Skip to main content

Advertisement

SpringerLink
Log in

Health-related quality of life among cancer survivors: pre-existing chronic conditions are to be given priority

  • Research
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to describe the health-related quality of life (HRQoL) of cancer survivors in China by the five-level EuroQol-5-dimension (EQ-5D-5L) questionnaire and to explore the impact of the comorbidity of pre-existing chronic conditions on HRQoL in cancer survivors.

Methods

Data on cancer survivors were obtained from two cross-sectional surveys conducted in Shandong Province, China. The data of the Chinese general population, the Chinese diabetes population, the Chinese hypertension population, and the Chinese urban population from the published studies were used as the controls. The χ2 test was conducted to compare the incidence of five-dimensional problems between the study and control populations. The non-parametric Mann–Whitney U test and Kruskal–Wallis test were performed to examine the differences in EQ-5D-5L utility scores. Besides, the Tobit regression model was used to examine the variables influencing the EQ-5D-5L utility score.

Results

One thousand fifty-one adult cancer survivors were included. Cancer survivors had significantly lower EQ-5D-5L utility scores (Z =  − 15.939, P < 0.001) and EQ-VAS scores (Z =  − 11.156, P < 0.001) than the general adult population. The average EQ-5D-5L utility score of hypertensive cancer survivors was lower than that of the hypertensive population (Z =  − 1.610, P = 0.107), but the difference was not statistically significant.

Conclusion

Compared to the general population, the HRQoL of cancer survivors was extremely poor in all dimensions of the EQ-5D-5L. Pre-existing chronic conditions had significant antecedent effects on the HRQoL of cancer survivors. Therefore, more attention should be paid to chronic diseases, and effective interventions should be adopted based on this.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data availability

The primary data from the survey are available from the first author on reasonable request.

References

  1. World Health Organization (2020) Global Cancer Observatory: cancer today-all cancers. https://gco.iarc.fr/today/data/factsheets/cancers/39-All-cancers-fact-sheet.pdf. Accessed 17 Jun 2023

  2. World Health Organization (2021) Global Cancer Observatory: cancer today-China. https://gco.iarc.fr/today/data/factsheets/populations/160-china-fact-sheets.pdf. Accessed 17 Jun 2023

  3. Firkins J, Hansen L, Driessnack M, Dieckmann N (2020) Quality of life in “chronic” cancer survivors: a meta-analysis. J Cancer Surviv Res Pract 14:504–517. https://doi.org/10.1007/s11764-020-00869-9

    Article  Google Scholar 

  4. Su M, Lao J, Zhang N et al (2020) Financial hardship in Chinese cancer survivors. Cancer 126:3312–3321. https://doi.org/10.1002/cncr.32943

    Article  PubMed  Google Scholar 

  5. Kemp E, Knott V, Ward P et al (2021) Barriers to employment of Australian cancer survivors living with geographic or socio-economic disadvantage: a qualitative study. Health Expect Int J Public Particip Health Care Health Policy 24:951–966. https://doi.org/10.1111/hex.13238

    Article  Google Scholar 

  6. Keaver L, McGough AM, Du M et al (2021) Self-reported changes and perceived barriers to healthy eating and physical activity among global breast cancer survivors: results from an exploratory online novel survey. J Acad Nutr Diet 121:233-241.e8. https://doi.org/10.1016/j.jand.2020.09.031

    Article  PubMed  Google Scholar 

  7. Gallaway MS, Townsend JS, Shelby D, Puckett MC (2020) Pain among cancer survivors. Prev Chronic Dis 17:E54. https://doi.org/10.5888/pcd17.190367

    Article  PubMed  PubMed Central  Google Scholar 

  8. Zhang X, Sun D, Qin N et al (2022) Factors correlated with fear of cancer recurrence in cancer survivors: a meta-analysis. Cancer Nurs 45:406–415. https://doi.org/10.1097/NCC.0000000000001020

    Article  PubMed  Google Scholar 

  9. Ji X, Cummings JR, Gilleland Marchak J et al (2020) Mental health among nonelderly adult cancer survivors: a national estimate. Cancer 126:3768–3776. https://doi.org/10.1002/cncr.32988

    Article  PubMed  Google Scholar 

  10. Götze H, Taubenheim S, Dietz A et al (2018) Comorbid conditions and health-related quality of life in long-term cancer survivors-associations with demographic and medical characteristics. J Cancer Surviv Res Pract 12:712–720. https://doi.org/10.1007/s11764-018-0708-6

