The association of socioeconomic status with quality of life in cancer patients over a 6-month period using individual growth models

  • Julia RoickEmail author
  • Helge Danker
  • Anette Kersting
  • Arne Dietrich
  • Andreas Dietz
  • Kirsten Papsdorf
  • Jürgen Meixensberger
  • Jens-Uwe Stolzenburg
  • Hubert Wirtz
  • Susanne Singer
Original Article



Studies examining longitudinal associations between socioeconomic factors and quality of life (QoL) in cancer patients are rare. This study investigates changes in QoL over a 6-month period.


Four hundred forty-two cancer patients (mean age 64, SD = 11, 70% male) completed standardized questionnaires at the beginning (t1) and end (t2) of their hospital stay and 3 (t3) and 6 months (t4) thereafter. QoL was assessed with the EORTC QLQ-C30 core questionnaire. Mixed effect models were employed to analyze individual changes in QoL in relation to socioeconomic status (education, income, job status) over the four timepoints. Age, sex, cohabitation, disease and treatment factors, and comorbidity were included as covariates in the models.


Income was a predictive factor for QoL. Patients with a low income had 8.8 percentage points (PP) lower physical, 4.9 PP lower emotional, and 11.4 PP lower role functioning. They also had 6.6 PP lower global QoL. Lower social functioning (6.2 PP) was found in patients with higher education or university degrees compared with those who were less educated or had not undergone an apprenticeship. Income also influenced trajectories of role functioning. There was no evidence that primary or secondary education and job type were related to QoL.


The fact that income is negatively associated with many aspects of quality of life should be considered during and after treatment with a focus on patients with special needs.


Cancer Quality of life Socioeconomic status Mixed effect model Growth curve analysis 



This study was funded by the German Federal Ministry of Health (grant number NKP-332-026).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed within this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

