Modifiable health-related factors (smoking, physical activity and body mass index) and health care use and costs among adult cancer survivors

Factors Affecting Health-Related Quality of Life among Survivors of Non-Hodgkin Lymphoma: A Population-Based Study

PURPOSE

To describe Health-Related Quality of Life (HRQoL) and to identify the association between sociodemographic, clinical and psychosocial factors, and self-reported HRQoL among NHL survivors.

METHODS

The data of the cancer registry specialized in hematological malignancies in Côte d'Or (France) were used to identify all patients diagnosed with follicular lymphoma (FL) and diffuse large B-cell lymphoma (DLBCL) from 2010 to 2017. Patients were invited to complete SF-12 and other questionnaires.

RESULTS

The HRQoL of NHL survivors was poorer than that of the French general population (p < 0.05) in vitality (48 vs. 56), general health (56 vs. 63), role physical scores (60 vs. 70), role emotional scores (64 vs. 72) and the Mental Component Scale (45 vs. 49). The mean difference in physical functioning decreased per unit increase in age (β = -1.1 (0.3); p < 0.001). Men had better vitality than women (β = 12.4 (6.1); p = 0.04) and the high education level was associated with greater role emotional scores (β = 14.1 (5.4); p = 0.01). Symptoms of anxiety and depression were associated with poorer HRQoL. The satisfaction of social support was associated with significantly greater scores on mental health (β = 17.3 (5.1); p = 0.001) and social functioning (β = 15.7 (7.8); p = 0.04). Socioeconomic deprivation was associated with poorer general health (β = -12.8 (5.2); p = 0.01).

CONCLUSIONS

From 3 to 11 years post-diagnosis, the main factors found to be associated with poor HRQoL of NHL survivors were age, sex, presence of anxiety, depression and economic problems. These findings suggest the need for supportive care to improve HRQOL and the consideration of these problems when developing care plans for NHL survivors.

A study of factors impacting disease based on the Charlson Comorbidity Index in UK Biobank

Objective

With advances in medical diagnosis, more people are diagnosed with more than one disease. The damage caused by different diseases varies, so relying solely on the number of diseases to represent multimorbidity is limited. The Charlson comorbidity index (CCI) is widely used to measure multimorbidity and has been validated in various studies. However, CCI's demographic and behavioral risk factors still need more exploration.

Methods

We conduct multivariate logistic regression analysis and restricted cubic splines to examine the influence factors of CCI and the relationship between covariates and risk of CCI, respectively. Our research employs the Multivariate Imputation by Chained Equations method to interpolate missing values. In addition, the CCI score for each participant is calculated based on the inpatient's condition using the International Classification of Diseases, edition 10 (ICD10). Considering the differences in the disease burden between males and females, the research was finally subgroup analyzed by sex.

Results

This study includes 5,02,411 participants (2,29,086 female) with CCI scores ranging from 0 to 98. All covariates differed between CCI groups. High waist-hip ratio (WHR) increases the risk of CCI in both males [OR = 19.439, 95% CI = (16.261, 23.241)] and females [OR = 12.575, 95% CI = (11.005, 14.370)], and the effect of WHR on CCI is more significant in males. Associations between age, Body Mass Index (BMI) and WHR, and CCI risk are J-shaped for all participants, males, and females. Concerning the association between Townsend deprivation index (TDI) and CCI risk, the U-shape was found in all participants and males and varied to a greater extent in males, but it is a J-shape in females.

Conclusions

Increased WHR, BMI, and TDI are significant predictors of poor health, and WHR showed a greater role. The impact of deprivation indices on health showed differences by sex. Socio-economic factors, such as income and TDI, are associated with CCI. The association of social status differences caused by these socioeconomic factors with health conditions should be considered. Factors might interact with each other; therefore, a comprehensive, rational, and robust intervention will be necessary for health.

