Abstract
Purpose
Our study provides a detailed overview of comorbid conditions and health-related quality of life of long-term cancer survivors and analyses the impact of demographic, disease- and treatment-related characteristics.
Methods
We present data obtained from 1000 survivors across mixed tumour entities 5 and 10 years after cancer diagnosis in a cross-sectional study. We analyse the prevalence of physical symptoms and health conditions via self-report and health-related quality of life using the EORTC QLQ-C30 in comparison to gender- and age-matched reference values of the general population.
Results
Cancer survivors reported on average 5 comorbidities; 23% had 7 or more comorbid conditions. Cancer survivors reported higher physical symptom burden than the population—especially fatigue, insomnia and pain. Type and prevalence of long-term and late effects differ with disease-related factors (e.g. cancer type, treatment) and characteristics of the patient. Cancer survivors also reported lower quality of life than the population, especially in everyday activities, social life, psychological well-being and financial difficulties. There was a positive association between high quality of life and a low level of morbidity.
Conclusions
The specific knowledge about physical long-term consequences for the individual types of cancer could raise awareness in health care professionals for high-risk patients and help to develop adequate prevention and survivorship-programs.
Implications for Cancer survivors
Limitations in the mental health area underlines the importance of psycho-oncological survivorship-care-plans, which go beyond the time of rehabilitation. Special attention should be given to the financial situation of patients in long-term follow-up care.
Similar content being viewed by others
References
Edwards BK, Noone A, Mariotto AB, Simard EP, Boscoe FP, Henley SJ, et al. Annual report to the nation on the status of cancer, 1975-2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer. Cancer. 2014;120(9):1290–314.
Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, et al. Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin. 2016;66(4):271–89.
Bray F, Ren J, Masuyer E, Ferlay J. Global estimates of cancer prevalence for 27 sites in the adult population in 2008. Int J Cancer. 2013;132(5):1133–45.
de Moor JS, Mariotto AB, Parry C, Alfano CM, Padgett L, Kent EE, et al. Cancer survivors in the United States: prevalence across the survivorship trajectory and implications for care. Cancer Epidemiol Biomark Prev. 2013;22(4):561–70.
Arndt V, Koch-Gallenkamp L, Jansen L, Bertram H, Eberle A, Holleczek B, et al. Quality of life in long-term and very long-term cancer survivors versus population controls in Germany. Acta Oncol. 2017;56(2):190–7.
Walsh K. Addressing psychosocial issues in cancer survivorship: past, present and future. Future Oncol. 2016;12(24):2823–34.
Salz T, Baxi S. Moving survivorship care plans forward: focus on care coordination. Cancer Med. 2016;5(7):1717–22.
Harrington CB, Hansen JA, Moskowitz M, Todd BL, Feuerstein M. It’s not over when it’s over: long-term symptoms in cancer survivors—a systematic review. Int J Psychiatry Med. 2010;40(2):163–81.
Hartung TJ, Brähler E, Faller H, Härter M, Hinz A, Johansen C, et al. The risk of being depressed is significantly higher in cancer patients than in the general population: prevalence and severity of depressive symptoms across major cancer types. Eur J Cancer. 2017;72:46–53.
Leach CR, Weaver KE, Aziz NM, Alfano CM, Bellizzi KM, Kent EE, et al. The complex health profile of long-term cancer survivors: prevalence and predictors of comorbid conditions. J Cancer Surviv. 2015;9(2):239–51.
Wu H, Harden JK. Symptom burden and quality of life in survivorship: a review of the literature. Cancer Nurs. 2015;38(1):E29–54.
Aziz NM. Cancer survivorship research: state of knowledge, challenges and opportunities. Acta Oncol. 2007;46(4):417–32.
Knowles G, Haigh R, McLean C, Phillips HA, Dunlop MG, Din FVN. Long term effect of surgery and radiotherapy for colorectal cancer on defecatory function and quality of life. Eur J Oncol Nurs. 2013;17(5):570–7.
Whitehead LC, Unahi K, Burrell B, Crowe MT. The experience of fatigue across long-term conditions: a qualitative meta-synthesis. J Pain Symptom Manag. 2016;52(1):131–143.e1.
