (%)	Good HRQoL n (%)	χ²	df	p-value
		N=58
Duration of illness	1 – 24 months	14 (24.1)	18 (31.0)	6.51	1	0.01^a
Duration of illness	>24 months	20 (34.50	6 (10.3)	6.51	1	0.01^a
Disease stage	Stage II	12 (20.7)	3 (5.2)	3.48	2	0.18
	Stage III	11 (19)	12 (20.7)
	Stage IV	11 (19)	9 (15.5)
Disease Management	Radiation Therapy	14 9 (24.1)	8 (13.8)	0.37	1	0.54
	Hormone therapy	18 (31)	13 (22.4)	0.01	1	0.93
	Chemotherapy	25 (43.1)	20 (34.5)	0.78	1	0.38
Presence of comorbidity	No	19 (32.8)	12 (20.7)	0.2	1	0.66
Presence of comorbidity	Yes	15 (25.9)	12 (20.7)	0.2	1	0.66

a- Statistically significant at 95%

Table 7 shows that participants who had been ill for more than 24 months were 4.75 times likely to have good HRQoL compared to participants who had been ill for two years and below (AOR 4.750, 95% CI [1.430 – 15.774], p = 0.011).

Table 7. Multivariate logistic regression showing association between HRQoL and clinical characteristics.

Variables		COR (95% CI)	AOR (95% CI)	p-value
Duration of illness	>24 months	4.29 (1.36 – 13.521)	4.75 (1.43 – 15.77)	0.011^a
Duration of illness	1 – 24 months	1	1	0.011^a
Disease stage	Stage II	0.33 (0.07 – 1.57)	0.29 (0.06 – 1.51)	0.14
	Stage III	1.33 (0.40 – 4.44)	1.16 (0.32 – 4.23)	0.82
	Stage IV	1	1	-

a- Statistically significant at 95%; 1- Reference category

4. Discussion

The participants’ age distribution between 60 to 90 years aligns with global

[19]

and local

[13, 14]

epidemiology showing PCa as a disease of older men

[2]

. Most participants were married, consistent with studies in Canada

[20]

and Kenya

[13]

, reflecting cultural norms where older men are more likely to be married or cohabiting

[21]

. This means that the participants could be experiencing Better HRQoL due to spousal support

[22]

. Socio-economic vulnerabilities were evident, with most participants reporting low household income, in contrast to patients in Nairobi who had relatively higher incomes

[23]

, but consistent with Wajir County findings where many households earn below Ksh 15,000 ($116)

[24]

. This mirrors rural Kenya’s elderly population, often retired or engaged in informal work, which makes affordability of care difficult. Financial insecurity remains a barrier to timely diagnosis and treatment in Sub-Saharan Africa (SSA)

[16, 25]

, shaping health-seeking behavior

[24]

. While unemployment was high, most participants reported having medical insurance, mainly through the government Social Health Authority (SHA), consistent with earlier findings

[14]

and reflecting the benefits of Universal Health Coverage (UHC) reforms in Kenya

[26, 27]

. This shows that, despite the low income levels, the participants were able to access the basic PCa care in the cancer centers.

Clinically, late-stage diagnosis was prominent, echoing trends in Kenya where poor awareness, inadequate screening, and delayed health-care seeking contribute to advanced presentations

[23, 28]

. The proportion diagnosed at late stage was higher than in developed countries

[29]

, contributing to elevated PCa mortality rates in SSA

[22, 24, 30]

. Regarding treatment, hormone therapy and chemotherapy were common, with minimal radiotherapy use, reflecting disparities in access to comprehensive cancer services. Such inequities highlight the role of social determinants, including income, education, awareness, insurance, and broader health system limitations in shaping treatment access and HRQoL outcomes among patients with PCa

[31]

More than half of the participants were classified as having poor HRQoL showing a substantial burden of PCa on patient’s well-being. This aligns with Holm et al, who reported that patients with metastatic PCa often experience poor HRQoL in years preceding death, highlighting the cumulative impact of disease progression and symptom burden

[32]

. Similarly, researchers in Finland found that even at the beginning of treatment, many patients with PCa reported compromised HRQoL suggesting that deterioration can begin early in the treatment trajectory

[33]

. The same was also reported among PCa patients in Nigeria

[34]

. Furthermore, Kenyan patients with PCa managed in a National referral hospital reported compromised HRQoL across a majority of the domains

[4]

, reinforcing the present study’s findings. These suggest that poor HRQoL remains a pervasive challenge among patients with PCa regardless of treatment setting.

