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Socioeconomic disparities in health-related quality of life among colorectal cancer survivors

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Abstract

Purpose

Improvements in colorectal cancer (CRC) prevention, early detection, and treatment have resulted in substantial gains in survival. However, the health-related quality of life (HRQoL) of CRC survivors often depends on access to supportive care, which differs by survivors’ socioeconomic characteristics. The purpose of this study was to investigate the relationship between socioeconomic characteristics and HRQoL in a diverse group of CRC survivors.

Methods

We conducted a population-based, cross-sectional study to examine the association between socioeconomic factors (household income, health literacy, and insurance status) and HRQoL domains of pain interference, fatigue, physical function, sleep disturbance, anxiety, and depression. PROMIS® Short Forms v.2.0 were used to assess domains of HRQoL. Linear regression modeling was used to estimate the coefficient representing the average HRQoL domain score and its 95% confidence interval (CI).

Results

Three hundred one CRC survivors participated in the survey. Low-income (≤ $30,000) CRC survivors had, on average, a 4.70-point (95% CI 1.10–8.28) higher pain interference score, a 7.02-point (95% CI 3.27–10.77) higher fatigue score, a 5.13-point (95% CI − 8.56 to − 1.71) lower physical function score, and a 4.44-point (95% 1.40–7.49) higher depression score than CRC survivors with an income ≥ $70,000. Survivors with Medicaid insurance reported significantly greater pain interference and worse physical function than privately insured survivors. Survivors with low health literacy reported significantly greater pain interference compared with survivors with high health literacy.

Conclusions

Substantial socioeconomic disparities in HRQoL were observed in this diverse population of CRC survivors.

Implications for Cancer Survivors

Designing supportive care interventions to improve HRQoL among low-income and Medicaid-insured CRC survivors is critical for eliminating disparities in CRC outcomes.

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Funding

The Surface Family Trust (A. Kinney) and internal start-up funding (A. Kinney and J. McDougall) from the University of New Mexico Comprehensive Cancer Center were used to support this project.

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Authors and Affiliations

  1. University of New Mexico Comprehensive Cancer Center, Albuquerque, NM, USA

    Jean A. McDougall, Cindy K. Blair, Charles L. Wiggins, Vi K. Chiu & Ashwani Rajput

  2. Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA

    Jean A. McDougall, Cindy K. Blair, Charles L. Wiggins & Vi K. Chiu

  3. University of New Mexico, MSC105550, Albuquerque, NM, 87131-0001, USA

    Jean A. McDougall

  4. Department of Economics, University of New Mexico, Albuquerque, NM, USA

    Michael B. Goodwin

  5. Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM, USA

    Ashwani Rajput

  6. Rutgers, School of Public Health, The State University of New Jersey, New Brunswick, NJ, USA

    Anita Y. Kinney

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  1. Jean A. McDougall
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Correspondence to Jean A. McDougall.

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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.

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McDougall, J.A., Blair, C.K., Wiggins, C.L. et al. Socioeconomic disparities in health-related quality of life among colorectal cancer survivors. J Cancer Surviv 13, 459–467 (2019). https://doi.org/10.1007/s11764-019-00767-9

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