    Article  Google Scholar 

  11. Schmidt ME, Wiskemann J, Steindorf K (2018) Quality of life, problems, and needs of disease-free breast cancer survivors 5 years after diagnosis. Qual Life Res Int J Qual Life Asp Treat Care Rehabil 27:2077–2086. https://doi.org/10.1007/s11136-018-1866-8

    Article  Google Scholar 

  12. Costa DSJ, Mercieca-Bebber R, Rutherford C et al (2021) How is quality of life defined and assessed in published research? Qual Life Res 30:2109–2121. https://doi.org/10.1007/s11136-021-02826-0

    Article  PubMed  Google Scholar 

  13. Phillips NS, Khan RB, Li C et al (2022) Seizures’ impact on cognition and quality of life in childhood cancer survivors. Cancer 128:180–191. https://doi.org/10.1002/cncr.33879

    Article  PubMed  Google Scholar 

  14. Schmidt ME, Goldschmidt S, Hermann S, Steindorf K (2022) Late effects, long-term problems and unmet needs of cancer survivors. Int J Cancer 151:1280–1290. https://doi.org/10.1002/ijc.34152

    Article  CAS  PubMed  Google Scholar 

  15. Beebe-Dimmer JL, Ruterbusch JJ, Harper FWK et al (2020) Physical activity and quality of life in African American cancer survivors: the Detroit Research on Cancer Survivors study. Cancer 126:1987–1994. https://doi.org/10.1002/cncr.32725

    Article  PubMed  Google Scholar 

  16. Cheng Z, Johar A, Lagergren J et al (2023) Health-related quality of life trajectories up to 15 years after curative treatment for esophageal cancer - a prospective cohort study. Int J Surg Lond Engl. https://doi.org/10.1097/JS9.0000000000001026

    Article  Google Scholar 

  17. Zheng Z, Shi KS, Kamal A et al (2023) Health-related quality of life among prostate cancer survivors with metastatic disease and non-metastatic disease and men without a cancer history in the USA. J Cancer Surviv. https://doi.org/10.1007/s11764-023-01509-8

    Article  PubMed  Google Scholar 

  18. Grivas P, Kopyltsov E, Su P-J et al (2023) Patient-reported outcomes from JAVELIN Bladder 100: avelumab first-line maintenance plus best supportive care versus best supportive care alone for advanced urothelial carcinoma. Eur Urol 83:320–328. https://doi.org/10.1016/j.eururo.2022.04.016

    Article  CAS  PubMed  Google Scholar 

  19. Catto JWF, Downing A, Mason S et al (2021) Quality of life after bladder cancer: a cross-sectional survey of patient-reported outcomes. Eur Urol 79:621–632. https://doi.org/10.1016/j.eururo.2021.01.032

    Article  PubMed  PubMed Central  Google Scholar 

  20. Zhu Y-J, Wu X-Y, Wang W et al (2022) Acupuncture for quality of life in gastric cancer patients undergoing adjuvant chemotherapy. J Pain Symptom Manage 63:210–220. https://doi.org/10.1016/j.jpainsymman.2021.09.009

    Article  PubMed  Google Scholar 

  21. Penson A, Walraven I, Bronkhorst E et al (2022) The impact of cancer-related fatigue on HRQOL in survivors of childhood cancer: a DCCSS LATER study. Cancers 14:2851. https://doi.org/10.3390/cancers14122851

    Article  PubMed  PubMed Central  Google Scholar 

  22. Lamu AN, Olsen JA (2018) Testing alternative regression models to predict utilities: mapping the QLQ-C30 onto the EQ-5D-5L and the SF-6D. Qual Life Res 27:2823–2839. https://doi.org/10.1007/s11136-018-1981-6

    Article  PubMed  Google Scholar 

  23. Richardson J, Mckie J, Bariola E (2014) Multiattribute utility instruments and their use. Encycl Health Econ. https://doi.org/10.1016/B978-0-12-375678-7.00505-8

    Article  Google Scholar 

  24. Zhou T, Guan H, Wang L et al (2021) Health-related quality of life in patients with different diseases measured with the EQ-5D-5L: a systematic review. Front Public Health 9:675523. https://doi.org/10.3389/fpubh.2021.675523