Social functioning was the lowest among all domains at 49.43% consistent with findings from developed settings such as China and Cyprus

[35, 36]

and developing countries

[14, 37]

. In Kenya, stigmatization and limited psychosocial support may exacerbate social withdrawal after diagnosis

[38]

. In contrast, physical functioning was relatively well preserved compared to studies in China, and Brazil

[36, 39]

, though consistent with previous Kenyan findings which reported that patients with PCa, despite some limitations, often manage daily tasks with assistance.

[14]

. Lifestyle factors like farming and walking in rural Kenya may have be helping the participants to sustain stamina. Similarly, role functioning was higher than in China and Europe

[35, 36]

, however it was aligning with a study done in South Africa

[40]

. Participants of the current study were elderly, probably engaging in minimal activities hence retaining their roles despite the illness. In addition, supportive community structures such as being married and flexible responsibilities may enable continued participation

[41]

. The cognitive functioning of the current study was higher than those of Cyprus and South Africa

[35, 40]

suggesting that robust family support systems in rural Kenya may buffer cognitive decline

[41]

. In terms of emotional functioning, the study showed stable cognitive functioning among the participants, which contradicted a study from China that found poor emotional outcomes

[36]

but consistent with studies from North Carolina, and China

[39, 42]

. This emotional resilience is likely fostered by strong family and spiritual support, particularly among married men

[42]

. However, the stable emotional functioning may not fully reflect the reality of the patients’ experiences. Cultural norms in the study area may discourage the open reporting of psychological distress, leading to an underestimation of the emotional burden

[43]

. This underscores the importance of strengthening psychosocial support systems to address low social functioning and hidden emotional distress among patients with PCa. Integrating culturally sensitive mental health and community based interventions into routine cancer care may enhance the overall HRQoL in resource-limited settings.

Financial difficulties, pain, and fatigue emerged as the most common symptoms/concerns in this study. Fatigue and pain were also prevalent, aligning with evidence that these are universal and persistent symptoms of PCa

[16, 44]

. Urinary problems were the most reported functional limitation in the EORTC QLQ-PR25, with participants citing increased frequency, urgency, and nocturia. This corresponds with Kenyan study

[14]

and global reports of lasting urinary effects post-radical prostatectomy

[45]

. In contrast, bowel symptoms were mild, similar to a previous study

[43]

, while sexual activity appeared relatively high, possibly reflecting underreporting due to stigma

[46]

contradicting

[47]

. These findings highlight the need for stronger financial protection and supportive care interventions to address persistent physical and functional burdens. Tailored strategies focusing on urinary, pain, and fatigue may improve HRQoL and reduce disparities in PCa care.

The study found that advanced age (≥75 years) was significantly associated with poor HRQoL, supporting previous findings that older patients with PCa experience worse outcomes

[9, 10]

. In Iran, older patients with PCa reported poorer physical and sexual functioning

[10]

, while in Kenya, older patients showed worse physical and psychological well-being

[48]

. This pattern reflects aging as a universal risk factor, driven by comorbidities, declining resilience, and reduced treatment tolerance

[9, 10]

. Our findings confirm this pattern but also adds the context from rural Kenya where limited access to geriatric oncology support may compound the vulnerability of older patients, an area often unexplored locally. Household income also emerged as a determinant of HRQoL, with patients of low income showing sevenfold higher odds of poor HRQoL. Financial strain is a recognized barrier to cancer care and is often associated with poor health outcomes

[49, 50]

. Even with full medical coverage, participants reported economic hardship, similar to findings from a previous study in Kenya

[14]

. This may reflect the ongoing transition challenge from the National Health Insurance Fund (NHIF) to the Social Health Authority (SHA), where oncology benefits remain inadequate compared to treatment costs

[51]

. This resonates with Kenyan

[12, 13]

and global evidence

[52]

underscoring the critical role of financial stability in sustaining QoL. Despite universal health insurance coverage through SHA, financial challenges persisted, suggesting that indirect costs such as transport, caregiving, and nutritional support remain substantial barriers among the participants.

