Skip to main content

Advertisement

SpringerLink
Log in

Associations between baseline demographic, clinical and lifestyle factors, and changes in fatigue, depression, and health-related quality of life in long-term cancer survivors: a cohort study

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

Abstract

Purpose

To investigate the longitudinal associations between demographic, clinical and lifestyle factors, and changes in patient-reported outcomes (PROs) in cancer survivors 6–9 years post-diagnosis in Western Australia.

Methods

A total of 290 individuals participated in this study. Three-quarters of participants were female, and 55%, 31%, and 14% were survivors of breast cancer, colon cancer, and non-Hodgkin lymphoma (NHL), respectively. PROs (fatigue, depression, and health-related quality of life (HRQOL)) were reported at two time points (2012–13 and 2017). Descriptive statistics were used to assess the overall changes over time and linear mixed models were used to identify factors associated with changes over time, after adjusting for confounders.

Results

No significant changes were observed in PROs between time point 1 and follow-up at the population level, yet a notable proportion of participants (23% for fatigue, 10% for depression, and 39% for HRQOL) reported a negative minimal clinically important difference (MCID). Being non-Caucasian and having had NHL were associated with negative changes over time. Being obese and having had radiotherapy were related to improved outcomes.

Conclusion

Cancer survivors whose levels of fatigue, depression, and quality of life are compromised during cancer treatment may require intervention even 6–9 years post-treatment. Our results suggest particular attention should be paid to those who are non-Caucasian and who have had NHL. This is crucial for providing appropriate care and to support those who are at increased risk of deteriorating naturally over time.

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

Similar content being viewed by others

Data availability

The syntax used to run the analysis reported in this manuscript is available from the corresponding author on reasonable request. The dataset cannot be shared due to ethical approval constraints.

References

  1. Australian Institute of Health and Welfare (2020) Cancer data in Australia. AIHW. https://www.aihw.gov.au/reports/cancer/cancer-data-in-australia. Accessed 27 Nov 2020

  2. Baili P, Di Salvo F, Marcos-Gragera R, Siesling S, Mallone S, Santaquilani M, Micheli A, Lillini R, Francisci S (2015) Age and case mix-standardised survival for all cancer patients in Europe 1999-2007: results of EUROCARE-5, a population-based study. Eur J Cancer 51(15):2120–2129. https://doi.org/10.1016/j.ejca.2015.07.025

    Article  PubMed  Google Scholar 

  3. Howlader N, Noone A, Krapcho M, Miller D, Brest A, Yu M (2020) SEER Cancer statistics review, 1975–2017. National Cancer Institute Bethesda, MD

    Google Scholar 

  4. American Cancer Society (2020) Cancer facts and figures 2020. https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2020.html. Accessed 27 Nov 2020

  5. Lagergren P, Schandl A, Aaronson NK, Adami HO, de Lorenzo F, Denis L, Faithfull S, Liu L, Meunier F, Ulrich C (2019) Cancer survivorship: an integral part of Europe’s research agenda. Mol Oncol 13(3):624–635

    Article  Google Scholar 

  6. Gegechkori N, Haines L, Lin JJ (2017) Long-term and latent side effects of specific cancer types. Med Clin North Am 101(6):1053–1073. https://doi.org/10.1016/j.mcna.2017.06.003

    Article  PubMed  PubMed Central  Google Scholar 

  7. Roila F, Fumi G, Ruggeri B, Antonuzzo A, Ripamonti C, Fatigoni S, Cavanna L, Gori S, Fabi A, Marzano N (2019) Prevalence, characteristics, and treatment of fatigue in oncological cancer patients in Italy: a cross-sectional study of the Italian Network for Supportive Care in Cancer (NICSO). Support Care Cancer 27(3):1041–1047

    Article  Google Scholar 

  8. Jones JM, Olson K, Catton P, Catton CN, Fleshner NE, Krzyzanowska MK, McCready DR, Wong RK, Jiang H, Howell D (2016) Cancer-related fatigue and associated disability in post-treatment cancer survivors. J Cancer Surviv 10(1):51–61

