Phenotypic and molecular characteristics associated with various domains of quality of life in oncology patients and their family caregivers
Not all oncology patients and their family caregivers (FCs) experience the same quality of life (QOL). The purposes of this study were to identify latent classes of oncology patients (n = 168) and their FCs (n = 85) with distinct physical, psychological, social, and spiritual well-being trajectories from prior to through 4 months after the completion of radiation therapy and to evaluate for demographic, clinical, and genetic characteristics that distinguished between these latent classes.
Using growth mixture modeling, two latent classes were found for three (i.e., physical, psychological, and social well-being) of the four QOL domains evaluated.
Across these three domains, the largest percentage of participants reported relatively high well-being scores across the 6 months of the study. Across these three QOL domains, patients and FCs who were younger, female, belonged to an ethnic minority group, had children at home, had multiple comorbid conditions, or had a lower functional status, were more likely to be classified in the lower QOL class. The social well-being domain was the only domain that had a polymorphism in nuclear factor kappa beta 2 (NFKB2) associated with latent class membership. Carrying one or two doses of the rare allele for rs7897947 was associated with a 54 % decrease in the odds of belonging to the lower social well-being class [OR (95 % CI) = .46 (.21, .99), p = .049].
These findings suggest that a number of phenotypic and molecular characteristics contribute to differences in QOL in oncology patients and their FCs.
KeywordsQuality of life Cytokines Genetics Growth mixture modeling Family caregivers Radiation therapy Oncology
This research was supported by a grant from the National Institute of Nursing Research (NR04835). Dr. Alexander received support from a grant from the Oncology Nursing Foundation (i.e., AACR-Genetech BioOncology Research Career Development Award). Dr. Miaskowski is funded by the American Cancer Society as a Clinical Research Professor and by a K05 award (CA168960) from the National Cancer Institute.
Compliance with ethical standards
Conflict of interest
The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
- 6.Auchter, R. M., Scholtens, D., Adak, S., Wagner, H., Cella, D. F., & Mehta, M. P. (2001). Quality of life assessment in advanced non-small-cell lung cancer patients undergoing an accelerated radiotherapy regimen: Report of ECOG study 4593. Eastern Cooperative Oncology Group. International Journal of Radiation Oncology Biology Physics, 50(5), 1199–1206.CrossRefGoogle Scholar
- 7.Marchand, V., Bourdin, S., Charbonnel, C., Rio, E., Munos, C., Campion, L., et al. (2010). No impairment of quality of life 18 months after high-dose intensity-modulated radiotherapy for localized prostate cancer: A prospective study. International Journal of Radiation Oncology Biology Physics, 77(4), 1053–1059.CrossRefGoogle Scholar
- 9.Mc Caughan, E., Mc Sorley, O., Prue, G., Parahoo, K., Bunting, B., Sullivan, J. O., et al. (2013). Quality of life in men receiving radiotherapy and neo-adjuvant androgen deprivation for prostate cancer: Results from a prospective longitudinal study. Journal of Advanced Nursing, 69(1), 53–65.PubMedCrossRefGoogle Scholar
- 10.Reddy, K., Gaspar, L. E., Kavanagh, B. D., Waziri, A., Damek, D. M., Ney, D., et al. (2013). Prospective evaluation of health-related quality of life in patients with glioblastoma multiforme treated on a phase II trial of hypofractionated IMRT with temozolomide. Journal of Neuro-oncology, 114(1), 111–116.PubMedCrossRefGoogle Scholar
- 12.van der Voort van Zyp, N. C., Prevost, J. B., van der Holt, B., Braat, C., van Klaveren, R. J., Pattynama, P. M., et al. (2010). Quality of life after stereotactic radiotherapy for stage I non-small-cell lung cancer. International Journal of Radiation Oncology, Biology, Physics, 77(1), 31–37.Google Scholar
- 13.Pijls-Johannesma, M., Houben, R., Boersma, L., Grutters, J., Seghers, K., Lambin, P., et al. (2009). High-dose radiotherapy or concurrent chemo-radiation in lung cancer patients only induces a temporary, reversible decline in QoL. Radiotherapy and Oncology, 91(3), 443–448.PubMedCrossRefGoogle Scholar
- 18.Geinitz, H., Thamm, R., Scholz, C., Heinrich, C., Prause, N., Kerndl, S., et al. (2010). Longitudinal analysis of quality of life in patients receiving conformal radiation therapy for prostate cancer. Strahlentherapie und Onkologie: Organ der Deutschen Rontgengesellschaft, 186(1), 46–52.CrossRefGoogle Scholar
- 19.Noal, S., Levy, C., Hardouin, A., Rieux, C., Heutte, N., Segura, C., et al. (2011). One- year longitudinal study of fatigue, cognitive functions, and quality of life after adjuvant radiotherapy for breast cancer. International Journal of Radiation Oncology Biology Physics, 81(3), 795–803.CrossRefGoogle Scholar
