Journal of the National Cancer Institute Advance Access published online on June 9, 2009
JNCI Journal of the National Cancer Institute, doi:10.1093/jnci/djp123
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Published by Oxford University Press 2009.
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Impact of Cancer on Health-Related Quality of Life of Older Americans
Affiliations of authors: Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute (BBR, AWS, PKH, NKA, SBC), and Statistician Research and Applications Branch, Surveillance Research Program (WWD), Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD; Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC (ALP); Division of General Internal Medicine & Health Services Research, UCLA Department of Medicine, Los Angeles, CA (RDH); Office of Research, Development, & Information, Centers for Medicare & Medicaid Services, Baltimore, MD (SCH)
Correspondence to: Bryce B. Reeve, PhD, Outcomes Research Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, EPN 4005, 6130 Executive Blvd, MSC 7344, Bethesda, MD 20892-7344 (e-mail: reeveb{at}mail.nih.gov).
Background: The impact of cancer on health-related quality of life (HRQOL) is poorly understood because of the lack of baseline HRQOL status before cancer diagnosis. To our knowledge, this is the first population-based study to quantify the nature and extent of HRQOL changes from before to after cancer diagnosis for nine types of cancer patients and to compare their health with individuals without cancer.
Methods: The Surveillance, Epidemiology, and End Results cancer registry data were linked with the Medicare Health Outcomes Survey (MHOS) data; data were collected from Medicare beneficiaries who were aged 65 years and older from 1998 through 2003. Cancer patients (n = 1432; with prostate, breast, colorectal, lung, bladder, endometrial, or kidney cancers; melanoma; or non-Hodgkin lymphoma [NHL]) were selected whose first cancer diagnosis occurred between their baseline and follow-up MHOS assessments. Control subjects without cancer (n = 7160) were matched to cancer patients by use of propensity scores that were estimated from demographics and comorbid medical conditions. Analysis of covariance models were used to estimate changes in HRQOL as assessed with the Medical Outcomes Study Short Form-36 survey (mean score = 50, SD = 10). All statistical tests were two-sided.
Results: Patients with all cancer types (except melanoma and endometrial cancer) reported statistically significant declines in physical health (mean scores: prostate cancer = –3.4, 95% confidence interval [CI] = –2.5 to –4.2; breast cancer = –3.5, 95% CI = –2.5 to –4.5; bladder cancer = –4.3, 95% CI = –2.5 to –6.1; colorectal cancer = –4.4, 95% CI = –3.3 to –5.5; kidney cancer = –5.7, 95% CI = –3.2 to –8.2; NHL = –6.7, 95% CI = –4.4 to –9.1; and lung cancer = –7.5, 95% CI = –5.9 to –9.2) compared with the control subjects (mean score = –1.8, 95% CI = –1.6 to –2.0) (all P < .05). However, only lung (mean score = –5.4, 95% CI = –3.5 to –7.2), colorectal (mean score = –3.5, 95% CI = –2.2 to –4.7), and prostate (mean score = –2.8, 95% CI = –1.8 to –3.7) cancer patients showed statistically significant decreases in mental health relative to the mean change of the control subjects (mean score = –1.2, 95% CI = –0.9 to –1.4) (all P < .05).
Conclusion: These findings provide validation of the specific deleterious effects of cancer on HRQOL and an evidence base for future research and clinical interventions aimed at understanding and remediating these effects.
| CONTEXT AND CAVEATS Prior knowledge How cancer impacts health-related quality of life is not clearly understood because health-related quality of life before cancer is often not measured or compared to individuals without cancer. Study design Data from the Medicare Health Outcomes Survey were linked with the National Cancer Institute's Surveillance, Epidemiology, and End Results cancer registry data which includes Medicare beneficiaries aged 65 years and older from 1998 through 2003. Mean survey scores of cancer patients (n = 1432) were compared with those of matched control subjects without cancer (n = 7160). Contribution All cancer patients, except melanoma and endometrial cancer, had lower mean physical health scores than control subjects, but only patients with colorectal, prostate, and lung cancers had lower mean mental health scores than control subjects. Patients with prostate, bladder, colorectal, kidney, or lung cancer or NHL reported greater declines in their social roles and well-being than controls. Implications The effects of cancer on health-related quality of life in this study population were specific, and these results provide a basis for future research and treatments to target these effects. Limitations It is unknown how representative the cohort in this study is to US cancer patients in this age range. Some cancer types had few patients, so the statistical power to detect important changes was reduced in these groups. Disease severity, treatment, and timing of survey completion related to the date of cancer diagnosis were not included in the analysis. From the Editors
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Manuscript received December 10, 2008; revised March 6, 2009; accepted April 9, 2009.
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