Disparities in quality of life, social distress and employment outcomes in Australian cancer survivors

Abstract

Purpose To 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. Methods Cross-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. Results 2115 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. Conclusions To 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.

Social inequality in cancer survivorship: Educational differences in health‐related quality of life among 27,857 cancer survivors in Denmark

“…Consistent with results of previous studies, we found shorter education to be associated with an increased risk of impaired physical function, fatigue, and pain in cancer survivors 8,9,11,15,16 . For example, one study among 2235 breast cancer survivors reported that survivors from a lower social class had an OR of 1.7 to report poor physical function 15 .…”

“…In addition to these classical risk factors for poor HRQoL, some studies have suggested that socioeconomic factors, e.g., living in a disadvantaged area, 15,16 or having a low socioeconomic position (SEP) 8,9,11 are associated with poorer HRQoL but these are limited by few participants 8,9 and non-cancer specific measures of HRQoL. 11,16 Only one of these studies investigated the association between SEP and HRQoL in a nationally representative sample of cancer survivors but the study only included 2235 survivors after breast cancer. 15 We need large population-based data to explore the association between SEP indicators such as educational level and HRQoL among cancer survivors across major cancer sites, for both short-and long-terms survivors.…”

Treatment patterns and out-of-hospital healthcare resource utilisation by patients with advanced cancer living with pain: An analysis from the Stop Cancer PAIN trial

“…Finally, generalisability of the results will be limited to similar healthcare and costing and funding models and similar populations. For example, a smaller proportion of participants received concessional payments compared with the general public, possibly reflecting a more affluent study population, particularly given evidence of inequalities in access to clinical trials [ 110 ] and cancer care more broadly in Australia [ 111 , 112 ].…”

Contribution of non‐socioeconomic factors to healthy quality of life in socioeconomically deprived patients with advanced gastrointestinal cancer: Measuring attributable fraction

“…Even within a universal healthcare system, many cancer patients and families experience financial hardship and emotional distress (Fitch et al, 2021(Fitch et al, , 2022. Socioeconomic status has become a prominent factor that affects the quality of life of cancer patients across disease types, with poorer socioeconomic status associated with poorer quality of life (Mon et al, 2020;Robinson et al, 2021;Su et al, 2019;White et al, 2022).…”