- 34.Kurtz, M. E., Kurtz, J. C., Given, C. W., & Given, B. A. (2004). Depression and physical health among family caregivers of geriatric patients with cancer—A longitudinal view. Medical Science Monitor, 10(8), CR447–CR456.Google Scholar
- 39.Muthen, B. O., & Kaplan, D. W. (2004). Latent variable analysis: Growth mixture modeling and related techniques for longitudinal data. In D. Kaplan (Ed.), The Sage handbook of quantitative methodology for the social sciences (pp. 345–368). Newbury Park, CA: Sage Publications.Google Scholar
- 43.Alexander, K., Cooper, B., Paul, S. M., West, C., Yates, P., Kober, K. M., et al. (2014). Evidence of associations between cytokine gene polymorphisms and quality of life in patients with cancer and their family caregivers. Oncology Nursing Forum, 41(5), E267–E281.Google Scholar
- 46.Sprangers, M. A., Sloan, J. A., Barsevick, A., Chauhan, C., Dueck, A. C., Raat, H., et al. (2010). Scientific imperatives, clinical implications, and theoretical underpinnings for the investigation of the relationship between genetic variables and patient-reported quality-of-life outcomes. Quality of Life Research, 19(10), 1395–1403.PubMedPubMedCentralCrossRefGoogle Scholar
- 48.Miaskowski, C., Cooper, B. A., Dhruva, A., Dunn, L. B., Langford, D. J., Cataldo, J. K., et al. (2012). Evidence of associations between cytokine genes and subjective reports of sleep disturbance in oncology patients and their family caregivers. PLoS ONE, 7(7), e40560.PubMedPubMedCentralCrossRefGoogle Scholar
- 54.SPSS. (2010). IBM SPSS for Windows (Version 22). Chicago, IL: SPSS Inc.Google Scholar
- 55.Muthen, L. K., & Muthen, B. O. (1998–2010). Mplus User’s Guide (6th ed.). Los Angeles, CA: Muthen & Muthen.Google Scholar
- 59.Tofighi, D., & Enders, C. K. (2008). Identifying the correct number of classes in growth mixture models. In G. R. Hancock & S. M. Samuelsen (Eds.), Advances in latent variable mixture models (pp. 317–341). Charlotte, NC: Information Age Publishing.Google Scholar
- 67.StataCorp. (2013). Stata Statistical Software: Release 13. College Station, TX: StataCorp LP.Google Scholar
- 70.Merriman, J. D., Aouizerat, B. E., Langford, D. J., Cooper, B. A., Baggott, C. R., Cataldo, J. K., et al. (2014). Preliminary evidence of an association between an Interleukin 6 promoter polymorphism and self-reported attentional function in oncology patients and their family caregivers. Biological Research for Nursing, 16(2), 152–159.PubMedCrossRefGoogle Scholar
- 71.Alfaro, E., Dhruva, A., Langford, D. J., Koetters, T., Merriman, J. D., West, C., et al. (2014). Associations between cytokine gene variations and self-reported sleep disturbance in women following breast cancer surgery. European Journal of Oncology Nursing, 18(1), 85–93.PubMedCrossRefGoogle Scholar
- 72.Dunn, L. B., Aouizerat, B. E., Langford, D. J., Cooper, B. A., Dhruva, A., Cataldo, J. K., et al. (2013). Cytokine gene variation is associated with depressive symptom trajectories in oncology patients and family caregivers. European Journal of Oncology Nursing, 17(3), 346–353.PubMedCrossRefGoogle Scholar
- 77.Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
- 79.Murray, S. A., Kendall, M., Boyd, K., Grant, L., Highet, G., & Sheikh, A. (2010). Archetypal trajectories of social, psychological, and spiritual wellbeing and distress in family care givers of patients with lung cancer: Secondary analysis of serial qualitative interviews. British Medical Journal, 340, c2581.PubMedPubMedCentralCrossRefGoogle Scholar
- 83.Bowen, D. J., Alfano, C. M., McGregor, B. A., Kuniyuki, A., Bernstein, L., Meeske, K., et al. (2007). Possible socioeconomic and ethnic disparities in quality of life in a cohort of breast cancer survivors. Breast Cancer Research and Treatment, 106(1), 85–95.PubMedPubMedCentralCrossRefGoogle Scholar
- 85.Ashing-Giwa, K. T., Padilla, G., Tejero, J., Kraemer, J., Wright, K., Coscarelli, A., et al. (2004). Understanding the breast cancer experience of women: A qualitative study of African American, Asian American, Latina and Caucasian cancer survivors. Psycho-oncology, 13(6), 408–428.PubMedPubMedCentralCrossRefGoogle Scholar
- 87.Sekine, R., Ogata, M., Uchiyama, I., Miyakoshi, K., Uruma, M., Miyashita, M., et al. (2015). Changes in and associations among functional status and perceived quality of life of patients with metastatic/locally advanced cancer receiving rehabilitation for general disability. The American Journal of Hospice & Palliative Care, 33(7), 695–702.CrossRefGoogle Scholar
- 92.Reeve, B. B., Chen, R. C., Moore, D. T., Deal, A. M., Usinger, D. S., Lyons, J. C., et al. (2014). Impact of comorbidity on health-related quality of life after prostate cancer treatment: Combined analysis of two prospective cohort studies. BJU International, 114(6b), E74–E81.PubMedCrossRefGoogle Scholar