A prospective study on educational level and adaptation to cancer, within one year after the diagnosis, in an older population

Inequality in income change among cancer survivors five years after diagnosis: Evidence from a French national survey

Worldwide, around 18 million people receive a cancer diagnosis each year, most of whom survive long enough to face additional cancer-related costs. In France, most costs directly related to cancer are covered by the National Health Insurance Fund, and cancer patients can receive treatments without paying advance fees. In this context, the costs faced by cancer survivors are mostly social costs. Drawing on fundamental cause theory, this study aimed to explore the socially-differentiated evolution of cancer survivor's income five years after diagnosis. Our study draws on the findings of VICAN5, a French national survey that was conducted in 2015/2016 in a representative sample of 4,174 cancer survivors to obtain information on living conditions five years after diagnosis, and that was restricted to 12 tumour sites accounting for 88% of global cancer incidence in France. We used the multiple imputation method and the Heckman selection model to identify the factors associated with a decrease in household income per consumption unit (HICU), while accounting for missing data. Among survivors still working five years after diagnosis, 17.6% reported lower income at survey than at diagnosis. After adjustment for socio-demographic and medical characteristics, the decrease in HICU was more frequent in women, singles, low educated survivors, and survivors with reduced working time. Finally, subjective measures of income variation and economic well-being were a useful complement to objective measures since 31.6% of cancer survivors still working five years after diagnosis reported a perceived decrease in household income. In conclusion, inequalities in economic well-being persist long after diagnosis in France, and this despite the fact that most cancer-related costs are covered by the French National Health Insurance Fund. Consequently, more attention should be paid to cancer patients with low socio-economic status to help reduce inequalities in post-diagnosis living conditions.

Socioeconomic status and health-related quality of life among patients with prostate cancer 6 months after radical prostatectomy: a longitudinal analysis

OBJECTIVES

To identify the associations between socioeconomic status (SES) and health-related quality of life (HRQOL) and the explanatory contribution of disease, patient and healthcare factors among patients with prostate cancer.

DESIGN

Prospective cohort study.

SETTING AND PARTICIPANTS

In all, 246 patients from 2 hospitals in Hamburg/Germany who underwent radical prostatectomy completed a questionnaire shortly before discharge from hospital and again 6 months later.

OUTCOME MEASURES

HRQOL as assessed by the European Organisation for Research and Treatment of Cancer (EORTC) QLQ C-30 including global quality of life, 5 functional scales and 9 symptom scales/items. Generalised estimating equations were calculated to analyse longitudinal data.

RESULTS

Lower SES measured by income, education and occupational status is significantly associated with lower HRQOL 6 months after treatment. This especially holds true for the functional scales. After introducing disease, patient and healthcare factors, associations remain significant in the majority of cases. The explanatory contribution of patient factors such as comorbidity or psychosocial characteristics and of healthcare factors is slightly stronger than that of disease factors.

CONCLUSIONS

We identified strong social inequalities in HRQOL among patients with prostate cancer 6 months after surgery, in Germany. The underlying causes could not be sufficiently identified, and further research regarding these associations and their explanatory factors is needed.

Exploring the relationship between physical well-being and healthy lifestyle changes among European- and Latina-American breast and cervical cancer survivors

BACKGROUND

Cancer and its treatments have a lingering and often negative impact on survivors' physical well-being. The physical sequelae impinge on daily functioning and overall HRQOL, and perhaps influence lifestyle changes post-cancer. This study aims to examine: (1) physical well-being items that are associated with low overall health-related quality of life; and (2) the relationship between physical well-being outcomes and healthy lifestyle changes by cancer type.

METHODS

This study employed a cross-sectional design with mixed sampling methods. In total 922 European- (n=452) and Latina-American (n=470) breast (BCS) or cervical cancer survivors (CCS) were recruited from the California Cancer Surveillance Program and Los Angeles area hospital registries. Item responses from survivors in the lowest quartile of total quality of life scores and percentages reflecting low physical well-being levels were calculated.

RESULTS

A statistical approach to individual items provides unique and valuable measurement and clinical information above and beyond physical well-being total scores. Physical well-being item responses varied according to ethnicity, income, and education. BCS and CCS showed different patterns in the relationship between physical well-being items and lifestyle changes. Specifically, exercise was significantly related to physical well-being items for BCS, while diet changes were significantly associated with physical well-being for CCS.

CONCLUSIONS

Results reveal unique correlates of physical well-being items by cancer type, ethnicity, and lifestyle changes. Clinically, this study highlights the need for greater consideration of individual and medical characteristics in developing culturally sensitive and patient responsive interventions to promote healthy lifestyles and improve survivorship outcomes.

Long-term prostate cancer survivors with low socioeconomic status reported worse mental health-related quality of life in a population-based study

OBJECTIVE

To explore whether socioeconomic status (SES) was associated with health-related quality of life (HRQL) and health care use among long-term prostate cancer survivors.

PATIENTS AND METHODS

Through urologists in the Comprehensive Cancer Center South, all 5- to 10-year prostate cancer survivors known in the Eindhoven Cancer Registry without disease progression were invited to complete the 36-item Short Form Health Survey (SF-36), the Expanded Prostate Cancer Index, and the Dutch sexual activities module. Multivariate linear regression assessed the effect of SES (based on home value and household income) on HRQL and health care use.

RESULTS

Five-hundred eighty-four patients (response rate 81%) were included. Survivors with a low SES exhibited lower mental SF-36 scores (6-16 points on a 0-100 scale), independent of sociodemographic and clinical characteristics (P < .05), and hardly any differences in physical SF-36 subscales, sexual function, and urinary and bowel function and bother. Presence of serious comorbidity had a stronger predictive value for HRQL than SES. Health care use did not seem to be associated with SES.

CONCLUSIONS

Prostate cancer survivors with a low SES exhibited a worse mental but not physical HRQL than those with a higher SES. Long-term health outcomes of patients with low SES may be maximized by paying extra attention to comorbid conditions.

Health-related quality of life in lung cancer patients in Serbia: correlation with socio-economic and clinical parameters

The objective of this study was to assess health-related quality of life (HRQoL) in patients with advanced non-small cell lung cancer (NSCLC). In Serbia, there is the lack of available data on HRQoL in lung cancer patients. The special attention in our study has been paid on relationships between socio-economic factors and HRQoL. This cross-sectional study was undertaken in group of 100 NSCLC patients with advanced stage diseases. HRQoL was measured using three standard instruments: 36-item Short Form Health Survey, EORTC QLQ-C30 and its Lung Cancer module (EORTC QLQ-LC13). Unexpected, highly educated patients reported significantly worse social functioning (P=0.044), and higher degree of financial difficulties (P=0.047), in comparison with less-educated. Also unusual, unemployed patients had significantly better HRQoL in all domains and significantly lower symptom distress. Significantly better overall HRQoL (P=0.043), social (P=0.024), emotional (P=0.001) and mental functioning (P=0.011) were observed in patients treated with chemotherapy in comparison with newly diagnosed ones. In addition, the most prominent side effects of chemotherapy were nausea and vomiting, and all QoL domains correlated significantly with them. Patients who undergo active treatment improve their HRQoL but chemotherapy-induced emesis adversely affects many HRQoL domains. Additionally, HRQoL is highly dependent on patient's socio-economic characteristic.