Interestingly, duration of illness showed a positive association with HRQoL, as patients ill for more than 24 months were nearly five times more likely to report better HRQoL. This aligns with findings from Poland and South Africa, where longer illness duration was associated with adaptation and improved coping

[12, 40]

. Our results contribute new evidence, reinforcing Pollock’s adaptation theory

[53]

, which posits that over time, patients adjust psychologically and benefit from symptom control and psychosocial support. This shows resilience and gradual adjustment may buffer long-term HRQoL even in resource-constrained environments.

5. Strengths and Limitations

The study used standardized instruments; EORTC QLQ-C30 and QLQ – PR25 enhancing reliability and comparability of findings with local and global studies. The study also examined both sociodemographic and clinical factors, giving a comprehensive view of predictors of HRQoL.

Despite the strengths, the use of cross-sectional study design limits causal inference between determinants and HRQoL. In addition, HRQoL data relied on patients self-reporting, which may be subject to recall bias.

6. Conclusion and Recommendations

This study sought to determine the factors associated with HRQoL of patients with PCa in Eastern Kenya. The findings highlight age, income, and illness duration as key determinants of HRQoL among the participants, with financial strain and advanced age emerging as critical vulnerabilities. Strengthening financial protection mechanisms, geriatric-focused care, and sustained psychosocial support may help optimize long-term outcomes for patients with PCa in Kenya and similar settings. There is need to integrate assessment of HRQoL in routine PCa care in Kenya. In addition, the county government in collaboration with national government should develop targeted interventions for older and low-income patients so as to enhance their quality of life. Moreover, future research on PCa in Kenya should focus on vulnerable populations, particularly elderly patients; 75 years and above, and those with low household income. A comparative cross-sectional study combined with qualitative methods is recommended to explore their unique challenges and inform tailored interventions. There is need to also determine the HRQoL of young patients (below 60 years) with PCa since the participants of the current study were 60 years and above.

Abbreviations

EORTC	European Organization of Cancer Research and Treatment
HRQoL	Health-Related Quality of life
NHIF	National Health Insurance Fund
PCa	Prostate Cancer
SSA	Sub-Saharan Africa
SHA	Social Health Authority
UHC	Universal Health Coverage

Acknowledgments

The authors would wish to acknowledge the participants of the study and the health care providers in the cancer centers where the study was done.

Author Contributions

Monicah Kiraki: Conceptualization, Formal Analysis, Methodology, Resources, Writing – original draft

Catherine Gichunge: Methodology, Supervision, Writing – review & editing

Domisiano Impwii: Methodology, Supervision, Writing – review & editing

Data Availability Statement

The data is available from the corresponding author upon reasonable request.

Conflicts of Interest

The authors declare no conflicts of interest.

References

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Kiraki, M., Gichunge, C., Impwii, D. (2025). Determinants of Health-Related Quality of Life of Patients with Prostate Cancer Attending Cancer Centers in Eastern Kenya. Journal of Cancer Treatment and Research, 13(4), 96-106. https://doi.org/10.11648/j.jctr.20251304.12

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Kiraki, M.; Gichunge, C.; Impwii, D. Determinants of Health-Related Quality of Life of Patients with Prostate Cancer Attending Cancer Centers in Eastern Kenya. J. Cancer Treat. Res. 2025, 13(4), 96-106. doi: 10.11648/j.jctr.20251304.12

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AMA Style

Kiraki M, Gichunge C, Impwii D. Determinants of Health-Related Quality of Life of Patients with Prostate Cancer Attending Cancer Centers in Eastern Kenya. J Cancer Treat Res. 2025;13(4):96-106. doi: 10.11648/j.jctr.20251304.12

