Effectiveness of Structured Educational Intervention on Breast Cancer Patients’ Knowledge and Practice Regarding Chemotherapy Side Effects in Sulaimani City: “A Quasi-Experimental Study”
DOI:
https://doi.org/10.21928/uhdjst.v10n2y2026.pp178-187Keywords:
Breast cancer, Chemotherapy, Adverse effects, Structured educational program, Knowledge, PracticeAbstract
Background: Chemotherapy is the main component of breast cancer treatment; however, it is associated with numerous adverse effects challenging patients to cope. Therefore, this study examines an educational intervention on knowledge and practice related to chemotherapy adverse effects in women with breast cancer. Methods: This quasi-experimental study was administered at Hiwa Hospital in Sulaimani City between February and October 2025. A total of 108 participants were selected through purposive sampling and evaluated at two time periods. Data were collected through a validated instrument comprising sociodemographic and clinical characteristics along with a developed 12-item-based knowledge and practice questionnaire. The intervention group underwent 2 months of educational intervention, while the control group received standard care. Before the study, pilot testing was conducted to determine the practicality of the instrument. Data were analyzed employing the Statistical Package for the Social Sciences version 27. Results: The baseline test confirmed deficient knowledge and practice about chemotherapy adverse effects, with no significant disparity between groups (P > 0.05). Following the post-test, the intervention group significantly improved knowledge and practice (P < 0.001) compared to the control group. The level of education was the sole factor significantly correlated with the knowledge domain (P = 0.015). Conclusion: The study concluded that structured educational intervention significantly improved breast cancer patients’ knowledge and practice concerning chemotherapy adverse effects.
References
[1] F. Bray, M. Laversanne, H. Sung, J. Ferlay, R. L. Siegel, I. Soerjomataram, A and Jemal. “Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries”. CA A Cancer Journal for Clinicians Cancer, vol. 74, no. 3, pp. 229-263, 2024.
[2] J. N. Al-Asadi. “Breast and Ovarian cancers’ incidence trends among Iraqi women during 2012-2022 and their relationship to fertility patterns”. Sultan Qaboos University Medical Journal, vol. 25, no. 1, pp. 499-505, 2025.
[3] Iraqi Cancer Board. “CANCER REGISTRY REPORT”; 2024. Available from: https://www.com/chrome/extension:// efaidnbmnnnibpcajpcglclefindmkaj/https://storage.moh.gov.iq/2 024/11/24/2024_11_24_12127028949_4299728097670824.pdf [Last accessed on 2025 Jul 05].
[4] A. J. Kerr, D. Dodwell, P. McGale, F. Holt, F. Duane, G. Mannu, S. C. Darby and C. W. Taylor. “Adjuvant and neoadjuvant breast cancer treatments: A systematic review of their effects on mortality”. Cancer Treatment Reviews, vol. 105, p. 102375, 2022.
[5] U. Anand, A. Dey, A. K. Singh Chandel, R. Sanyal, A. Mishra, D. K. Pandey, V. De Falco, A. Upadhyay, R. Kandimalla, A. Chaudhary, J. K. Dhanjal, S. Dewanjee, J. Vallamkondu and J. M. Pérez De La Lastra. “Corrigendum to ‘cancer chemotherapy and beyond: Current status, drug candidates, associated risks and progress in targeted therapeutics’ [genes & diseases 10 (2023) 1367-1401]”. Genes and Diseases, vol. 11, no. 4, p. 101211, 2024.
[6] N. A. Yahaya, K. L. Abdullah, V. Ramoo, N. Z. Zainal, L. P. Wong and M. Danaee. “Effects of self-care education intervention program (SCEIP) on activation level, psychological distress, and treatment-related information”. Healthcare, vol. 10, no. 8, p. 1572, 2022.
[7] S. Aranda, M. Jefford, P. Yates, K. Gough, J. Seymour, P. Francis, C. Baravelli, S. Breen and P. Schofield. “Impact of a novel nurse-led prechemotherapy education intervention (ChemoEd) on patient distress, symptom burden, and treatment-related information and support needs: Results from a randomised, controlled trial”. Annals of Oncology, vol. 23, no. 1, pp. 222-231, 2012.
[8] K. N. Ali and I. Shah. “Symptoms and treatment-related knowledge of cancer patients receiving chemotherapy)”. Journal of World Science, vol. 2, no. 12, pp. 1907-1920, 2023.
[9] B. E. El-Feqi, M. A. El-Aziz, M. S. Hassan and Y. Mohamed. “Knowledge and self care practices for women with breast cancer related lymphedema”. Egyptian Journal of Health Care, vol. 11, no. 2, pp. 46-65, 2020.
[10] K. Christiansen, L. Buswell and T. Fadelu. “A systematic review of patient education strategies for oncology patients in low- and middle-income countries”. Oncologist, vol. 28, no. 1, pp. 2-11, 2023.
[11] J. Avery, R. Thomas, D. Howell and C. J. Dubouloz Wilner. “Empowering cancer survivors in managing their own health: A paradoxical dynamic process of taking and letting go of control”. Qualitative Health Research, vol. 33, no. 5, pp. 412-425, 2023.
[12] B. Rogers, B. Pesata, J. H. Lee, J. Zhao, J. Krieger and K. Daily. “Chemotherapy education: Current practices of oncology nurses counseling patients”. Supportive Care in Cancer, vol. 29, no. 12, pp. 7323-7328, 2021.
[13] S. Sánchez-Castro, M. Pueyo-Garrigues, N. Canga-Armayor, C. Alfaro-Díaz, M. Lavilla-Gracia and N. Esandi. “Nurse-led health education interventions for women with primary breast cancer initiating treatment: A scoping review”. Seminars in Oncology Nursing, vol. 42, p. 152242, 2026.