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


  1. 1.
    Mackenbach JP, Stirbu I, Roskam A-JR et al (2008) Socioeconomic inequalities in health in 22 European countries. N Engl J Med 358(23):2468–2481CrossRefGoogle Scholar
  2. 2.
    Singer S, Roick J, Briest S, Stark S, Gockel I, Boehm A, Papsdorf K, Meixensberger J, Müller T, Prietzel T, Schiefke F, Dietel A, Bräunlich J, Danker H (2016) Impact of socio-economic position on cancer stage at presentation. Int J Cancer 139(8):1696–1702CrossRefGoogle Scholar
  3. 3.
    Woods LM, Rachet B, Coleman MP (2006) Origins of socio-economic inequalities in cancer survival. Ann Oncol 17(1):5–19CrossRefGoogle Scholar
  4. 4.
    Kogevinas M, Porta M (1997) Socioeconomic differences in cancer survival: a review of the evidence. IARC Sci Publ 138:177–206Google Scholar
  5. 5.
    Klein J, Knesebeck O (2016) Soziale Ungleichheit und Krebs. In: Mehnert A, Koch U (eds) Handbuch Psychoonkologie, 1. Auflage edn. Hogrefe, Göttingen, pp 121–244Google Scholar
  6. 6.
    Kuznetsov L, Mielck A (2012) Regional concentration of social disadvantage and of risks for lung cancer and colon cancer: systematic review and recommendations for research. Gesundheitswesen 74(6):42–51CrossRefGoogle Scholar
  7. 7.
    Doubeni CA, Laiyemo AO, Major JM, Schootman M, Lian M, Park Y, Graubard BI, Hollenbeck AR, Sinha R (2012) Socioeconomic status and the risk of colorectal cancer. Cancer 118(14):3636–3644CrossRefGoogle Scholar
  8. 8.
    Shack L, Jordan C, Thomson CS et al (2008) Variation in incidence of breast, lung and cervical cancer and malignant melanoma of skin by socioeconomic group in England. BMC Cancer 8:271CrossRefGoogle Scholar
  9. 9.
    Meijer M, Bloomfield K, Engholm G (2013) Neighbourhoods matter too. J Epidemiol Community Health 67(1):6–13CrossRefGoogle Scholar
  10. 10.
    Hoebel J, Kroll LE, Fiebig J, Lampert T, Katalinic A, Barnes B, Kraywinkel K (2018) Socioeconomic inequalities in total and site-specific cancer incidence in Germany. Front Oncol 8:402CrossRefGoogle Scholar
  11. 11.
    Gondos A, Bray F, Brewster DH, Coebergh JW, Hakulinen T, Janssen-Heijnen ML, Kurtinaitis J, Brenner H, EUNICE Survival Working Group (2008) Recent trends in cancer survival across Europe between 2000 and 2004. Eur J Cancer 44(10):1463–1475CrossRefGoogle Scholar
  12. 12.
    Mielck A, Vogelmann M, Leidl R (2014) Health-related quality of life and socioeconomic status. Health Qual Life Outcomes 12:58CrossRefGoogle Scholar
  13. 13.
    Miravitlles M, Naberan K, Cantoni J, Azpeitia A (2011) Socioeconomic status and health-related quality of life of patients with chronic obstructive pulmonary disease. Respiration 82(5):402–408CrossRefGoogle Scholar
  14. 14.
    Kogevinas M, Pearce N, Susser M et al (2006) Social inequalities and cancer. IARC scientific publication no. 138. World Health Organization, GenevaGoogle Scholar
  15. 15.
    Dalton SO, Schüz J, Engholm G, Johansen C, Kjær SK, Steding-Jessen M, Storm HH, Olsen JH (2008) Social inequality in incidence of and survival from cancer in a population-based study in Denmark, 1994-2003. Eur J Cancer 44(14):2074–2085CrossRefGoogle Scholar
  16. 16.
    Montazeri A (2009) Quality of life data as prognostic indicators of survival in cancer patients. Health Qual Life Outcomes 7:102CrossRefGoogle Scholar
  17. 17.
    Quinten C, Martinelli F, Coens C, Sprangers MAG, Ringash J, Gotay C, Bjordal K, Greimel E, Reeve BB, Maringwa J, Ediebah DE, Zikos E, King MT, Osoba D, Taphoorn MJ, Flechtner H, Schmucker-von Koch J, Weis J, Bottomley A, on behalf of Patient Reported Outcomes and Behavioral Evidence (PROBE) and the European Organization for Research and Treatment of Cancer (EORTC) Clinical Groups (2014) A global analysis of multitrial data investigating quality of life and symptoms as prognostic factors for survival in different tumor sites. Cancer 120(2):302–311CrossRefGoogle Scholar
  18. 18.
    Lee YJ, Suh S-Y, Choi YS, Shim JY, Seo AR, Choi SE, Ahn HY, Yim E (2014) EORTC QLQ-C15-PAL quality of life score as a prognostic indicator of survival in patients with far advanced cancer. Support Care Cancer 22(7):1941–1948CrossRefGoogle Scholar
  19. 19.
    Ferrell BR, Dow KH, Leigh S, Ly J, Gulasekaram P (1995) Quality of life in long-term cancer survivors. Oncol Nurs Forum 22(6):915–922PubMedGoogle Scholar
  20. 20.
    Klein J, Lüdecke D, Hofreuter-Gätgens K, Fisch M, Graefen M, von dem Knesebeck O (2017) Income and health-related quality of life among prostate cancer patients over a one-year period after radical prostatectomy. Qual Life Res 26(9):2363–2373CrossRefGoogle Scholar
  21. 21.
    Simon AE, Wardle J (2008) Socioeconomic disparities in psychosocial wellbeing in cancer patients. Eur J Cancer 44(4):572–578CrossRefGoogle Scholar
  22. 22.
    Penson DF, Stoddard ML, Pasta DJ, Lubeck DP, Flanders SC, Litwin MS (2001) The association between socioeconomic status, health insurance coverage, and quality of life in men with prostate cancer. J Clin Epidemiol 54(4):350–358CrossRefGoogle Scholar
  23. 23.
    Hofreuter-Gätgens K, Klein J, Knesebeck Ovd (2017) Soziale Ungleichheit bei Brust- und Prostatakrebs. Inanspruchnahme von Versorgungsleistungen, gesundheitsbezogene Lebensqualität und Rückkehr zur Arbeit. MedizinsoziologieGoogle Scholar
