The impact of cancer type, treatment, and distress on health-related quality of life: cross-sectional findings from a study of Australian cancer patients
This study examined the mediating effects of cancer type, treatment, and distress on health-related quality of life (HRQoL) for early diagnosis cancer patients. Results were interpreted with respect to established thresholds for clinical meaningfulness.
A cross-sectional design was used. Patients completed surveys collecting demographics, cancer type, treatment, comorbid conditions, distress (HADS), and HRQoL (FACT-G). Hierarchical multivariate regressions examined associations between cancer type, treatment, and distress on HRQoL. Established minimum differences were used to identify clinically meaningful changes in HRQoL.
Of the 1183 patients surveyed, 21% were classified as having elevated anxiety and 13% had elevated depression. Our sample reported significantly lower physical and emotional well-being compared to population norms. Patients with prostate, melanoma, gynaecological, and urological cancers had higher HRQoL scores than those with colorectal cancer. However, when effects for treatment type and distress were considered, differences between cancer types became non-significant. Anxiety and depression were associated with lower HRQoL scores as was chemotherapy. Only depression, anxiety, and chemotherapy were associated with clinically meaningful decreases in HRQoL scores.
While statistically significant differences in HRQoL were found between different cancer types, only chemotherapy, anxiety, and depression produced clinically meaningful poorer HRQoL scores. In practice, clinically meaningful differences could promote a shift in resources toward interventions where a positive effect on patient well-being is appreciated by both the patient and health professional.
KeywordsCancer Treatment Distress Quality of life Patient-reported outcomes Clinically meaningful differences
We would like to acknowledge contributions from Dr. Mariko Carey and Dr. Sandra Ieropoli for developing the survey tool and overseeing data collection. We would also like to acknowledge the contribution of Ms. Helen Farrugia, Head of the Victorian Cancer Registry. We give our thanks and respect to the time and effort our survey participants gave to the project.
Funding for this study was provided by the Cancer Council Victoria (institutional funding).
Compliance with ethical standards
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
Conflict of interest
The authors declare that they have no conflicts of interest.
- 2.Taphoorn MJB, Stupp R, Coens C, Osoba D, Kortmann R, van den Bent MJ, Mason W, Mirimanoff RO, Baumert BG, Eisenhauer E, Forsyth P, Bottomley A, Ncic CTG (2005) Health-related quality of life in patients with glioblastoma: a randomised controlled trial. Lancet Oncol 6(12):937–944. https://doi.org/10.1016/s1470-2045(05)70432-0 CrossRefPubMedGoogle Scholar
- 3.Efficace F, Bottomley A, Smit EF, Lianes P, Legrand C, Debruyne C, Schramel F, Smit HJ, Gaafar R, Biesma B, Manegold C, Coens C, Giaccone G, Van Meerbeeck J, Grp ELC, Quality Life U (2006) Is a patient’s self-reported health-related quality of life a prognostic factor for survival in non-small-cell lung cancer patients? A multivariate analysis of prognostic factors of EORTC study 08975. Ann Oncol 17(11):1698–1704. https://doi.org/10.1093/annonc/mdl183 CrossRefPubMedGoogle Scholar
- 4.Valderas JM, Kotzeva A, Espallargues M, Guyatt G, Ferrans CE, Halyard MY, Revicki DA, Symonds T, Parada A, Alonso J (2008) The impact of measuring patient-reported outcomes in clinical practice: a systematic review of the literature. Qual Life Res 17(2):179–193. https://doi.org/10.1007/s11136-007-9295-0 CrossRefPubMedGoogle Scholar
- 8.Detmar SB, Muller MJ, Schornagel JH, Wever LDV, Aaronson NK (2002) Health-related quality-of-life assessments and patient-physician communication - a randomized controlled trial. Jama-Journal of the American Medical Association 288(23):3027–3034. https://doi.org/10.1001/jama.288.23.3027 CrossRefGoogle Scholar
