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The impact of comorbidity on Health-Related Quality of Life among cancer survivors: analyses of data from the PROFILES registry

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Abstract

Purpose

The aim of this study was to assess the difference in explained variance of Health-Related Quality of Life (HRQoL) between comorbidity, sociodemographic characteristics and cancer characteristics. This association was assessed among thyroid cancer, colorectal cancer, and (non-)Hodgkin's lymphoma patients.

Methods

Data from three large population-based surveys on survivors of thyroid cancer, colorectal cancer, and (non-)Hodgkin's lymphoma were used. Cancer-specific HRQoL was assessed with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) of which physical function, emotional function, fatigue, and pain were included in the analyses. Comorbidity was assessed using the Self-reported Comorbidity Questionnaire. The association between comorbidity and HRQoL was assessed with multivariate linear regression models. Semi-partial R 2 was reported to assess the amount of variance in HRQoL explained by comorbidity in comparison with sociodemographic and cancer characteristics.

Results

In total, 3,792 cancer survivors were included in this analysis. The variance in HRQoL subscales explained by comorbidity was higher compared with sociodemographic and cancer characteristics for physical function (11–17 vs. 2–4 and 1–2 %, respectively) and emotional function (7–17 vs. 1–3 and 1–3 %, respectively), regardless of cancer type. In addition, comorbidity explained 7–20 and 11–13 % of the variance in pain and fatigue, respectively, compared to 0–4 % for both sociodemographic and cancer characteristics. Osteoarthritis and back pain were strongly associated with physical function and pain, while depression was strongly associated with emotional function. Depression and back pain were strongly associated with fatigue.

Conclusions

This study showed that comorbidity explained more variance in physical and emotional function, pain, and fatigue in comparison with sociodemographic and cancer characteristics in cancer survivors, regardless of cancer type. Our findings emphasize the importance of adjusting for the presence of comorbid diseases when assessing HRQoL in cancer survivors.

Implication for cancer survivors

Cancer survivors suffering from comorbid diseases experience lower levels of health-related quality of life. Clinicians should become more aware of the impact of comorbidity on HRQoL and provide necessary psychological support to assist self-management of comorbid diseases.

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Acknowledgments

We thank all the patients and their doctors for their participation in the study. Special thanks to Dr. M van Bommel for her availability as an independent advisor and willingness to answer patients' queries. In addition, we thank the following hospitals for their cooperation: Amphia Hospital (Breda), Bernhoven Hospital (Veghel and Oss), Catharina Hospital (Eindhoven), Elkerliek Hospital (Helmond), Jeroen Bosch Hospital ('s-Hertogenbosch), Maxima Medical Center (Eindhoven and Veldhoven), St Anna Hospital (Geldrop), St Elisabeth Hospital (Tilburg), Twee Steden Hospital (Tilburg and Waalwijk), and VieCuri Hospital (Venlo and Venray).

The present research is supported in part by a Social Psychology Fellowship from the Dutch Cancer Society to Melissa Thong (no. UVT2011-4960) and a Cancer Research Award from the Dutch Cancer Society (no. UVT-2009-4349) to Lonneke van de Poll-Franse. Data collection for this study was funded by the Comprehensive Cancer Center South, Eindhoven, The Netherlands; the Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, The Netherlands; and an investment subsidy (no. 480-08-009) of The Netherlands Organization for Scientific Research (The Hague, The Netherlands). The funding sources were neither involved in the collection, interpretation, and analysis of the data, nor in the decision for the writing and submission of this report for publication.

Conflict of interest

The authors have declared no conflicts of interest.

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Authors and Affiliations

  1. CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands

    P. A. J. Vissers, M. S. Y. Thong, F. Pouwer & L. V. van de Poll-Franse

  2. Comprehensive Cancer Center South, Eindhoven Cancer Registry, Eindhoven, The Netherlands

    P. A. J. Vissers, M. S. Y. Thong, M. M. J. Zanders, J. W. W. Coebergh & L. V. van de Poll-Franse

  3. Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands

    J. W. W. Coebergh

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  1. P. A. J. Vissers
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  2. M. S. Y. Thong
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  6. L. V. van de Poll-Franse
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Correspondence to P. A. J. Vissers.

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Vissers, P.A.J., Thong, M.S.Y., Pouwer, F. et al. The impact of comorbidity on Health-Related Quality of Life among cancer survivors: analyses of data from the PROFILES registry. J Cancer Surviv 7, 602–613 (2013). https://doi.org/10.1007/s11764-013-0299-1

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