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Influence of social and behavioral determinants on health-related quality of life among cancer survivors in the USA

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Abstract

Purpose

Cancer survivors experience a worse health-related quality of life (HRQoL) than non-cancer survivors. However, it is not fully understood whether social determinants of health (SDOH) and health behaviors are significantly associated with HRQoL among cancer survivors. The purpose of this study was to investigate the influence of SDOH and health behaviors on HRQoL among cancer survivors.

Methods

We identified adult (18 years or older) cancer survivors (n = 5784) in the 2017 and 2019 Behavioral Risk Factor Surveillance System. The primary outcome (HRQoL) was defined as whether cancer survivors reported having poor mental or physical health (e.g., 14 or more mentally or physically unhealthy days). Unadjusted and adjusted logistic regression was used to compute the odds ratios and 95% CIs of factors associated with poor HRQoL among the cancer survivors.

Results

More than half of the cancer survivors were non-Hispanic White, female, and 65 years or older. In the adjusted multivariable logistic regression models, cancer survivors who were physically active and who did not avoid care because of costs had a lower risk of poor mental and physical health. Current smokers were more likely to report poor physical health. Homeowners were less likely to report poor mental health. Daily fruit and vegetable consumption and healthcare coverage were not associated with poor HRQoL.

Conclusions

Some SDOH (healthcare access, economic stability, and the neighborhood and built environment) and health behavior (physical activity) are associated with lower likelihood of experiencing poor mental and/or physical health in the cancer survivors. The study findings can be used to target survivors who experience suboptimal HRQoL and to inform research, public health policies, and/or programs.

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Data availability

Behavioral Risk Factor Surveillance System (BRFSS) survey data and the questionnaires are publicly available to researchers.

Code availability

The SAS code is available upon request.

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Funding

Natasha Renee Burse was funded by National Cancer Institute F99 (1F99CA253762-01). Susan Veldheer is supported by the National Center for Advancing Translational Sciences, Grant KL2 TR002015 and Grant UL1 TR002014.

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Authors and Affiliations

  1. Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA

    Natasha Renee Burse, Xingran Weng, Li Wang & Susan Veldheer

  2. Epidemiology Program, University of Delaware, Newark, DE, USA

    Yendelela L. Cuffee

  3. Department of Family and Community Medicine, The Pennsylvania State University College of Medicine, Hershey, PA, USA

    Susan Veldheer

Authors
  1. Natasha Renee Burse
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  2. Xingran Weng
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  3. Li Wang
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Contributions

Conceptualization: Natasha Renee Burse and Susan Veldheer; methodology: Natasha Renee Burse, Xingran Weng, and Li Wang; formal analysis and investigation: Natasha Renee Burse; writing (original draft preparation): Natasha Renee Burse; writing (review and editing); Natasha Renee Burse, Xingran Weng, Li Wang, Yendelela Cuffee, and Susan Veldheer; funding acquisition: Natasha Renee Burse; supervision: Susan Veldheer. All the authors read and approved the manuscript.

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Correspondence to Natasha Renee Burse.

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Burse, N.R., Weng, X., Wang, L. et al. Influence of social and behavioral determinants on health-related quality of life among cancer survivors in the USA. Support Care Cancer 31, 67 (2023). https://doi.org/10.1007/s00520-022-07534-0

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