[14] X. B. Lai, S. S. Y. Ching, F. K. Y. Wong, C. W. Y. Leung, L. H. Lee, J. S. Y. Wong and Y. F. Lo. “The cost-effectiveness of a nurse-led care program for breast cancer patients undergoing outpatient-based chemotherapy - a feasibility trial”. European Journal of Oncology Nursing, vol. 36, pp. 16-25, 2018.
[15] G. A. Osman and R. N. Alla Hussain. “Effectiveness of an educational program on physical and psychological quality of life among breast cancer patients in Erbil City, Iraq: A quasi-experimental study”. Journal of Pioneering Medical Sciences, vol. 15, no. 01, pp. 194-200, 2026.
[16] J. Cohen. “Statistical Power Analysis for the Behavioral Sciences”. 2nd ed. 1988. Available from: https://www.scirp.org/reference/refer encespapers?referenceid=2041144 [Last accessed on 2026 Jun 06].
[17] W. C. Mak and S. S. Yin Ching. “Effect of an education program on knowledge, self-care behavior and handwashing competence on prevention of febrile neutropenia among breast cancer patients receiving doxorubicin and cyclophosphamide in chemotherapy day centre”. Asia-Pacific Journal of Oncology Nursing, vol. 2, no. 4, pp. 276-288, 2015.
[18] M. E. Schmidt, M. Milzer, C. Weiß, P. Reinke, M. Grapp and K. Steindorf. “Cancer-related fatigue: Benefits of information booklets to improve patients’ knowledge and empowerment”. Supportive Care in Cancer, vol. 30, no. 6, pp. 4813-4821, 2022.
[19] O. Berger, B. H. Grønberg, J. H. Loge, S. Kaasa and K. Sand. “Cancer patients’ knowledge about their disease and treatment before, during and after treatment: A prospective, longitudinal study”. BMC Cancer, vol. 18, no. 1, p. 381, 2018.
[20] WHO. “Process of Translation and Adaptation of Instruments”. World Health Organization. Available from: https://www.who.int/ substance_abuse/research_tools/translation/en/ [Last accessed on 2026 Jun 06].
[21] B. T. Feleke, M. Z. Wale and M. T. Yirsaw. “Knowledge, attitude and preventive practice towards COVID-19 and associated factors among outpatient service visitors at Debre Markos compressive specialized hospital, North-West Ethiopia, 2020”. PLoS One, vol. 16, no. 7, p. e0251708, 2021.
[22] NCCN. “NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Cancer-Related Fatigue Version 2.2024”. Available from: https://beoncosup-acc.sciensano.be/sites/default/files/ guideline/nccn_fatigue_version%202_2023.pdf [Last accessed on 2026 Jun 07].
[23] National Cancer Institute. “Chemotherapy and You”. Availabe from: https://www.cancer.gov/publications/patient-education/chemo-and-you [Last accessed on 2026 Jun 07].
[24] H. White and S. Sabarwal. “Quasi-experimental design and methods”. Methodological Briefs: Impact Evaluation, vol. 8, pp. 1-16, 2014.
[25] K. Ayalew, Y. Ayalew, T. Alemu and T. Gebru. “Knowledge and experience of women with breast cancer receiving chemotherapy in selected public hospitals, Addis Ababa Ethiopia, 2021: cross-sectional study”. Asian Pacific Journal of Cancer Care, vol. 7, no. 4, pp. 657-664, 2022.
[26] A. A. Ali and R. I. Ali. “Knowledge of patients undergoing chemotherapy toward self care in kirkuk center for oncology and hematology”. International Journal of Pharmaceutical and Bio- Medical Science, vol. 4, no. 6, pp. 539-545, 2024.
[27] S. I. Mohammed and K. H. Alkashaf. “Impact of clinical pharmacist intervention on chemotherapy knowledge, attitude, and practice among breast cancer women”. Journal of the Faculty of Medicine Baghdad, vol. 66, no. 1, pp. 103-109, 2024.
[28] L. Heydarzadeh, L. Alilu, H. Habibzadeh and J. RasouIi. “The effect of peer education on knowledge, comprehension, and knowledge application of patients regarding chemotherapy complications”. Iranian Journal of Nursing and Midwifery Research, vol. 25, no. 1, p. 40, 2020.
[29] B. Gullu Gucuyener and B. Gulseven Karabacak. “Effect of chemotherapy patient education using the teach-back method on symptom management and quality of life: A randomized controlled trial”. Journal of Cancer Education, vol. 40, no. 5, pp. 700-712, 2025.
[30] Y. Wang, H. Wu and F. Xu. “Impact of clinical pharmacy services on KAP and QOL in cancer patients: A single-center experience”. BioMed Research International, vol. 2015, pp. 502431, 2015.
[31] R. Sadeghian, M. A. Hamedani, S. Salehipour, A. Sarabandi, F. Kiani and H. Babamohamadi. “The health literacy level and its related factors in Iranian women with breast cancer undergoing chemotherapy”. Frontiers in Public Health, vol. 11, p. 1150148, 2023.
[32] R. A. Moahmmed, B. H. Ahmed and D. A. Al-Banna. “Knowledge of breast cancer patients regarding side effects of chemotherapy at rizgary teaching hospital in Erbil City-Iraq”. Journal Of Raparin University, vol. 3, no. 9, pp. 47-60, 2016.
[33] M. Suhail, F. Saulat, H. Khurram, F. Fatima, A. Zenab, M. Wasim, N. U. Sadia, F. Afzaal, H. Latif and M. Nasrullah. “Knowledge, attitude and practice related to chemotherapy among cancer patients”. Inquiry a Journal of Medical Care Organization, Provision and Financing, vol. 61, p. 469580241246460, 2024.
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