  24. 24.
    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, Haes JCJM, Kaasa S, Klee M, Osoba D, Razavi D, Rofe PB, Schraub S, Sneeuw K, Sullivan M, Takeda F (1993) The European Organization for Research and Treatment of Cancer QLQ-C30. JNCI J Natl Cancer Inst 85(5):365–376CrossRefGoogle Scholar
  25. 25.
    Fayers PM, Aaronson NK, Bjordal K, Groenvold M, Curran D, Bottomley A (2001) ORTC QLQ-C30 Scoring Manual, 3rd edn. EORTC Publications, BrusselsGoogle Scholar
  26. 26.
    Shek DTL, Ma CMS (2011) Longitudinal data analyses using linear mixed models in SPSS. Sci World J 11:42–76CrossRefGoogle Scholar
  27. 27.
    Vissers PAJ, Thong MSY, Pouwer F, Zanders MMJ, Coebergh JWW, van de Poll-Franse LV (2013) The impact of comorbidity on health-related quality of life among cancer survivors. J Cancer Surviv 7(4):602–613CrossRefGoogle Scholar
  28. 28.
    Singer JD, Willett JB (2003) Applied longitudinal data analysis. Modeling change and event occurrence. Oxford Univ. Press, OxfordCrossRefGoogle Scholar
  29. 29.
    Ristevska G, Rajchanovska D, Jovanovska T, Dejanova B (2017) Low income deteriorates quality of life in early breast cancer survivors. Eur Psychiatry 41:S670–S671CrossRefGoogle Scholar
  30. 30.
    Macleod U, Mitchell ED, Burgess C, Macdonald S, Ramirez AJ (2009) Risk factors for delayed presentation and referral of symptomatic cancer. Br J Cancer 101(Suppl 2):S92–S101CrossRefGoogle Scholar
  31. 31.
    Domenighetti G, Vineis P, de Pietro C et al (2010) Ability to pay and equity in access to Italian and British National Health Services. Eur J Pub Health 20(5):500–503CrossRefGoogle Scholar
  32. 32.
    Hastert TA, Ruterbusch JJ, Beresford SAA, Sheppard L, White E (2016) Contribution of health behaviors to the association between area-level socioeconomic status and cancer mortality. Soc Sci Med (1982) 148:52–58CrossRefGoogle Scholar
  33. 33.
    Weyers S, Dragano N, Möbus S, Beck EM, Stang A, Möhlenkamp S, Jöckel KH, Erbel R, Siegrist J (2008) Low socio-economic position is associated with poor social networks and social support. Int J Equity Health 7:13CrossRefGoogle Scholar
  34. 34.
    Vonneilich N, Jöckel K-H, Erbel R, Klein J, Dragano N, Weyers S, Moebus S, Siegrist J, von dem Knesebeck O (2011) Does socioeconomic status affect the association of social relationships and health? A moderator analysis. Int J Equity Health 10:43CrossRefGoogle Scholar
  35. 35.
    Mehnert A, Lehmann C, Graefen M et al (2010) Depression, anxiety, post-traumatic stress disorder and health-related quality of life and its association with social support in ambulatory prostate cancer patients. Eur J Cancer Care 19(6):736–745CrossRefGoogle Scholar
  36. 36.
    Earle CC, Chretien Y, Morris C, Ayanian JZ, Keating NL, Polgreen LA, Wallace R, Ganz PA, Weeks JC (2010) Employment among survivors of lung cancer and colorectal cancer. J Clin Oncol 28(10):1700–1705CrossRefGoogle Scholar
  37. 37.
    Alfonsson S, Olsson E, Hursti T, Lundh MH, Johansson B (2016) Socio-demographic and clinical variables associated with psychological distress 1 and 3 years after breast cancer diagnosis. Support Care Cancer 24(9):4017–4023CrossRefGoogle Scholar
  38. 38.
    Loehrer PJ, Greger HA, Weinberger M et al (1991) Knowledge and beliefs about cancer in a socioeconomically disadvantaged population. Cancer 68(7):1665–1671CrossRefGoogle Scholar
  39. 39.
    Macleod U, Ross S, Fallowfield L, Watt GCM (2004) Anxiety and support in breast cancer. Br J Cancer 91(5):879–883CrossRefGoogle Scholar
  40. 40.
    Hamidou Z, Dabakuyo TS, Bonnetain F (2011) Impact of response shift on longitudinal quality-of-life assessment in cancer clinical trials. Expert Rev Pharmacoecon Outcomes Res 11(5):549–559CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Julia Roick
    • 1
    Email author return OK on get
  • Helge Danker
    • 2
  • Anette Kersting
    • 3
  • Arne Dietrich
    • 4
  • Andreas Dietz
    • 5
  • Kirsten Papsdorf
    • 6
  • Jürgen Meixensberger
    • 7
  • Jens-Uwe Stolzenburg
    • 8
  • Hubert Wirtz
    • 9
  • Susanne Singer
    • 10
  1. 1.Institute of Medical Sociology, Medical FacultyMartin Luther University Halle-WittenbergHalle (Saale)Germany
  2. 2.Devision of Medical Psychology and Medical SociologyUniversity Medical Center LeipzigLeipzigGermany
  3. 3.Department of Psychosomatic Medicine and PsychotherapyUniversity Medical Center LeipzigLeipzigGermany
  4. 4.Department of Visceral, Transplantation, Thoracic, and Vascular SurgeryUniversity Medical Center LeipzigLeipzigGermany
  5. 5.Department of OtolaryngologyUniversity Medical Center LeipzigLeipzigGermany
  6. 6.Department of Radiation-OncologyUniversity Medical Center LeipzigLeipzigGermany
  7. 7.Department of NeurosurgeryUniversity Medical Center LeipzigLeipzigGermany
  8. 8.Department of UrologyUniversity Medical Center LeipzigLeipzigGermany
  9. 9.Department of PneumologyUniversity Medical Center LeipzigLeipzigGermany
  10. 10.Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI)University Medical Centre of Johannes Gutenberg University MainzMainzGermany

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