Abstract
PurposeTo examine how socio-demographic, comorbidities and information needs influence quality of life (QoL) outcomes of survivors of breast, colorectal, or prostate cancer, non-Hodgkin lymphoma or melanoma.MethodsCross-sectional postal survey with eligible participants identified through a population-based cancer registry. QoL outcomes were assessed by EQ-5D-5L, social difficulties index (SDI) and, for those employed at diagnosis, current employment. Regression analyses explored associations between outcome variables and cancer type, age, time since diagnosis, residential location, socio-economic disadvantage, comorbidities and unmet information needs. Mediation analyses examined whether comorbidities and information needs explained relationships between outcome variables and socio-economic disadvantage.Results2115 survivors participated. Mean EQ-5D-5L scores (mean = 0.84) were similar to population averages and SDI scores were low for the entire sample (mean = 3.80). In multivariate analyses, being aged over 80, greater socio-economic disadvantage, comorbidities and unmet information needs decreased EQ-5D-5L scores. Higher SDI scores were associated with socio-economic disadvantage, comorbidities and unmet information needs. Not being employed was associated with being aged over 50, more comorbidities and socio-economic disadvantage. Comorbidities but not information needs partially mediated the impact of socio-economic disadvantage on EQ-5D-5L and SDI accounting for 17% and 14% of the total effect of socio-economic disadvantage respectively. Neither comorbidities nor information needs mediated the association between socio-economic disadvantage and employment outcomes.ConclusionsTo improve quality of life, survivorship care should be better tailored to address the needs of individuals given their overall health and impact of comorbidities, their age and type of cancer and not simply time since diagnosis.
Highlights
With better treatments and earlier detection, an increasing number of people are surviving cancer, with recent estimates suggesting seven out of every 10 people diagnosed with cancer in Australia will survive 5 or more years [1]
Given potential confounding between socio-economic position, comorbidities and unmet information needs, we aimed to determine the direct and indirect effects of socio-economic position on quality of life (QoL) by exploring whether its association is mediated by comorbidity and unmet information needs
Potential participants were identified through the populationbased Victorian Cancer Registry (VCR) that maintains a list of all people with a new diagnosis of cancer in Victoria, Australia’s second most populous state
Summary
With better treatments and earlier detection, an increasing number of people are surviving cancer, with recent estimates suggesting seven out of every 10 people diagnosed with cancer in Australia will survive 5 or more years [1]. White and Karolina Lisy contributed and are joint first authors. Extended author information available on the last page of the article experience a range of physical, emotional, psychological, social, financial and practical challenges [2–4]. A number of sociodemographic factors have been associated with variation in outcomes for cancer survivors. Cancer survival is known to vary by socio-economic advantage/disadvantage [6–11] with this difference partly explained by variations in stage at diagnosis and treatment differences [6]. Recent evidence suggests that psychosocial factors including living alone, being unmarried and higher levels of depression can negatively impact survival [12, 13].
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