Factors Affecting the Occurrence of Mental Health Problems in Female Cancer Survivors: A Nationwide Cohort Study

The purpose of this study is to determine the effect of cancer survivorship stage and health-related behaviors on the risk of developing mental health problems (depressive and anxiety disorders) in women who have experienced cancers that affect women (breast cancer, cervical cancer, ovarian cancer, endometrial cancer). Using the healthcare utilization and medical checkup data from 2010 to 2020 provided by the National Health Insurance Service, the occurrence of mental health problems since 2020 was tracked for 36,801 women diagnosed with cancer. The occurrence of mental health problems was defined as the cases in which the disease code was assigned to anxiety disorders (F40~F44, F48) and depressive disorders (F32~34, F41.2, F92) as presented in ICD-10. To evaluate the effect of cancer survivorship stage and health-related behaviors on the development of mental health problems, the hazard ratio (HR) and 95% confidence intervals (CI) were calculated using the Cox proportional hazard model. During the follow-up period of 5.6 years, anxiety disorder occurred in 14,698 (39.9%), and by cancer type, breast cancer survivors accounted for the most at 1.02 per 1000 person-years. The risk of anxiety disorders increased in those who experienced cervical cancer (AHR, 1.08, 95% CI, 1.03-1.13) and those in the acute survivorship stage (AHR, 1.38, 95% CI, 1.22-1.55). In terms of health-related behaviors, the risk of developing anxiety disorder was shown to be reduced in drinkers (AHR, 0.91, 95% CI, 0.87-0.96), former smokers (AHR, 0.86, 95% CI, 0.77-0.97), and current smokers (AHR, 0.80, 95% CI, 0.71-0.90). During the follow-up period of 5.6 years, depressive disorder occurred in 6168(16.8%), and by cancer type, ovarian cancer survivors accounted for the most at 1.30 per 1000 person-years. The risk of developing depressive disorders was highest in those who experienced ovarian cancer (AHR, 1.40, 95% CI, 1.27-1.53) and those in the acute survivorship stage (AHR, 2.99, 95% CI, 2.60-3.42). For health-related behaviors, the risk of developing depressive disorders was increased in former smokers (AHR, 1.32, 95% CI, 1.14-1.54), current smokers (AHR, 1.21, 95% CI, 1.04-1.41), and those with insufficient physical activity (AHR, 1.09, 95% CI, 1.02-1.15). It has been confirmed that cancer type, cancer survivorship stage, and health-related behaviors, such as smoking, drinking, and physical activity, are significantly related to the risk of mental health problems. Thus, it is necessary to develop strategies to cope with mental health problems at the individual and national levels and to develop interventions to promote a more active lifestyle.

Significant Physical and Exercise-Related Variables for Exercise-Centred Lifestyle: Big Data Analysis for Gynaecological Cancer Patients

This study investigated the characteristics of gynaecological cancers and is aimed at identifying significant risk variables using the National Health Insurance Sharing Service database to develop practical interventions for affected patients. Data regarding patients with uterine and ovarian cancer from the National Health Insurance Sharing Service database were collected and analysed using Student's t-test, logistic regression, and receiver operating characteristic curve analyses. Student's t-test analyses revealed that age, body mass index, blood pressure, and waist variables differed significantly among patients with uterine cancer. Gamma-glutamyl transpeptidase levels were higher in patients with ovarian cancer than in patients with uterine cancer. Physical fitness function tests reflected the status of patients with cancer. Moreover, physical disability was associated with an increased incidence of ovarian cancer. Intensive exercise for 20 min more than 1 time per week must be avoided to prevent uterine cancer. Receiver operating characteristic curve analyses showed that the optimal cutoff value for one-leg standing time, a prognostic and preventive factor in ovarian cancer, was 9.50 s (sensitivity, 94.9%; specificity, 96.9%). Controlling significant variables for each gynaecological cancer type in an individualised and optimised manner is recommended, including by maintenance of an adjusted exercise-centred lifestyle.

Factors Associated With Health-Related Quality of Life Among Cancer Survivors in the United States

Background

With increasing prevalence of cancer survivors in the United States, health-related quality of life (HRQOL) has become a major priority. We describe HRQOL in a nationally representative sample of cancer survivors and examine associations with key sociodemographic, clinical, and lifestyle characteristics.

Methods

Cancer survivors, defined as individuals ever diagnosed with cancer (N = 877), were identified from the 2016 Medical Expenditure Panel Survey-Experiences with Cancer Survivorship Supplement, a nationally representative survey. Physical and mental health domains of HRQOL were measured by the Global Physical Health (GPH) and Global Mental Health (GMH) subscales of the Patient-Reported Outcomes Measurement Information System Global-10. Multivariable linear regression was used to examine associations of sociodemographic, clinical, and lifestyle factors with GPH and GMH scores. All statistical tests were 2-sided.

