Quality of Life Research

, Volume 3, Issue 2, pp 127–141

Quality of life in adult survivors of lung, colon and prostate cancer

  • C. A. C. Schag
  • P. A. Ganz
  • D. S. Wing
  • M. -S. Sim
  • J. J. Lee
Research Papers


In a cross-sectional study design, a disease free sample of 57 lung, 117 colon, and 104 prostate cancer survivors who represented short, intermediate and long-term survivors completed a detailed assessment of quality of life (QOL) and rehabilitation needs using the CAncer Rehabilitation Evaluation System (CARES). Demographic and medical data, social support, and a global QOL rating were also assessed. Lung cancer patients showed no differences in QOL with respect to their period of survival. QOL improved for survivors of colon cancer as they lived for longer periods, but declined with time for survivors of prostate cancer. The best predictor of QOL for all groups was KPS, although other variables such as type of hospital, gender, and work status were predictive for survivors of colon cancer. For survivors of prostate cancer comorbidity with other medical illnesses, time since diagnosis and comorbidity due to psychiatric difficulties were predictive of QOL. All groups had significant rehabilitation problems in the domains of physical, psychosocial, sexual, medical interaction, and marital relationships. Lung cancer survivors had more problems than the other cancer survivors. We conclude that patients who survive cancer do not return to a state of normal health. They demonstrate a variety of difficulties with which they must cope as they continue to survive. Greater efforts need to be made early in diagnosis and treatment to understand rehabilitation problems and target interventions in the hope of reducing later sequelae.

