Quality of Life Research

, Volume 9, Issue 10, pp 1093–1104 | Cite as

Multiple Chronic Health Problems are Negatively Associated with Health Related Quality of Life (HRQoL) irrespective of Age

  • Helena Michelson
  • Christina Bolund
  • Yvonne Brandberg


Purpose: To examine HRQoL measured by EORTC QLQ-C30 with respect to an increasing number of self-reported chronic health problems in the general Swedish population and to study the association between HRQoL, chronic health problems and age, gender, income, marital status and employment status. Method: A postal survey among a large random sample of 4000 adults aged 18–79 years. The study material contained EORTC QLQ-C30 core questionnaire supplemented by a sociodemographic questionnaire including questions about 13 chronic health problems of which four categories, `No', `Few', `Some' or `A lot of' chronic health problems were constructed. Results: Multiple chronic health problems were significantly associated with reduced HRQoL. The increased number of chronic health problems was also associated with age. When the number of chronic health problems was accounted for, the influence of age diminished. Low income and unemployment were associated with greater decline in HRQoL with respect to increasing number of problems among the respondents in working age. Conclusion: The impact of increased number of chronic health problems had varying consequences in different age groups. Moreover, sociodemographic and economic factors showed to interact differently with chronic health problems and HRQoL in various age groups. It appears from our results that an assessment and a careful consideration of these factors will be valuable in order to facilitate the interpretation of the effects of cancer and treatment on long-term HRQoL of cancer patients.