- 9.Granger CL, McDonald CF, Berney S, Chao C, Denehy L (2011) Exercise intervention to improve exercise capacity and health-related quality of life for patients with non-small cell lung cancer: a systematic review. Lung Cancer 72(2):139–153. https://doi.org/10.1016/j.lungcan.2011.01.006 CrossRefPubMedGoogle Scholar
- 13.Lee CK, Stockler MR, Coates AS, Gebski V, Lord SJ, Simes RJ, Australian New Zealand Breast C (2010) Self-reported health-related quality of life is an independent predictor of chemotherapy treatment benefit and toxicity in women with advanced breast cancer. Br J Cancer 102(9):1341–1347. https://doi.org/10.1038/sj.bjc.6605649 CrossRefPubMedPubMedCentralGoogle Scholar
- 16.Popovic M, Lao N, Zeng L, Zhang L, Cella D, Beaumont JL, Chow R, Chiu N, Chiu L, Lam H, Poon M, Chow E (2013) The impact of clinical and sociodemographic features on quality of life in patients with early stage cancers using the functional assessment of cancer therapy-general assessment tool. Support Care Cancer 21(8):2267–2277. https://doi.org/10.1007/s00520-013-1789-4 CrossRefPubMedGoogle Scholar
- 22.Maringwa J, Quinten C, King M, Ringash J, Osoba D, Coens C, Martinelli F, Reeve BB, Gotay C, Greimel E, Flechtner H, Cleeland CS, Schmucker-Von Koch J, Weis J, Van Den Bent MJ, Stupp R, Taphoorn MJ, Bottomley A, Project EP, Brain C (2011) Minimal clinically meaningful differences for the EORTC QLQ-C30 and EORTC QLQ-BN20 scales in brain cancer patients. Ann Oncol 22(9):2107–2112. https://doi.org/10.1093/annonc/mdq726 CrossRefPubMedGoogle Scholar
- 23.Maringwa JT, Quinten C, King M, Ringash J, Osoba D, Coens C, Martinelli F, Vercauteren J, Cleeland CS, Flechtner H, Gotay C, Greimel E, Taphoorn MJ, Reeve BB, Schmucker-Von Koch J, Weis J, Smit EF, van Meerbeeck JP, Bottomley A, Project EP, Lung Canc G (2011) Minimal important differences for interpreting health-related quality of life scores from the EORTC QLQ-C30 in lung cancer patients participating in randomized controlled trials. Support Care Cancer 19(11):1753–1760. https://doi.org/10.1007/s00520-010-1016-5 CrossRefPubMedGoogle Scholar
- 27.ABS (2013) Socio-economic indexes for areas (SEIFA), 2011. vol 2033.0.55.001. Australia Bureau of Statistics, CanberraGoogle Scholar
- 28.Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6):361–370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x CrossRefPubMedGoogle Scholar
- 29.Sellick SM, Crooks DL (1999) Depression and cancer: an appraisal of the literature for prevalence, detection, and practice guideline development for psychological interventions. Psycho-Oncology 8(4):315–333. https://doi.org/10.1002/(sici)1099-1611(199907/08)8:4<315::aid-pon391>3.0.co;2-g CrossRefPubMedGoogle Scholar
- 33.Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, Silberman M, Yellen SB, Winicour P, Brannon J, Eckberg K, Lloyd S, Purl S, Blendowski C, Goodman M, Barnicle M, Stewart I, McHale M, Bonomi P, Kaplan E, Taylor S, Thomas CR, Harris J (1993) The functional assessment of cancer-therapy scale - delevopment and validation of the general measure. J Clin Oncol 11(3):570–579CrossRefGoogle Scholar
- 35.Petrick JL, Reeve BB, Kucharska-Newton AM, Foraker RE, Platz EA, Stearns SC, Han XS, Windham BG, Irwin DE (2014) Functional status declines among cancer survivors: trajectory and contributing factors. J Geriatr Oncol 5(4):359–367. https://doi.org/10.1016/j.jgo.2014.06.002 CrossRefPubMedPubMedCentralGoogle Scholar
- 37.Choi EP, Wong CK, Tsu JH, Chin WY, Kung K, Wong CK, Yiu MK (2016) Health-related quality of life of Chinese patients with prostate cancer in comparison to general population and other cancer populations. Support Care Cancer 24(4):1849–1856. https://doi.org/10.1007/s00520-015-2980-6 CrossRefPubMedGoogle Scholar
- 40.World Health Organization (1990) Cancer pain relief and palliative care. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser 804:1–75Google Scholar
- 43.Jefford M, Ward AC, Lisy K, Lacey K, Emery JD, Glaser AW, Cross H, Krishnasamy M, McLachlan SA, Bishop J (2017) Patient-reported outcomes in cancer survivors: a population-wide cross-sectional study. Support Care Cancer 22(22):3171–3179. https://doi.org/10.1007/s00520-017-3725-5 CrossRefGoogle Scholar