Quality of life among cancer survivors by model of cancer survivorship care

Abstract

Background: There were an estimated 16.9 million cancer survivors in the United States in 2019, but there is wide variation in survivorship care. Patient-reported outcomes associated with distinct care models are unknown. Thus, we examined differences in quality of life by cancer survivorship care model. Materials and methods: We conducted a comparative effectiveness trial, recruiting 32 Commission on Cancer-accredited centers in 2015–2016. Sites were characterized as one of three models: 1) Single Consultative visit, 2) Specialized Longitudinal care with ongoing visits at predetermined intervals, 3) Oncology-Embedded care with visits as needed. We included breast, prostate, and colorectal cancer survivors who had completed active treatment but had not yet attended a survivorship visit (n = 991). Quality of life was assessed using 20 physical, 14 social/emotional, and 7 practical concerns, adapted from the Quality of Life-Breast Cancer Survivors and Functional Living Index Cancer scales. 1 , 2 We used frequencies to describe prevalent symptoms and ANOVA to test for global differences in concerns by survivorship care model, post-hoc Tukey’s test for pairwise comparisons, and mixed-effects models to describe changes in quality of life by care model over six-months. Results: While unadjusted results suggested that nearly all concerns worsened over six months, no differences were observed in quality of life concerns by care model for physical or practical concerns. At baseline, social/emotional concerns showed a global difference by model (p = 0.008; pairwise results showed fewer concerns among Oncology-Embedded survivors compared to Specialized Consultative survivors; 12.1 vs 15.2, p < 0.05), but no differences were found at six months (global p = 0.311). Mixed effects models showed no change in quality of life by model over six-months. Conclusions: Our results do not support an association between quality of life and care model over six-months. Still, participants reported many quality of life concerns across domains that must be addressed, regardless of care model.