Assessment of Patients Knowledge Undergoing Chemotherapy toward Self Care after Gastrectomy at Oncology Unit of Al-Haboby Teaching Hospital in AL-Naseria City

: Background: Knowledge of self-care is an important index for evaluating the outcomes of treatment and the long-term survival of patients with cancer. Aims of the study: This study aimed to assess patients’ knowledge of self-care after Gastrectomy; and determine the relationship between patient’s knowledge and their socio-demographic data. Methodology: A descriptive study is conducted for the periods of 26 / December / 2020 to 1 / June / 2021. The study is carried out at the Oncology Unit of AL-Haboby Teaching Hospital. By non-probability purposive sample was selected from patients who were diagnosed with undergoing chemotherapy. The validity of the questionnaire was achieved through a panel of experts


INTRODUCTION
Stomach cancer refers to any malignant neoplasm in the region that runs between the pylorus and the gastric esophagus.About 95% of the stomach tumors are adenocarcinomalike and epithelia.Adenocarcinomas, however, are rare, squamous and undifferentiated (1) .Stomach cancer is characterized by a proliferation of cancer cells in the stomach lining, which is sometimes slowly spreading for several years leading to a true cancer and regularly causes early changes in the stomach's inner lining (mucosa).Stomach cancer can spread in various ways (metastasize) (2) .Self-care behavior was performed and followed by the patients before side effects become persistent or severe through prior information of side effects and their management techniques (3) .In addition, Stromberg advocates teaching self-care to encourage persons with cancer to increase their sense of self-control and lessen feelings of helplessness that often accompany cancer and its treatment (4) .The nurse is further challenged to teach patients to actively participate in their care rather than remaining dependent on the healthcare professional (5) .Using skill as a patient educator, the nurse enlists the patient and family members in a partnership to promote self-care (6) .This requires the nurse to use great creativity and flexibility to individualize the approach to patient management problems.Patient knowledge for self-care orientation is the main objective of intervention (7) .According to Foster and colleagues, cancer patient self-management is an individual's strategy for controlling disease conditions to maximize well-being, or approaches chosen by an individual to optimize living conditions with cancer (8) .

AIMS OF THE STUDY
The study aims at: 1.To assess patient's knowledge towards self-care after Gastrectomy.2. To determine the relationship between patient's knowledge and their socio-demographic data.

METHODOLOGY
A descriptive study is conducted to investigate the knowledge for the periods of December 26th 2020 to Jun 1st 2021.The study is carried out at the Oncology Unit of AL-Haboby Teaching Hospital.By non-probability purposive sample was selected from patients who were diagnosed with undergoing chemotherapy.A questionnaire consists of the following parts including: Part Ⅰ: Socio-demographic data of nurses includes age, gender, and level of education, marital status, occupation, residents, and monthly income.Part Ⅱ: Knowledge of gastric carcinoma patients undergoing chemotherapy after gastrectomy towards self-care.These domains divided into three sub-domains include: A. Knowledge of gastric carcinoma patients undergoing chemotherapy after gastrectomy about general information about stomach cancer and gastrectomy include of (8) items.B. Knowledge of gastric carcinoma patients undergoing chemotherapy after gastrectomy about general information of chemotherapy which include of (6) items.C. Knowledge of gastric carcinoma patients undergoing chemotherapy after gastrectomy about self-care of side effects of chemotherapy and self-care of daily activities include of (14) items.
A content validity was achieved through an (11) panel of experts, and reliability was achieved through a pilot study.It conducted on (10) were selected among chemotherapy patients at the Oncology Unit of AL-Haboby Teaching Hospital.Cronbach's Alpha= 83 which indicates a pass questionnaire items.
The data collection process used the interview technique and questionnaire and is analyzed through descriptive and inferential statistics.years with a mean of (73.8) years.Related to the gender cooperative in study most of study sample were male 26 (65.0%) of all study samples, regarding the educational level of patients in the study sample, the majority with primary school graduation 24 (60.0%).Concerning the social status, the greater number of the study sample are 35 married and accounted for (87.5%).Regarding the level of occupation status, the greater number of them with house wife and they account for 13 (32.5%) of the sample.With respect for patient's monthly income the majority of the study sample with insufficient monthly income and account for 24 (60.0%) of the whole sample.Findings show that study sample information was presented a low level of knowledge at all items except (7) which presented as (Moderate) level.Findings show that study sample information was presented Moderate level of knowledge at items (1, 3 and 5).Findings show that study sample information was presented a low level of knowledge at all items except (11), which presented as (Moderate) level of assessment.

