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Income and health-related quality of life among prostate cancer patients over a one-year period after radical prostatectomy: a linear mixed model analysis

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Abstract

Purpose

To examine income-related disparities in health-related quality of life (HRQOL) over a one-year period after surgery (radical prostatectomy) and its contributory factors in a longitudinal perspective. Evidence of associations between income and HRQOL among patients with prostate cancer (PCa) is sparse and their explanations still remain unclear.

Methods

246 males of two German hospitals filled out a questionnaire at the time of acute treatment, 6 and 12 months later. Age, partnership status, baseline disease and treatment factors, physical and psychological comorbidities, as well as treatment factors and adverse effects at follow-up were additionally included in the analyses to explain potential disparities. HRQOL was assessed with the EORTC (European Organisation for Research and Treatment of Cancer) QLQ-C30 core questionnaire and the prostate-specific QLQ-PR25. A linear mixed model for repeated measures was calculated.

Results

The fixed effects showed highly significant income-related inequalities regarding the majority of HRQOL scales. Less affluent PCa patients reported lower HRQOL in terms of global quality of life, all functional scales and urinary symptoms. After introducing relevant covariates, some associations became insignificant (physical, cognitive and sexual function), while others only showed reduced estimates (global quality of life, urinary symptoms, role, emotional and social function). In particular, mental disorders/psychological comorbidity played a relevant role in the explanation of income-related disparities.

Conclusions

One year after surgery, income-related disparities in various dimensions of HRQOL persist. With respect to economically disadvantaged PCa patients, the findings emphasize the importance of continuous psychosocial screening and tailored interventions, of patients’ empowerment and improved access to supportive care.

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Acknowledgements

The authors would like to thank the physicians, nurses and administrators of both participating hospitals for their support, and furthermore all participating patients.

Funding

This work was supported by the vffr (association for promotion of research in rehabilitation in Hamburg, Schleswig–Holstein and Mecklenburg-West Pomerania e. V.) (Grant Number 172).

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Authors and Affiliations

  1. Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    Jens Klein, Daniel Lüdecke, Kerstin Hofreuter-Gätgens & Olaf von dem Knesebeck

  2. Department of Urology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    Margit Fisch

  3. Martini-Clinic, Prostate Cancer Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    Markus Graefen

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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. The study has been approved by the Ethics Committee Hamburg (PV4493).

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Klein, J., Lüdecke, D., Hofreuter-Gätgens, K. et al. Income and health-related quality of life among prostate cancer patients over a one-year period after radical prostatectomy: a linear mixed model analysis. Qual Life Res 26, 2363–2373 (2017). https://doi.org/10.1007/s11136-017-1582-9

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