    Article  PubMed  PubMed Central  Google Scholar 

  25. World Health Organization (2023) World health statistics 2023: monitoring health for the SDGs, sustainable development goals. https://www.who.int/publications/i/item/9789240074323. Accessed 17 Jun 2023

  26. Cuthbert CA, Hemmelgarn BR, Xu Y, Cheung WY (2018) The effect of comorbidities on outcomes in colorectal cancer survivors: a population-based cohort study. J Cancer Surviv Res Pract 12:733–743. https://doi.org/10.1007/s11764-018-0710-z

  27. Swann R, McPhail S, Witt J et al (2018) Diagnosing cancer in primary care: results from the National Cancer Diagnosis Audit. Br J Gen Pract J R Coll Gen Pract 68:e63–e72. https://doi.org/10.3399/bjgp17X694169

    Article  Google Scholar 

  28. Gurney J, Sarfati D, Stanley J (2015) The impact of patient comorbidity on cancer stage at diagnosis. Br J Cancer 113:1375–1380. https://doi.org/10.1038/bjc.2015.355

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Xie S, Wu J, Chen G (2023) Comparative performance and mapping algorithms between EQ-5D-5L and SF-6Dv2 among the Chinese general population. Eur J Health Econ HEPAC Health Econ Prev Care. https://doi.org/10.1007/s10198-023-01566-x

    Article  Google Scholar 

  30. Cai Y, Wu H, Yang Z (2020) Comparison analysis of European quality of life-5 dimensions with three-level and five-level based on four types of people in China. Chin J Dis Control Prev 24:1190–1194. https://doi.org/10.1007/s11764-018-0710-z

  31. Yang Z, Busschbach J, Liu G, Luo N (2018) EQ-5D-5L norms for the urban Chinese population in China. Health Qual Life Outcomes 16:210. https://doi.org/10.1186/s12955-018-1036-2

    Article  PubMed  PubMed Central  Google Scholar 

  32. EuroQol Group (2021) EQ-5D-5L – EQ-5D. https://euroqol.org/eq-5d-instruments/eq-5d-5l-about/. Accessed 13 Jun 2023

  33. Xia J, Wu N-W, Ma T-P et al (2020) Evaluation of reliability and validity of EQ-5D-5L based on residents in Southwest China. Sichuan Da Xue Xue Bao Yi Xue Ban 51:691–694. https://doi.org/10.12182/20200960504

    Article  PubMed  Google Scholar 

  34. EuroQol Group (2019) EQ-5D user guides. https://euroqol.org/publications/user-guides/. Accessed 13 Jun 2023

  35. Luo N, Liu G, Li M et al (2017) Estimating an EQ-5D-5L value set for China. Value Health 20:662–669. https://doi.org/10.1016/j.jval.2016.11.016

    Article  PubMed  Google Scholar 

  36. Devlin N, Parkin D, Janssen B (2020) Analysis of EQ VAS data. In: Devlin N, Parkin D, Janssen B (eds) Methods for Analysing and Reporting EQ-5D Data. Springer International Publishing, Cham, pp 51–59

  37. Cheng LJ, Tan RL-Y, Luo N (2021) Measurement properties of the EQ VAS around the globe: a systematic review and meta-regression analysis. Value Health J Int Soc Pharmacoeconomics Outcomes Res 24:1223–1233. https://doi.org/10.1016/j.jval.2021.02.003

    Article  Google Scholar 

  38. LeMasters T, Madhavan S, Sambamoorthi U, Kurian S (2013) A population-based study comparing HRQoL among breast, prostate, and colorectal cancer survivors to propensity score matched controls, by cancer type, and gender. Psychooncology 22:2270–2282. https://doi.org/10.1002/pon.3288

    Article  PubMed  PubMed Central  Google Scholar 

  39. Elliott J, Fallows A, Staetsky L et al (2011) The health and well-being of cancer survivors in the UK: findings from a population-based survey. Br J Cancer 105:S11–S20. https://doi.org/10.1038/bjc.2011.418

    Article  PubMed  PubMed Central  Google Scholar 

  40. Husson O, Haak HR, Buffart LM et al (2013) Health-related quality of life and disease specific symptoms in long-term thyroid cancer survivors: a study from the population-based PROFILES registry. Acta Oncol Stockh Swed 52:249–258. https://doi.org/10.3109/0284186X.2012.741326

    Article  Google Scholar 

  41. Foster C (2022) The need for quality self-management support in cancer care. BMJ Qual Saf 31:1–4. https://doi.org/10.1136/bmjqs-2021-013366