DISCUSSION
According to the Table 1, the highest age group was 56-60 years old with a percentage of 13 (32.5%)with a mean of (73.8) years, and this result was consistent with Chen et al. ( 2016) (9) .The average age of those living with stomach cancer was 60.6 ± 6.6 years.
The prevalence is increasing with the age of gastric cancer.Aging is linked to increased injury susceptibility, delayed cure of gastric mucosa, and expression of cancer stem cell markers.Furthermore, H. pylori gastritis rises with age.However, it was not clear, whether the prediction of gastric cancer already known worsened with age (10) .
Related to the gender cooperative in study the majority of study sample were male 26 (65.0%) of all study sample.There are no apparent explanations for these disparities.Exposures to the environment or work may take on a function.For example, men have traditionally been more likely to smoke tobacco products, including in countries where men and women have equal levels of smoking.Still higher concentrations of men tend to exist.Alternatively, sex distinctions may represent variations in physiology.Estrogens can protect against gastric cancer growth (11) .
Regarding to educational level of patients in the study sample, the majority with primary school graduation 24 (60.0%).Increased education of both sexes has been linked to a declining risk of esophagogastric cancer.Compared with elementary school graduation, higher education posed a lower threat to both sexes.This relationship was close for each of the 4 esophagogastric cancer subtypes and may be greater for gastric cancer (12) .
Concerning the social status, the more significant number of the study samples are 35 married and accounted for (87.5%).This result was consistent with findings the investigated the prevalence and prognostic implications of psychological distress in patients with gastric cancer (13) .
Regarding to the level of occupation status, the greater number of them with house wife and they account for 13 (32.5%) of the sample.This finding disagrees with the outcome of the environmental factors in the etiology of gastric cancer (14) .
Rural people only see physicians as problems occur.This could lead to higher mortality in rural areas compared to urban areas through delayed diagnosis and treatment.Policymakers should propose improving the understanding of gastric cancer through education in health care and extending early detection screening and early therapy to minimize the disparity in gastric cancer mortality across urban and rural areas (15) .For patients' monthly income, the majority of the study sample with insufficient monthly income and account for 24 (60.0%) of the whole sample, this result was consistent with gastric cancer screening in low-income countries that reported; Gastric cancer shows significant geographical variations in and within regions with over 70% of the incidence cases clustered in countries with low and mid-income (16) .
Self-care is an active agent in patient health outcomes, with higher care patients taking greater responsibility to adopt behaviors that address their chemotherapy-related symptoms and their outcomes.Therefore, our findings show that study sample information was presented low level of knowledge about bout general information about stomach cancer and gastrectomy, general information of chemotherapy and self-care of side effects of chemotherapy (tables 2, 3, and 4).Those results come because the cancerous patients were lack of knowledge to interest to themselves.This reflects patients that need to the educational program to maintain self-care during chemotherapy treatment.
In those regards, the findings of the study conducted in Pakistan come to agree with our findings.It illustrated results that cancer patients who receive chemotherapy were reported poor to moderate self-care due to lack of information about the self-car.The study recommends that patients need to be educational program about managing their self-care after receiving chemotherapy (17) .
Moreover, the participant cancerous patients towards self-care behavior at Tikur Anbessa Specialized hospital, Addis Ababa Ethiopia, in 2018 depicts that 55.10% of studied patients were with poor self-care during chemotherapy.As well as, the patients express poor self-care in dryness of mouth and lips, nausea and vomiting occurs, loss of appetite, fatigue, headache, depression and frustration.The lack of self-care were associated with patients knowledge and patients need awareness towards management of themselves, and, the health care provides deals with cancerous patient need to be qualifications (18) .
The assessment of self-care among cancer patients was demonstrated poor self-care when the patients take chemotherapy.In those regards, findings were confirmed that the poor self-care was associated with an information need, which means the patients needed to workshop deals with self-care during chemotherapies (19) .
Findings presented there were the no-significant relationship between patients' knowledge and their demographic data (table 4).As well as, study conduct in Thailand on self-care behavior and patients undergo chemotherapy, there was no association between selfcare and their socio demographic characteristics.However, study conducted in Thailand showed that chemotherapy individual's demographic characteristics were not significantly associated with self-care behavior (20,21) .

CONCLUSION
Patients expressed poor knowledge of self-care after gastrectomy and that knowledge not influenced by their socio-demographic data.

RECOMMENDATIONS
It is specialized centers to educate patients about self-care stomach cancer and diseasecausing risk factors and the importance of early detection of cancer.As well as, a booklet of the side effects of chemotherapy and how to manage it should be write in simple words and use attractive pictures given to the patients and family.

Table ( 1): Distribution of the Study by their demographic characteristics Basic Information Groups Frequency Percent Age groups
This table indicated that 13 (32.5%) of the patients within the age group of (56-60)

Table (
1Refers --------to any malignant tumor that arises from the area between the portal and the gastro esophageal junction.

Table ( 4): Knowledge
of gastric carcinoma patients about self-care of side effects of chemotherapy and self-care of daily activities L