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@article{10.11648/j.jctr.20251304.12,
  author = {Monicah Kiraki and Catherine Gichunge and Domisiano Impwii},
  title = {Determinants of Health-Related Quality of Life of Patients with Prostate Cancer Attending Cancer Centers in Eastern Kenya
},
  journal = {Journal of Cancer Treatment and Research},
  volume = {13},
  number = {4},
  pages = {96-106},
  doi = {10.11648/j.jctr.20251304.12},
  url = {https://doi.org/10.11648/j.jctr.20251304.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jctr.20251304.12},
  abstract = {Introduction: Patients with PCa experience alterations in sexual, genitourinary, and bowel functions, as well as psychological and financial difficulties, which in turn affect their HRQoL. However, there is paucity of data on the HRQoL among of patients with PCa being treated within the rural areas in Kenya. Aim: The aim of this study was to determine determinants of HRQoL among patients with PCa. Methodology: A descriptive cross-sectional design was used. Simple random sampling method was used to recruit 58 participants from two public cancer centers in Eastern Kenya. Data was collected using a researcher developed and administered semi-structured questionnaire. European Organization of Cancer Research and Treatment (EORTC) QLQ - C30 and QLQ – PR25 tools were used to obtain the HRQoL data and data was analyzed with SPSS version 29. Logistic regression tool was used to determine the predictors of HRQoL. A p-value of Results: The mean age of the participants was about 73 years (±7.62) with a range of 60 to 90 years. Most participants were diagnosed in the 3rd stage of disease (39.7%, n=23) and had poor HRQoL (58.6%, n = 34). On the EORTC QLQ - C30, social functioning had the lowest average score of 49.43, while role functioning had the highest average score of 67.529%. On symptom scales/items, financial difficulties, fatigue, pain and insomnia were the most frequently reported. On EORTC QLQ – PR 25, urinary symptoms were the most prevalent (34.84%) while sexual activity domain scored relatively high, with a mean of 71.84%. Poor HRQoL was significantly associated with older age and low income while longer illness duration was associated with better HRQoL (p = < 0.05). The findings highlight age, income, and illness duration as key determinants of HRQoL among the participants, with financial strain and advanced age emerging as critical vulnerabilities. Strengthening financial protection mechanisms, geriatric-focused care, and sustained psychosocial support may help optimize long-term outcomes for patients with PCa in Kenya and similar settings.
},
 year = {2025}
}

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TY - JOUR
T1 - Determinants of Health-Related Quality of Life of Patients with Prostate Cancer Attending Cancer Centers in Eastern Kenya

AU - Monicah Kiraki
AU - Catherine Gichunge
AU - Domisiano Impwii
Y1 - 2025/10/18
PY - 2025
N1 - https://doi.org/10.11648/j.jctr.20251304.12
DO - 10.11648/j.jctr.20251304.12
T2 - Journal of Cancer Treatment and Research
JF - Journal of Cancer Treatment and Research
JO - Journal of Cancer Treatment and Research
SP - 96
EP - 106
PB - Science Publishing Group
SN - 2376-7790
UR - https://doi.org/10.11648/j.jctr.20251304.12
AB - Introduction: Patients with PCa experience alterations in sexual, genitourinary, and bowel functions, as well as psychological and financial difficulties, which in turn affect their HRQoL. However, there is paucity of data on the HRQoL among of patients with PCa being treated within the rural areas in Kenya. Aim: The aim of this study was to determine determinants of HRQoL among patients with PCa. Methodology: A descriptive cross-sectional design was used. Simple random sampling method was used to recruit 58 participants from two public cancer centers in Eastern Kenya. Data was collected using a researcher developed and administered semi-structured questionnaire. European Organization of Cancer Research and Treatment (EORTC) QLQ - C30 and QLQ – PR25 tools were used to obtain the HRQoL data and data was analyzed with SPSS version 29. Logistic regression tool was used to determine the predictors of HRQoL. A p-value of Results: The mean age of the participants was about 73 years (±7.62) with a range of 60 to 90 years. Most participants were diagnosed in the 3rd stage of disease (39.7%, n=23) and had poor HRQoL (58.6%, n = 34). On the EORTC QLQ - C30, social functioning had the lowest average score of 49.43, while role functioning had the highest average score of 67.529%. On symptom scales/items, financial difficulties, fatigue, pain and insomnia were the most frequently reported. On EORTC QLQ – PR 25, urinary symptoms were the most prevalent (34.84%) while sexual activity domain scored relatively high, with a mean of 71.84%. Poor HRQoL was significantly associated with older age and low income while longer illness duration was associated with better HRQoL (p = < 0.05). The findings highlight age, income, and illness duration as key determinants of HRQoL among the participants, with financial strain and advanced age emerging as critical vulnerabilities. Strengthening financial protection mechanisms, geriatric-focused care, and sustained psychosocial support may help optimize long-term outcomes for patients with PCa in Kenya and similar settings.