    Article  PubMed  Google Scholar 

  42. Foster C, Breckons M, Cotterell P et al (2015) Cancer survivors’ self-efficacy to self-manage in the year following primary treatment. J Cancer Surviv Res Pract 9:11–19. https://doi.org/10.1007/s11764-014-0384-0

    Article  CAS  Google Scholar 

  43. Kent EE, Rowland JH, Northouse L et al (2016) Caring for caregivers and patients: research and clinical priorities for informal cancer caregiving. Cancer 122:1987–1995. https://doi.org/10.1002/cncr.29939

    Article  PubMed  Google Scholar 

  44. Driessen HPA, Kranenburg LW, van der Rijt KCD et al (2022) Evaluation of centers for information and support combining formal and informal care for patients with cancer: a systematic review of the literature. Support Care Cancer Off J Multinatl Assoc Support Care Cancer 30:7079–7098. https://doi.org/10.1007/s00520-022-07047-w

    Article  Google Scholar 

  45. Bauer UE, Briss PA, Goodman RA, Bowman BA (2014) Prevention of chronic disease in the 21st century: elimination of the leading preventable causes of premature death and disability in the USA. Lancet Lond Engl 384:45–52. https://doi.org/10.1016/S0140-6736(14)60648-6

    Article  Google Scholar 

  46. Pergolotti M, Deal AM, Williams GR et al (2017) Activities, function, and health-related quality of life (HRQOL) of older adults with cancer. J Geriatr Oncol 8:249–254. https://doi.org/10.1016/j.jgo.2017.02.009

    Article  PubMed  PubMed Central  Google Scholar 

  47. Tsai M-H, Wu Y-H, Bevel MS (2023) The relationship of chronic disease conditions to mental and physical health among cancer survivors. Support Care Cancer 31:364. https://doi.org/10.1007/s00520-023-07841-0

    Article  PubMed  Google Scholar 

  48. Whittemore R, Dixon J (2008) Chronic illness: the process of integration. J Clin Nurs 17:177–187. https://doi.org/10.1111/j.1365-2702.2007.02244.x

    Article  PubMed  PubMed Central  Google Scholar 

  49. Allegrante JP, Wells MT, Peterson JC (2019) Interventions to support behavioral self-management of chronic diseases. Annu Rev Public Health 40:127–146. https://doi.org/10.1146/annurev-publhealth-040218-044008

    Article  PubMed  PubMed Central  Google Scholar 

  50. Lambrinou E, Hansen TB, Beulens JW (2019) Lifestyle factors, self-management and patient empowerment in diabetes care. Eur J Prev Cardiol 26:55–63. https://doi.org/10.1177/2047487319885455

    Article  PubMed  Google Scholar 

  51. Wang C, Lang J, Xuan L et al (2017) The effect of health literacy and self-management efficacy on the health-related quality of life of hypertensive patients in a western rural area of China: a cross-sectional study. Int J Equity Health 16:58. https://doi.org/10.1186/s12939-017-0551-9

    Article  PubMed  PubMed Central  Google Scholar 

  52. Holmes HM, Nguyen HT, Nayak P et al (2014) Chronic conditions and health status in older cancer survivors. Eur J Intern Med 25:374–378. https://doi.org/10.1016/j.ejim.2013.12.003

    Article  PubMed  Google Scholar 

  53. Rowland C, Eiser C, Rowe R, Danson S (2012) The effect of smoking on health-related quality of life in lung cancer patients: a systematic review. BMJ Support Palliat Care 2:312–318. https://doi.org/10.1136/bmjspcare-2011-000186

    Article  PubMed  Google Scholar 

  54. Nasim F, Sabath BF, Eapen GA (2019) Lung cancer. Med Clin North Am 103:463–473. https://doi.org/10.1016/j.mcna.2018.12.006

    Article  PubMed  Google Scholar 

  55. Bouazza YB, Chiairi I, El Kharbouchi O et al (2017) Patient-reported outcome measures (PROMs) in the management of lung cancer: a systematic review. Lung Cancer 113:140–151. https://doi.org/10.1016/j.lungcan.2017.09.011

    Article  PubMed  Google Scholar 

  56. Avancini A, Sartori G, Gkountakos A et al (2020) Physical activity and exercise in lung cancer care: will promises be fulfilled? Oncologist 25:e555–e569. https://doi.org/10.1634/theoncologist.2019-0463