    Article  Google Scholar 

  9. Abrahams H, Gielissen M, Schmits I, Verhagen C, Rovers M, Knoop H (2016) Risk factors, prevalence, and course of severe fatigue after breast cancer treatment: a meta-analysis involving 12 327 breast cancer survivors. Ann Oncol 27(6):965–974

    Article  CAS  Google Scholar 

  10. Bower JE (2014) Cancer-related fatigue—mechanisms, risk factors, and treatments. Nat Rev Clin Oncol 11(10):597–609

    Article  CAS  Google Scholar 

  11. Brandenbarg D, Maass S, Geerse OP, Stegmann ME, Handberg C, Schroevers MJ, Duijts SFA (2019) A systematic review on the prevalence of symptoms of depression, anxiety and distress in long-term cancer survivors: implications for primary care. Eur J Cancer Care 28(3):e13086. https://doi.org/10.1111/ecc.13086

    Article  Google Scholar 

  12. Niedzwiedz CL, Knifton L, Robb KA, Katikireddi SV, Smith DJ (2019) Depression and anxiety among people living with and beyond cancer: a growing clinical and research priority. BMC Cancer 19(1):943. https://doi.org/10.1186/s12885-019-6181-4

    Article  PubMed  PubMed Central  Google Scholar 

  13. Götze H, Friedrich M, Taubenheim S, Dietz A, Lordick F, Mehnert A (2020) Depression and anxiety in long-term survivors 5 and 10 years after cancer diagnosis. Support Care Cancer 28(1):211–220

    Article  Google Scholar 

  14. Schlesinger S, Walter J, Hampe J, von Schönfels W, Hinz S, Küchler T, Jacobs G, Schafmayer C, Nöthlings U (2014) Lifestyle factors and health-related quality of life in colorectal cancer survivors. Cancer Causes Control 25(1):99–110

    Article  Google Scholar 

  15. Jansen L, Koch L, Brenner H, Arndt V (2010) Quality of life among long-term (⩾5 years) colorectal cancer survivors - systematic review. Eur J Cancer 46(16):2879–2888. https://doi.org/10.1016/j.ejca.2010.06.010

    Article  CAS  PubMed  Google Scholar 

  16. Mehra K, Berkowitz A, Sanft T (2017) Diet, physical activity, and body weight in cancer survivorship. Med Clin N Am 101(6):1151–1165. https://doi.org/10.1016/j.mcna.2017.06.004

    Article  PubMed  Google Scholar 

  17. Arndt V, Koch-Gallenkamp L, Jansen L, Bertram H, Eberle A, Holleczek B, Schmid-Höpfner S, Waldmann A, Zeissig SR, Brenner H (2017) Quality of life in long-term and very long-term cancer survivors versus population controls in Germany. Acta Oncol 56(2):190–197

    Article  Google Scholar 

  18. Koch L, Jansen L, Herrmann A, Stegmaier C, Holleczek B, Singer S, Brenner H, Arndt V (2013) Quality of life in long-term breast cancer survivors–a 10-year longitudinal population-based study. Acta Oncol 52(6):1119–1128

    Article  Google Scholar 

  19. Boyle T, Vallance JK, Ransom EK, Lynch BM (2016) How sedentary and physically active are breast cancer survivors, and which population subgroups have higher or lower levels of these behaviors? Support Care Cancer 24(5):2181–2190. https://doi.org/10.1007/s00520-015-3011-3

    Article  PubMed  Google Scholar 

  20. Lynch BM, Boyle T, Winkler E, Occleston J, Courneya KS, Vallance JK (2016) Patterns and correlates of accelerometer-assessed physical activity and sedentary time among colon cancer survivors. Cancer Causes Control : CCC 27(1):59–68. https://doi.org/10.1007/s10552-015-0683-4

    Article  PubMed  Google Scholar 

  21. Boyle T, Lynch BM, Ransom EK, Vallance JK (2017) Volume and correlates of objectively measured physical activity and sedentary time in non-Hodgkin lymphoma survivors. Psycho-oncology 26(2):239–247. https://doi.org/10.1002/pon.4027