Results

Cancer survivors' mean GPH (49.28, SD = 8.79) and mean GMH (51.67, SD = 8.38) were similar to general population means (50, SD = 10). Higher family income was associated with better GPH and GMH scores, whereas a greater number of comorbidities and lower physical activity were statistically significantly associated with worse GPH and GMH. Survivors last treated 5 years ago and longer had better GPH than those treated during the past year, and current smokers had worse GMH than nonsmokers (all β > 3 and all P < .001).

Conclusions

Cancer survivors in the United States have generally good HRQOL, with similar physical and mental health scores to the general US population. However, comorbidities, poor health behaviors, and recent treatment may be risk factors for worse HRQOL. Multimorbidity management and healthy behavior promotion may play a key role in maximizing HRQOL for cancer survivors.

Disparities in the Occurrence of Late Effects following Treatment among Adolescent and Young Adult Melanoma Survivors

BACKGROUND

Melanoma is the third most common cancer in the adolescent and young adult (AYA) population; however, no studies have addressed the occurrence of adverse health conditions following melanoma treatment in these survivors.

METHODS

Data for patients ages 15 to 39 years diagnosed with cutaneous melanoma from 1996 to 2012 and surviving ≥2 years were obtained from the California Cancer Registry and linked to statewide hospitalization data. The influence of age at diagnosis, sex, race/ethnicity, neighborhood socioeconomic status (SES), health insurance, and surgery on the development of adverse health conditions was evaluated using Cox proportional hazards regression models.

RESULTS

Of 8,259 patients, 35.3% were male, 83.3% were non-Hispanic White, 82.4% had private health insurance, and 60.5% were considered high SES. In Cox regression models, males had an increased risk of developing adverse health conditions across all systems, including cardiac [HR, 1.73, 95% confidence interval (CI), 1.47-2.03], lymphedema (HR, 1.56; 95% CI, 1.37-1.77), hematologic disorders (HR, 1.17; 95% CI, 1.03-1.33), major infection/sepsis (HR, 1.59; 95% CI, 1.39-1.82), and second cancers (HR, 1.51; 95% CI, 1.31-1.74). Patients with public/no insurance (vs. private) had a greater risk of developing all studied adverse health conditions, including subsequent cancers (HR, 2.34; 95% CI, 1.94-2.82). AYA patients residing in low SES neighborhoods had similar increased risk of developing adverse health conditions.

CONCLUSIONS

Of AYA melanoma survivors, males, those with public/no health insurance, and those living in low SES neighborhoods had a greater likelihood of developing adverse health conditions.

IMPACT

Strategies to improve surveillance and secondary prevention of these adverse health conditions are needed among AYA melanoma survivors, specifically for the at-risk populations identified.

"It still affects our economic situation": long-term economic burden of breast cancer and lymphedema

PURPOSE

Financial toxicity after breast cancer may be exacerbated by adverse treatment effects, like breast cancer-related lymphedema. As the first study of long-term out-of-pocket costs for breast cancer survivors in the USA with lymphedema, this mixed methods study compares out-of-pocket costs for breast cancer survivors with and without lymphedema.

METHODS

In 2015, 129 breast cancer survivors from Pennsylvania and New Jersey completed surveys on demographics, economically burdensome events since cancer diagnosis, cancer treatment factors, insurance, and comorbidities; and prospective monthly out-of-pocket cost diaries over 12 months. Forty participants completed in-person semi-structured interviews. GLM regression predicted annual dollar amount estimates.

RESULTS

46.5% of participants had lymphedema. Mean age was 63 years (SD = 8). Average time since cancer diagnosis was 12 years (SD = 5). Over 98% had insurance. Annual adjusted health-related out-of-pocket costs excluding productivity losses totaled $2306 compared to $1090 (p = 0.006) for those without lymphedema, or including productivity losses, $3325 compared to $2792 (p = 0.55). Interviews suggested that the cascading nature of economic burden on long-term savings and work opportunities, and insufficiency of insurance to cover lymphedema-related needs drove cost differences. Higher costs delayed retirement, reduced employment, and increased inability to access lymphedema care.

CONCLUSIONS

Long-term cancer survivors with lymphedema may face up to 112% higher out-of-pocket costs than those without lymphedema, which influences lymphedema management, and has lasting impact on savings and productivity. Findings reinforce the need for actions at policy, provider, and individual patient levels, to reduce lymphedema costs. Future work should explore patient-driven recommendations to reduce economic burden after cancer.