Chronic health problems General population Quality of life 


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  1. 1.
    Hassey Dow K, Ferrell BR, Haberman MR, Eaton L. The meaning of quality of life in cancer survivorship. Oncol Nursing Forum 1999; 26(3): 519–527.Google Scholar
  2. 2.
    Hjermstad MJ, Holte H, Evensen SA, Fayers PM, Kaasa S. Do patients who are treated with stem cell transplantation have a health-related quality of life comparable to the general population after 1 year? Bone Marrow Transplant 1999; 24(8): 911–918.PubMedCrossRefGoogle Scholar
  3. 3.
    Abrahamsen AF, Loge JH, Hannisdal E, Holte H, Kvaløy S. Socio-medical situation for long-term survivors of Hodgkin's disease: A survey of 459 patients treated at one institution. Eur J Cancer 1998; 34(12): 1865–1870.PubMedCrossRefGoogle Scholar
  4. 4.
    Bush NE, Haberman M, Donaldson G, Sullivan KM. Quality of life of 125 adults surviving 6- 18 years after bone marrow transplantation. Soc Sci Med 1995; 40(4): 479–490.PubMedCrossRefGoogle Scholar
  5. 5.
    Dorval M, Maunsell E, Deschê nes L, Brisson J, Mâ sse B. Long-term quality of life after breast cancer: Comparison of 8-year survivors with population controls. J Clin Oncol 1998; 16(2): 487–494.PubMedGoogle Scholar
  6. 6.
    Cook Gotay C, Muraoka MY. Quality of life in long-term survivors of adult-onset cancers. J Natl Cancer Inst 1998; 90(9): 656–667.CrossRefGoogle Scholar
  7. 7.
    Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: A quality of life instrument for use in interna-tional clinical trials in oncology. J Natl Cancer Inst 1993; 85: 365–376.PubMedGoogle Scholar
  8. 8.
    Hjermstad MJ, Fayers PM, Bjordal K, Kaasa S. Health-related quality of life in the general Norwegian population assessed by the European Organization for Research and Treatment of Cancer core quality of life questionnaire. The QLQ = C30 (+3). J Clin Oncol 1998; 16(3): 1188–1196.PubMedGoogle Scholar
  9. 9.
    Klee M, Groenvold M, Machin D. Quality of life of Danish women: Population-based norms for the EORTC QLQ-C30. Qual Life Res 1997; 6: 27–34.PubMedCrossRefGoogle Scholar
  10. 10.
    Michelson H, Bolund C, Nilsson B, Brandberg Y. Health related quality of life measured by the EORTC QLQ-C30- reference values from a large sample of the Swedish population. Acta Oncol 2000; 39: 477–484.PubMedCrossRefGoogle Scholar
  11. 11.
    Hjermstad MJ, Fayers PM, Bjordal K, Kaasa S. Using reference data on quality of life-the importance of adjusting for age and gender, exemplified by the EORTC QLQ-C30 (+3). Eur J Cancer 1998; 34(9): 1381–1389.PubMedCrossRefGoogle Scholar
  12. 12.
    Brazier JE, Harper R, Jones NMB, et al. Validating the SF-36 health survey questionnaire: New outcome measure for primary care. BMJ 1992; 305: 160–164.PubMedGoogle Scholar
  13. 13.
    Garratt AM, Ruta DA, Abdalla MI, Buckingham JK, Russell IT. The SF-36 health survey questionnaire: An outcome measure suitable for routine use within the NHS? BMJ 1993; 306: 1440–1444.PubMedCrossRefGoogle Scholar
  14. 14.
    Jenkinson C, Coulter A, Wright L. Short Form 36 (SF 36) health survey questionnaire: Normative data for adults of working age. BMJ 1993; 306: 1437–1440.PubMedCrossRefGoogle Scholar
  15. 15.
    Fayers P, Aaronson N, Bjordal K, Sullivan M. On behalf of the EORTC Quality of Life Study Group. EORTC QLQ-C30 Scoring Manual. EORTC Study Group on Quality of Life: Brussels, 1997.Google Scholar
  16. 16.
    Loge JH, Foss Abrahamsen A, Ekeberg Ø, Kaasa S. Reduced health-related quality of life among Hodgkin's disease survivors: A comparative study with general population norms. Ann Oncol 1999; 10: 71–77.PubMedCrossRefGoogle Scholar
  17. 17.
    Osoba D, Brada M, Yung WKA, Prados M. Health-related quality of life in patients treated with Temozolomide versus Procarbazine for recurrent glioblastoma multiforme. J Clin Oncol 2000; 18(7): 1481–1491.PubMedGoogle Scholar
  18. 18.
    Bowling A, Windsor J. Discriminative power of the health status questionnaire 12 in relation to age, sex, and long-standing illness: Findings from a survey of households in Great Britain. J Epidemiol Community Health 1997; 51: 564–573.PubMedGoogle Scholar
  19. 19.
    The Public Health Report 1997. SoS-rapport 1997:18. Stockholm; National Board of Health and Welfare, 1997; 63–67.Google Scholar
  20. 20.
    Greimel ER, Padilla GV, Grant MM. Physcial and psy-chosocial outcomes in cancer patients: A comparison of different age groups. Br J Cancer 1997; 76(2): 251–255.PubMedGoogle Scholar
  21. 21.
    Schag CAC, Ganz PA, Wing DS, Sim MS, Lee JJ. Quality of life in adult survivors of lung, colon and prostate cancer. Qual Life Res 1994; 3: 127–141.PubMedCrossRefGoogle Scholar
  22. 22.
    Lindgren A-M, Svärdsudd K, Tibblin G. Factors related to perceived health among elderly people: The Albertina project. Age and ageing 1994; 23: 328–333.PubMedGoogle Scholar
  23. 23.
    Brown N, Melville M, Gray D, et al. Quality of life four years after acute myocardial infarction: Short form 36 scores compared with a normal population. Heart 1999; 81: 352–358.PubMedGoogle Scholar
  24. 24.
    Lukkarinen H, Hentinen M. Assessment of quality of life with the Nottingham Health Profile among patients with coronary heart disease. J Adv Nursing 1997; 26: 73–84.CrossRefGoogle Scholar
  25. 25.
    Roberts CS, Severinsen C, Carraway C, Clark D, Freeman M, Daniel P. Life changes and problems experienced by young adults with cancer. J Psychosoc oncol 1997; 15(1): 15–25.CrossRefGoogle Scholar
  26. 26.
    Dow KH, Ferrell BR, Leigh S, Ly J, Gulasekaram P. An evaluation of the quality of life among long-term survivors of breast cancer. Breast Cancer Res Treat 1996; 39(3): 261–273.PubMedCrossRefGoogle Scholar
  27. 27.
    Leeflang RLI, Klein-Hesselink DJ, Spruit IP. Health effects of unemployment - II. Men and women. Soc Sci Med 1992; 34(4): 351–363.PubMedCrossRefGoogle Scholar
  28. 28.
    Bowling A. The effects of illness on quality of life: Findings from a survey of households in great Britain. J Epidemiol Community Health 1996; 50: 149–155.PubMedCrossRefGoogle Scholar
  29. 29.
    Whedon M, Stearns D, Mills LE. Quality of life of long-term adult survivors of autologous bone marrow transplantation. Oncol Nursing Forum 1995; 22(10): 1527–1537.Google Scholar
  30. 30.
    Wingard JR, Curbow B, Baker F, Pintadosi S. Health, functional status and employment of adult survivors of bone marrow transplantation. Ann Intern Med 1991; 114: 113–118.PubMedGoogle Scholar
  31. 31.
    Neymark N, Kiebert W, Torfs K, et al. Methodological and statistical issues of quality of life (QoL) and economic evaluation in cancer clinical trials: Report of a workshop. Eur J Cancer 1998; 34(9): 1317–1333.PubMedCrossRefGoogle Scholar

Copyright information

© Kluwer Academic Publishers 2000

Authors and Affiliations

  • Helena Michelson
    • 1
  • Christina Bolund
    • 1
  • Yvonne Brandberg
    • 2
  1. 1.Psychosocial UnitDepartment of OncologyRadiumhemmet
  2. 2.Department of Cancer Epidemiology, Institution of Oncology/PathologyKarolinska InstitutetStockholmSweden

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