Brearley SG, Stamataki Z, Addington-Hall J, Foster C, Hodges L, Jarrett N, et al. The physical and practical problems experienced by cancer survivors: a rapid review and synthesis of the literature. Eur J Oncol Nurs. 2011;15(3):204–12.
Savard J, Ivers H, Savard M, Morin CM. Cancer treatments and their side effects are associated with aggravation of insomnia: results of a longitudinal study. Cancer. 2015;121(10):1703–11.
Vissers PAJ, Thong MSY, Pouwer F, Zanders MMJ, Coebergh JWW, van de Poll-Franse LV. The impact of comorbidity on health-related quality of life among cancer survivors: analyses of data from the PROFILES registry. J Cancer Surviv. 2013;7(4):602–13.
Deimling GT, Arendt JA, Kypriotakis G, Bowman KF. Functioning of older, long-term cancer survivors: the role of cancer and comorbidities. J Am Geriatr Soc. 2009;57(Suppl 2):S289–92.
Ezendam NPM, Pijlman B, Bhugwandass C, Pruijt JFM, Mols F, Vos MC, et al. Chemotherapy-induced peripheral neuropathy and its impact on health-related quality of life among ovarian cancer survivors: results from the population-based PROFILES registry. Gynecol Oncol. 2014;135(3):510–7.
Weaver KE, Forsythe LP, Reeve BB, Alfano CM, Rodriguez JL, Sabatino SA, et al. Mental and physical health-related quality of life among U.S. cancer survivors: population estimates from the 2010 National Health Interview Survey. Cancer Epidemiol Biomark Prev. 2012;21(11):2108–17.
Braithwaite D, Moore DH, Satariano WA, Kwan ML, Hiatt RA, Kroenke C, et al. Prognostic impact of comorbidity among long-term breast cancer survivors: results from the LACE study. Cancer Epidemiol Biomark Prev. 2012;21(7):1115–25.
Husson O, Mols F, Ezendam NPM, Schep G, van de Poll-Franse LV. Health-related quality of life is associated with physical activity levels among colorectal cancer survivors: a longitudinal, 3-year study of the PROFILES registry. J Cancer Surviv. 2015;9(3):472–80.
Vissers PAJ, Martucci RB, Mols F, Bours MJL, Winkels RM, Kampman E, et al. The impact of body mass index and waist circumference on health-related quality of life among colorectal cancer survivors: results from the PROFILES registry. Nutr Cancer. 2017;69(8):1177–84.
Rowland JH, Kent EE, Forsythe LP, Loge JH, Hjorth L, Glaser A, et al. Cancer survivorship research in Europe and the United States: where have we been, where are we going, and what can we learn from each other? Cancer. 2013;119(Suppl 11):2094–108.
van de Poll-Franse LV, Horevoorts N, van Eenbergen M, Denollet J, Roukema JA, Aaronson NK, et al. The patient reported outcomes following initial treatment and long term evaluation of survivorship registry: scope, rationale and design of an infrastructure for the study of physical and psychosocial outcomes in cancer survivorship cohorts. Eur J Cancer. 2011;47(14):2188–94.
Danese MD, O’Malley C, Lindquist K, Gleeson M, Griffiths RI. An observational study of the prevalence and incidence of comorbid conditions in older women with breast cancer. Ann Oncol. 2012;23(7):1756–65.
Hinz A, Singer S, Brähler E. European reference values for the quality of life questionnaire EORTC QLQ-C30: results of a German investigation and a summarizing analysis of six European general population normative studies. Acta Oncol. 2014;53(7):958–65.
Bayliss EA, Ellis JL, Steiner JF. Subjective assessments of comorbidity correlate with quality of life health outcomes: initial validation of a comorbidity assessment instrument. Health Qual Life Outcomes. 2005;3:51.
Bayliss EA, Ellis JL, Steiner JF. Seniors’ self-reported multimorbidity captured biopsychosocial factors not incorporated into two other data-based morbidity measures. J Clin Epidemiol. 2009;62(5):550–7.e1.
Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993;85(5):365–76.