Key words

Colon lung prostate cancer quality of life survivorship 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    American Cancer Society. Facts and Figures. American Cancer Society, 1990.Google Scholar
  2. 2.
    Loescher LJ, Welch-McCaffrey D, Leigh SA, Hoffman B, Meyskens FL. Surviving adult cancers. Part 1: physiologic effects. Ann Intern Med 1989; 111: 411–32.Google Scholar
  3. 3.
    Welch-McCaffrey D, Hoffman B, Leigh SA, Loescher LJ, Meyskens FL. Surviving adult cancers. Part 2: psychosocial implications. Ann Intern Med 1989; 111: 517–24.Google Scholar
  4. 4.
    Fobair R, Hoppe RT, Bloom J, Cos R, Varghese A, Spiegel D. Psychosocial problems among survivors of Hodgkin's disease. J Clin Oncol 1986; 4: 805–14.Google Scholar
  5. 5.
    Greaves-Otte JGW, Greaves J, Kruyt PM, vanLeeuwen O, van derWouden JC, van derDoes E. Problems at social re-integration of long-term cancer survivors. Eur J Cancer 1991; 27: 178–81.Google Scholar
  6. 6.
    Moinpour CM, Feigel P, Metch B, et al. Quality of life end points in cancer clinical trials: Review and recommendations. J Natl Cancer Inst 1989; 7: 485–95.Google Scholar
  7. 7.
    Cella DF, Tulsky DS. Measuring quality of life today: Methodological aspects. Oncology 1990; 4: 29–38.Google Scholar
  8. 8.
    Aaronson NK. Quality of life: What it is? How should it be measured? Oncology 1988; 2: 69–74.Google Scholar
  9. 9.
    Schipper H, Levitt M. Measuring quality of life: risks and benefits. Cancer Treat Rep 1985; 69: 1115–23.Google Scholar
  10. 10.
    Ware JEJr. Conceptualizing disease impact and treatment outcomes. Cancer 1984; 53 (suppl): 2316.Google Scholar
  11. 11.
    Mullan F. Seasons of survival: reflections of a physician with cancer. N Engl J Med 1985; 313: 270–3.Google Scholar
  12. 12.
    Schag CAC, Heinrich RL. Developing a comprehensive tool: The CAncer Rehabilitation Evaluation System. Oncology 1990; 4: 135–8.Google Scholar
  13. 13.
    Schag CAC, Heinrich RL. CA ncer R ehabilitation E valuation S ystem (CARES): Manual, 1st edn. Los Angeles: Cares Consultants, 1989.Google Scholar
  14. 14.
    Schag CC, Heinrich RL, Ganz PA. Cancer Inventory of Problem Situations: An instrument for assessing cancer patients' rehabilitation needs. J Psychosocial Oncol 1983; 1: 11–24.Google Scholar
  15. 15.
    Heinrich RL, Schag CC, Ganz PA. Living with cancer: The Cancer Inventory of Problem Situations. J Clin Psychol 1984; 40: 972–80.Google Scholar
  16. 16.
    Schag CC, Heinrich RL. The impact of cancer on daily living: A comparison with cardiac patients and healthy controls. Rehab Psych 1986; 31: 157–67.Google Scholar
  17. 17.
    Ganz PA, Rofessart J, Polinsky ML, Schag CC, Heinrich RL. A comprehensive approach to cancer patients' needs assessment: The Cancer Inventory of Problem Situations (CIPS) and a companion interview J Psychosocial Oncol 1986; 4: 27–42.Google Scholar
  18. 18.
    Ganz PA, Schag CC, Heinrich RL. Cancer rehabilitation. In. Haskell CM (ed) Cancer Treatment. W. B. Saunders, 1990.Google Scholar
  19. 19.
    Schag CAC, Heinrich RL, Aadland RL, Ganz PA. Assessing problems of cancer patients: Psychometric properties of the Cancer Inventory of Problem Situations. Health Psych 1990; 9: 83–102.Google Scholar
  20. 20.
    Ganz PA, Schag CAC, Cheng H. Assessing the quality of life in newly-diagnosed breast cancer patients. J Clin Epidemiol 1990; 43: 75–86.Google Scholar
  21. 21.
    Schag CAC, Ganz PA, Heinrich RL. CAncer Rehabilitation Evaluation System-Short-Form (CARESSF): A cancer specific rehabilitation and quality of life instrument. Cancer 1991; 68: 1406–13.Google Scholar
  22. 22.
    Ganz PA, Schag CAC, Lee JJ, Sim M-S The CARES: A generic measure of health-related quality of life for Cancer patients. Quality Life Res 1992; 1: 19–29.Google Scholar
  23. 23.
    Gough IR, Furnival CM, Schilder L, et al. Assessment of the quality of life of patients with advanced cancer. Eur J Cancer Clin Oncol 1983; 19: 1161–5.Google Scholar
  24. 24.
    Karnofsky DA, Burchenal JH. The clinical evaluation of chemotherapeutic agents in cancer. In McCleod CM (ed). Evaluation of Chemotherapeutic Agents. New York: Columbia University Press, 1949; 191–205.Google Scholar
  25. 25.
    Schag CC, Heinrich RL, Ganz PA. Karnofsky performance status revisited: Reliability, validity, and guidelines. J Clin Oncol 1984; 2: 187–93.Google Scholar
  26. 26.
    SAS Institute Inc. SAS/STAT Users Guide, Version 6 4th Edn, Vol. 1: Cary NC: SAS Institute Inc., 1989.Google Scholar
  27. 27.
    Ganz PA, Hirji K, Sim M-S, Schag CAC, Fred C, Polinsky ML. Predicting psychosocial distress in patients with breast cancer. Med Care 1993; 5: 419–31.Google Scholar
  28. 28.
    Schag CAC, Ganz PA, Polinsky ML, Fred C, Hirji K, Petersen L. Characteristics of women at risk for psychosocial distress in the year after breast cancer. J Clin Oncol 1993; 11: 783–93.Google Scholar
  29. 29.
    Frank E, Anderson C, Rubenstein D. Frequency of sexual dysfunction in ‘normal’ couples. New Engl J Med 1978; 299: 111–5.Google Scholar
  30. 30.
    Polinsky ML, Fred C, Ganz PA. Quantitative and qualitative assessment of a case management program for cancer patients. Health Social Work 1991; 16: 176–183.Google Scholar
  31. 31.
    Gordon WA, Freidenbergs I, Diller L et al. Efficacy of psychosocial intervention with cancer patients. J Consult Clin Psychol 1980; 48: 743–59.Google Scholar
  32. 32.
    Lehman J, DeLisa J, Warren G, deLateur B, Sand-Bryant P, Nicholson C. Cancer rehabilitation: Assessment of need development and evaluation of a model of care. Arch Phys Med Rehab 1978; 59: 410–19.Google Scholar

Copyright information

© Rapid Communications of Oxford Ltd 1994

Authors and Affiliations

  • C. A. C. Schag
    • 1
    • 2
  • P. A. Ganz
    • 2
    • 3
    • 4
  • D. S. Wing
    • 5
  • M. -S. Sim
    • 6
  • J. J. Lee
    • 7
  1. 1.Departments of Medicine Psychiatry and Biobehavioral SciencesUCLA School of MedicineUSA
  2. 2.Division of Cancer Prevention and Control ResearchJonsson Comprehensive Cancer Center UCLALos AngelesUSA
  3. 3.Department of MedicineUCLA School of MedicineLos AngelesUSA
  4. 4.Department of Health ServicesUCLA School of Public HealthLos AngelesUSA
  5. 5.Veterans Administration Medical CenterSepulvedaUSA
  6. 6.The BASE Unit, Jonsson Comprehensive Cancer CenterUCLALos AngelesUSA
  7. 7.Department of BiomathUniversity of Texas, M. D. Anderson Cancer CenterHoustonUSA

Personalised recommendations