Abstract
BackgroundPrevious reports highlight the greater number of side effects that women experience during cancer treatment, but little is known about sex differences in symptoms and functioning in long-term survivors. MethodsWe investigated sex differences in the prevalence of physical (EORTC QLQ-C30) and emotional symptoms (Hospital Anxiety and Depression Scale) and loss of functioning (EORTC QLQ-C30) in 5339 cancer survivors (55% males). General linear models were computed to assess the differences in symptoms and functioning between female and male cancer survivors and between survivors and an age-matched reference population. ResultsThe direct comparison between female and male cancer survivors identified more symptoms, such as nausea and vomiting (M = 5.0 versus. 3.2), insomnia (M = 26.1 versus. 15.9), anxiety (M = 5.2 versus. 4.2), and lower physical (M = 77.5 versus. 82.5) and emotional functioning (M = 83.4 versus. 86.3), in female survivors. However, comparison with an age-matched reference population demonstrated that several symptoms, such as fatigue, dyspnea, anxiety and depression, appeared to be more frequent in male patients. The investigation of functioning domains — compared with a reference population — highlighted further sex-specific differences. Female survivors experienced a moderate net loss in physical and cognitive functioning (−6.1 [95% CI = −8.1; −4,1] and −5.2 respectively [95% CI = −7; −3.5]), whereas male survivors displayed a significant net loss in role and social functioning compared to the reference population (−9.9 [95% CI = −11.2; −8.6] and −7.7 [95% CI = −9.6; −7.6] respectively). ConclusionTo adequately capture sex differences in symptoms and functioning in long-term cancer survivors, a comparison with a reference population should always be considered. In our study population, this adjustment highlighted a significant and unexpected long-term impact on male patients. Role and social functioning were especially impacted in male patients, emphasizing the need to further investigate these gendered domains.
Highlights
Almost all, not sex-specific, cancers affect men more than women, with the well-documented exception of thyroid cancer [1]
This study represents the first examination of sex differences in symptoms and functioning in long-term cancer survivors
Comparison to an age-matched reference population without cancer reduced or inverted these differences. Several symptoms such as fatigue and dyspnea, as well as anxiety and depression, were reported more frequently in the male patients than in the female ones when adjusted to an age-matched reference population
Summary
Not sex-specific, cancers affect men more than women, with the well-documented exception of thyroid cancer [1]. More common in female patients, reduced HRQoL is occasionally reported in male patients, e.g. in stroke, lupus erythematosus, lumbar degenerative disease [17e19] and in some specific forms of cancer [20] These differences originate from a combination of the severity of disease, treatment, and presence of comorbidity, among other factors [17]. Norms and relations d is challenging to measure according to traditional medical methodology, yet it can significantly impact people’s risk behaviour and their resources and resilience after disease [22]. This variable could, represent a meaningful source of information to improve patients’ long-term journeys. Gender is necessary to reveal potential sex-specific and gender-specific consequences of living with a tumour
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