    Article  PubMed  Google Scholar 

  22. Australian Bureau of Statistics (2018) Census of population and housing: socio-economic indexes for areas (SEIFA), Australia, 2016. https://www.abs.gov.au/ausstats/abs@.nsf/mf/2033.0.55.001. Accessed 12 Aug 2019

  23. Department of Health and Aged Care (2001) Measuring remoteness: accessibility/remoteness index of Australia (ARIA). https://www1.health.gov.au/internet/main/publishing.nsf/Content/health-historicpubs-hfsocc-ocpanew14a.htm. Accessed 28 Aug 2019

  24. Yellen SB, Cella DF, Webster K, Blendowski C, Kaplan E (1997) Measuring fatigue and other anemia-related symptoms with the Functional Assessment of cancer Therapy (FACT) measurement system. J Pain Symptom Manag 13(2):63–74. https://doi.org/10.1016/s0885-3924(96)00274-6

    Article  CAS  Google Scholar 

  25. Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, Silberman M, Yellen SB, Winicour P, Brannon J (1993) The Functional Assessment of cancer Therapy scale: development and validation of the general measure. J Clin Oncol 11(3):570–579

    Article  CAS  Google Scholar 

  26. Webster K, Cella D, Yost K (2003) The functional assessment of chronic illness therapy (FACIT) measurement system: properties, applications, and interpretation. Health Qual Life Outcomes 1(79):79

    Article  Google Scholar 

  27. Cella D, Eton DT, Lai J-S, Peterman AH, Merkel DE (2002) Combining anchor and distribution-based methods to derive minimal clinically important differences on the Functional Assessment of cancer Therapy (FACT) anemia and fatigue scales. J Pain Symptom Manag 24(6):547–561. https://doi.org/10.1016/S0885-3924(02)00529-8

    Article  Google Scholar 

  28. Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16(9):606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Löwe B, Unützer J, Callahan CM, Perkins AJ, Kroenke K (2004) Monitoring depression treatment outcomes with the Patient Health Questionnaire-9. Med Care 42(12):1194–1201

    Article  Google Scholar 

  30. Cella D (1997) The Functional Assessment of Cancer Therapy-Anemia (FACT-An) scale: a new tool for the assessment of outcomes in cancer anemia and fatigue. Semin Hematol 34(3 Suppl 2):13–19

    CAS  PubMed  Google Scholar 

  31. Pearman T, Yanez B, Peipert J, Wortman K, Beaumont J, Cella D (2014) Ambulatory cancer and US general population reference values and cutoff scores for the functional assessment of cancer therapy. Cancer 120(18):2902–2909. https://doi.org/10.1002/cncr.28758

    Article  PubMed  Google Scholar 

  32. Westreich D, Greenland S (2013) The table 2 fallacy: presenting and interpreting confounder and modifier coefficients. Am J Epidemiol 177(4):292–298. https://doi.org/10.1093/aje/kws412

    Article  PubMed  PubMed Central  Google Scholar 

  33. Lederer DJ, Bell SC, Branson RD, Chalmers JD, Marshall R, Maslove DM, Ost DE, Punjabi NM, Schatz M, Smyth AR (2019) Control of confounding and reporting of results in causal inference studies. Guidance for authors from editors of respiratory, sleep, and critical care journals. Ann Am Thorac Soc 16(1):22–28

    Article  Google Scholar 

  34. Hewitt M, Greenfield S, Stovall E (2005) From cancer patient to cancer survivor: lost in transition. National Academies Press

  35. Schoormans D, Czene K, Hall P, Brandberg Y (2015) The impact of co-morbidity on health-related quality of life in breast cancer survivors and controls. Acta Oncol 54(5):727–734

    Article  Google Scholar 

  36. Rodriguez JL, Hawkins NA, Berkowitz Z, Li C (2015) Factors associated with health-related quality of life among colorectal cancer survivors. Am J Prev Med 49(6):S518–S527

    Article  Google Scholar 

  37. Butow PN, Bell ML, Aldridge L, Sze M, Eisenbruch M, Jefford M, Schofield P, Girgis A, King M, Duggal P (2013) Unmet needs in immigrant cancer survivors: a cross-sectional population-based study. Support Care Cancer 21(9):2509–2520

