Abstract
The influence of area-based and individual indicators of socioeconomic status (SES) on health-related quality of life (HRQOL) and patient concerns following head and neck cancer is complex and under-reported. The aim of this study is to use baseline data collected as part of a randomised controlled trial to provide greater detail on the attribution of SES to University of Washington Quality of Life version 4 (UWQOL v4), Distress Thermometer and European Quality of Life Five-Dimension Five-Level (EQ-5D-5L) outcomes. A total of 288 trial patients attended baseline clinics a median (Interquartile (IQR)) of 103 (71–162) days after the end of treatment. Area-based SES was assessed using the Index of Multiple Deprivation (IMD) 2019. Thirty-eight per cent (110/288) of patients lived in the most deprived IMD rank quintile. Less than good overall quality of life (31% overall) was associated with current working situation (p = 0.008), receipt of financial benefits (p < 0.001), total household income (p = 0.003) and use of tobacco (p = 0.001). Income and employment were significant patient level indicators predictors of HRQOL outcomes after case-mix adjustment. The number of Patient Concerns Inventory items selected varied significantly by overall clinical tumour clinical stage (p < 0.001) and by treatment (p < 0.001) but not by area IMD or patient-level deprivation indicators. In conclusion, interventions to improve employment and finance could make a substantial positive effect on HRQOL outcomes and concerns.
Highlights
The term ‘determinants of health’ was introduced in the 1970s and refers to factors that have a significant influence, positive or negative, on health [1]
The trial groups (140 Patient Concerns Inventory (PCI), 148 no PCI) were well matched at baseline in regard to the primary, secondary and other health-related quality of life (HRQOL) measures analysed in this paper [16]
Socioeconomic factors have a strong influence on HRQOL following Head and neck cancer (HNC), especially in patients with low socioeconomic status (SES) who show the strongest impairment [27]
Summary
The term ‘determinants of health’ was introduced in the 1970s and refers to factors that have a significant influence, positive or negative, on health [1]. These may be biological, behavioural, sociocultural, economic and ecological [2]. The determinants of health can be divided into four categories: nutrition, lifestyle, environment and genetics [3]. Evidence shows that the incidence of cancer and chronic diseases share modifiable risk factors such as alcohol consumption, cigarette smoking, unhealthy diet and physical inactivity [4]. Some determinants are modifiable such as nutrition and lifestyle. People should be encouraged and supported in making modifications where possible, and this is an integral component of cancer care [4]
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