VL - 13
IS - 4
ER -

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Monicah Kiraki

School of Health Sciences, Karatina University, Nyeri, Kenya

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http://orcid.org/0000-0003-3302-5573
Catherine Gichunge

School of Nursing and Public Health, Chuka University, Chuka, Kenya

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http://orcid.org/0000-0002-7902-3816
Domisiano Impwii

School of Nursing and Public Health, Chuka University, Chuka, Kenya

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http://orcid.org/0000-0001-7135-7822

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Kiraki, M., Gichunge, C., Impwii, D. (2025). Determinants of Health-Related Quality of Life of Patients with Prostate Cancer Attending Cancer Centers in Eastern Kenya. Journal of Cancer Treatment and Research, 13(4), 96-106. https://doi.org/10.11648/j.jctr.20251304.12

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Kiraki, M.; Gichunge, C.; Impwii, D. Determinants of Health-Related Quality of Life of Patients with Prostate Cancer Attending Cancer Centers in Eastern Kenya. J. Cancer Treat. Res. 2025, 13(4), 96-106. doi: 10.11648/j.jctr.20251304.12

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AMA Style

Kiraki M, Gichunge C, Impwii D. Determinants of Health-Related Quality of Life of Patients with Prostate Cancer Attending Cancer Centers in Eastern Kenya. J Cancer Treat Res. 2025;13(4):96-106. doi: 10.11648/j.jctr.20251304.12

Copy | Download

@article{10.11648/j.jctr.20251304.12,
  author = {Monicah Kiraki and Catherine Gichunge and Domisiano Impwii},
  title = {Determinants of Health-Related Quality of Life of Patients with Prostate Cancer Attending Cancer Centers in Eastern Kenya
},
  journal = {Journal of Cancer Treatment and Research},
  volume = {13},
  number = {4},
  pages = {96-106},
  doi = {10.11648/j.jctr.20251304.12},
  url = {https://doi.org/10.11648/j.jctr.20251304.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.jctr.20251304.12},
  abstract = {Introduction: Patients with PCa experience alterations in sexual, genitourinary, and bowel functions, as well as psychological and financial difficulties, which in turn affect their HRQoL. However, there is paucity of data on the HRQoL among of patients with PCa being treated within the rural areas in Kenya. Aim: The aim of this study was to determine determinants of HRQoL among patients with PCa. Methodology: A descriptive cross-sectional design was used. Simple random sampling method was used to recruit 58 participants from two public cancer centers in Eastern Kenya. Data was collected using a researcher developed and administered semi-structured questionnaire. European Organization of Cancer Research and Treatment (EORTC) QLQ - C30 and QLQ – PR25 tools were used to obtain the HRQoL data and data was analyzed with SPSS version 29. Logistic regression tool was used to determine the predictors of HRQoL. A p-value of Results: The mean age of the participants was about 73 years (±7.62) with a range of 60 to 90 years. Most participants were diagnosed in the 3rd stage of disease (39.7%, n=23) and had poor HRQoL (58.6%, n = 34). On the EORTC QLQ - C30, social functioning had the lowest average score of 49.43, while role functioning had the highest average score of 67.529%. On symptom scales/items, financial difficulties, fatigue, pain and insomnia were the most frequently reported. On EORTC QLQ – PR 25, urinary symptoms were the most prevalent (34.84%) while sexual activity domain scored relatively high, with a mean of 71.84%. Poor HRQoL was significantly associated with older age and low income while longer illness duration was associated with better HRQoL (p = < 0.05). The findings highlight age, income, and illness duration as key determinants of HRQoL among the participants, with financial strain and advanced age emerging as critical vulnerabilities. Strengthening financial protection mechanisms, geriatric-focused care, and sustained psychosocial support may help optimize long-term outcomes for patients with PCa in Kenya and similar settings.
},
 year = {2025}
}

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TY - JOUR
T1 - Determinants of Health-Related Quality of Life of Patients with Prostate Cancer Attending Cancer Centers in Eastern Kenya

VL - 13
IS - 4
ER -

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