VanderWalde A, Hurria A. Early breast cancer in the older woman. Clin Geriatr Med. 2012;28(1):73–91.
Avis NE, Deimling GT. Cancer survivorship and aging. Cancer. 2008;113(12 Suppl):3519–29.
Ness S, Kokal J, Fee-Schroeder K, Novotny P, Satele D, Barton D. Concerns across the survivorship trajectory: results from a survey of cancer survivors. Oncol Nurs Forum. 2013;40(1):35–42.
Romito F, Cormio C, Giotta F, Colucci G, Mattioli V. Quality of life, fatigue and depression in Italian long-term breast cancer survivors. Support Care Cancer. 2012;20(11):2941–8.
Goldstein D, Bennett BK, Webber K, Boyle F, de Souza PL, Wilcken NRC, et al. Cancer-related fatigue in women with breast cancer: outcomes of a 5-year prospective cohort study. J Clin Oncol. 2012;30(15):1805–12.
Bellury L, Pett MA, Ellington L, Beck SL, Clark JC, Stein KD. The effect of aging and cancer on the symptom experience and physical function of elderly breast cancer survivors. Cancer. 2012;118(24):6171–8.
Brant JM, Beck S, Dudley WN, Cobb P, Pepper G, Miaskowski C. Symptom trajectories in posttreatment cancer survivors. Cancer Nurs. 2011;34(1):67–77.
Husson O, Haak HR, Buffart LM, Nieuwlaat W, Oranje WA, Mols F, et al. Health-related quality of life and disease specific symptoms in long-term thyroid cancer survivors: a study from the population-based PROFILES registry. Acta Oncol. 2013;52(2):249–58.
Schmidt ME, Chang-Claude J, Seibold P, Vrieling A, Heinz J, Flesch-Janys D, et al. Determinants of long-term fatigue in breast cancer survivors: results of a prospective patient cohort study. Psychooncology. 2015;24(1):40–6.
Kent EE, Ambs A, Mitchell SA, Clauser SB, Smith AW, Hays RD. Health-related quality of life in older adult survivors of selected cancers: data from the SEER-MHOS linkage. Cancer. 2015;121(5):758–65.
LeMasters T, Madhavan S, Sambamoorthi U, Kurian S. A population-based study comparing HRQoL among breast, prostate, and colorectal cancer survivors to propensity score matched controls, by cancer type, and gender. Psychooncology. 2013;22(10):2270–82.
Faller H, Brahler E, Harter M, Keller M, Schulz H, Wegscheider K, et al. Performance status and depressive symptoms as predictors of quality of life in cancer patients. A structural equation modeling analysis. Psychooncology. 2015;24(11):1456–62.
Elliott J, Fallows A, Staetsky L, Smith PWF, Foster CL, Maher EJ, et al. The health and well-being of cancer survivors in the UK: findings from a population-based survey. Br J Cancer Suppl. 2011;105(Suppl 1):S11–20.
Mols F, Beijers T, Lemmens V, van den Hurk CJ, Vreugdenhil G, van de Poll-Franse LV. Chemotherapy-induced neuropathy and its association with quality of life among 2- to 11-year colorectal cancer survivors: results from the population-based PROFILES registry. J Clin Oncol. 2013;31(21):2699–707.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
The research was approved by the local ethics committees. Prior to participation, all patients provided written informed consent. The study received research ethics committee approval by the University of Leipzig (Az. 070-14-10032014).
Conflict of interest
The funding source was not involved in any stage of the research process. The authors declare that they have no conflict of interest.
Ethical approval
All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Electronic supplementary material
Online Resource 1
(DOCX 20 kb)
Online Resource 2
(DOCX 17 kb)
Online resource 3
(DOCX 19 kb)
Online Resource 4
(DOCX 15 kb)
Rights and permissions
About this article
Cite this article
Götze, H., Taubenheim, S., Dietz, A. et al. Comorbid conditions and health-related quality of life in long-term cancer survivors—associations with demographic and medical characteristics. J Cancer Surviv 12, 712–720 (2018). https://doi.org/10.1007/s11764-018-0708-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11764-018-0708-6