    Article  PubMed  Google Scholar 

  57. Sullivan R, Alatise OI, Anderson BO et al (2015) Global cancer surgery: delivering safe, affordable, and timely cancer surgery. Lancet Oncol 16:1193–1224. https://doi.org/10.1016/S1470-2045(15)00223-5

    Article  PubMed  Google Scholar 

  58. Zhao N, Chen K (2023) Equity and efficiency of medical and health service system in China. BMC Health Serv Res 23:33. https://doi.org/10.1186/s12913-023-09025-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Zhao Y, Tang S, Mao W, Akinyemiju T (2021) Socio-economic and rural-urban differences in healthcare and catastrophic health expenditure among cancer patients in china: analysis of the china health and retirement longitudinal study. Front Public Health 9:779285. https://doi.org/10.3389/fpubh.2021.779285

    Article  PubMed  Google Scholar 

  60. Mello S, Tan AS, Armstrong K et al (2013) Anxiety and depression among cancer survivors: the role of engagement with sources of emotional support information. Health Commun 28:389–396. https://doi.org/10.1080/10410236.2012.690329

    Article  PubMed  Google Scholar 

  61. Lu P, Yang C, Yao J, Shelley M (2020) Outpatient and inpatient service use by Chinese adults living in rural low-income households. Soc Work Public Health 35:223–233. https://doi.org/10.1080/19371918.2020.1774458

    Article  PubMed  Google Scholar 

  62. Myerson R, Lu T, Yuan Y, Liu GG-E (2019) Cancer diagnosis and care among rural-to-urban migrants in China. BMJ Glob Health 4:e001923. https://doi.org/10.1136/bmjgh-2019-001923

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

The paper is supported by the Natural Science Foundation of Shandong Province (Grant No. ZR2023QG079), the Humanities and Social Science Fund of Ministry of Education of China (Grant No. 23YJCZH193), the Postdoctoral Innovation Project of Shandong Province (Grant No. SDCX-RS-202303002), and Shandong University Multidisciplinary Research and Innovation Team of Young Scholars (Grant No. 2020QNQT019).

Author information

Authors and Affiliations

  1. Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Wenhuaxi Road 44#, Jinan, China

    Yujia Feng, Mingzhu Su, Yanxiu Liu, Jiaqi Peng & Xiaojie Sun

  2. National Health Commission Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China

    Yujia Feng, Mingzhu Su, Yanxiu Liu, Jiaqi Peng & Xiaojie Sun

Authors
  1. Yujia Feng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mingzhu Su
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yanxiu Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jiaqi Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xiaojie Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by YF and MS. YL and JP interpreted the results. The first draft of the manuscript was written by YF, and all authors commented on previous versions of the manuscript. XS performed project administration, acquired funding, supervised the study, and reviewed and edited the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Xiaojie Sun.

Ethics declarations

Ethics approval and consent to participate

The Ethics Review Board of the School of Public Health, Shandong University, approved this study (No. 20140201), and it adhered to the tenets of the Declaration of Helsinki. Informed consent was obtained from all participants prior to entry into this study.

Competing interests

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Appendix

Appendix

Fig. 5
figure 5

Location of household and hospital surveys in Shandong Province

Full size image
Fig. 6
figure 6figure 6

The ratio of problem incidence rates between diabetic cancer survivors and the Chinese diabetic population by EQ-5D-5L. A Comparison of diabetic cancer survivors versus diabetic population. B–F Diabetic cancer survivors are stratified by residential area, cancer site, sex, cancer stage, and duration of disease since diagnosis

Full size image
Fig. 7
figure 7figure 7

The ratio of problem incidence rates between urban cancer survivors and the Chinese urban population by EQ-5D-5L. A Comparison of urban cancer survivors versus urban population. B–F Urban cancer survivors are stratified by pre-existing chronic conditions, cancer site, sex, cancer stage, and duration of disease diagnosis

Full size image
Table 3 The comparisons of the incidence of problems in the five dimensions of EQ-5D-5L among different populations
Full size table

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Feng, Y., Su, M., Liu, Y. et al. Health-related quality of life among cancer survivors: pre-existing chronic conditions are to be given priority. Support Care Cancer 32, 124 (2024). https://doi.org/10.1007/s00520-024-08315-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00520-024-08315-7

Keywords

Search

Navigation