    Article  CAS  Google Scholar 

  38. Bouskill K, Kramer M (2016) The impact of cancer and quality of life among long-term survivors of breast cancer in Austria. Support Care Cancer 24(11):4705–4712

    Article  Google Scholar 

  39. Andrykowski MA, Donovan KA, Laronga C, Jacobsen PB (2010) Prevalence, predictors, and characteristics of off-treatment fatigue in breast cancer survivors. Cancer 116(24):5740–5748

    Article  Google Scholar 

  40. Reinertsen KV, Cvancarova M, Loge JH, Edvardsen H, Wist E, Fosså SD (2010) Predictors and course of chronic fatigue in long-term breast cancer survivors. J Cancer Surviv 4(4):405–414

    Article  Google Scholar 

  41. Jaeschke R, Singer J, Guyatt GH (1989) Measurement of health status: ascertaining the minimal clinically important difference. Control Clin Trials 10(4):407–415

    Article  CAS  Google Scholar 

  42. Nekhlyudov L, Ganz PA, Arora NK, Rowland JH (2017) Going beyond being lost in transition: a decade of progress in cancer survivorship. J Clin Oncol 35(18):1978–1981. https://doi.org/10.1200/JCO.2016.72.1373

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors are grateful to the participants of the study.

Code availability

Not applicable.

Funding

This work was supported by the Breast Cancer Research Centre-Western Australia (grant to TB, BML, and JKV), Cancer Council Western Australia (grant to TB, BML, and JKV; award to TB), and Curtin University (funding to TB). BML is supported by a Mid-Career Fellowship (MCRF18005) from the Victorian Cancer Agency.

Author information

Authors and Affiliations

  1. Department of Epidemiology, Maastricht University, Maastricht, the Netherlands

    Shannen R. van der Kruk & Ilse Mesters

  2. Australian Centre for Precision Health, University of South Australia, Adelaide, SA, Australia

    Shannen R. van der Kruk & Terry Boyle

  3. Cancer Research Institute, University of South Australia, Adelaide, SA, Australia

    Shannen R. van der Kruk, Kate M. Gunn & Terry Boyle

  4. Department of Rural Health, University of South Australia, Adelaide, SA, Australia

    Kate M. Gunn

  5. Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, VIC, Australia

    Brigid M. Lynch

  6. Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia

    Brigid M. Lynch

  7. Baker Heart and Diabetes Institute, Physical Activity Laboratory, Melbourne, VIC, Australia

    Brigid M. Lynch

  8. Faculty of Health Disciplines, Athabasca University, Athabasca, AB, Canada

    Jeff K. Vallance

  9. Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia

    Terry Boyle

  10. School of Public Health, Curtin University, Perth, WA, Australia

    Terry Boyle

Authors
  1. Shannen R. van der Kruk
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kate M. Gunn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ilse Mesters
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Brigid M. Lynch
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jeff K. Vallance
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Terry Boyle
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

SRK was involved in the conception and design, analyses and interpretation of data, drafting, revising, and final approval of the article. KG was involved in the conception and design, interpretation of data, and drafting, revising, and final approval of the article. IM was involved in interpretation of data and drafting, revising, and final approval of the article. BML was involved in the material preparation, data collection, interpretation of data, revising, and final approval of the article. JKV was involved in the material preparation, data collection, interpretation of data, revising, and final approval of the article. TB was involved in the material preparation, data collection, conception and design, analysis and interpretation of data, drafting, revising, and final approval of the article.

Corresponding author

Correspondence to Terry Boyle.

Ethics declarations

Ethics approval

The baseline and follow-up study was approved by the Human Research Ethics Committees at the Western Australian Department of Health, The University of Western Australia, Curtin University, and the University of South Australia.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent for publication

Not applicable.

Conflict of interest

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.

Supplementary information

ESM 1

(DOCX 216 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

van der Kruk, S.R., Gunn, K.M., Mesters, I. et al. Associations between baseline demographic, clinical and lifestyle factors, and changes in fatigue, depression, and health-related quality of life in long-term cancer survivors: a cohort study. Support Care Cancer 29, 4711–4722 (2021). https://doi.org/10.1007/s00520-021-06015-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-021-06015-0

Keywords

Search

Navigation