Impact of Cancer on Health-Related Quality of Life of Older Americans
Open accessAbstract
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.
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Epidemiological studies find that survivors of almost all types of cancer have significantly poorer mental health and health-related QOL than nonsurvivors.
“Epidemiological studies find that survivors of almost all types of cancer have significantly poorer mental health46 and health-related QOL47 than nonsurvivors.”
From Individualized, Single Session Yoga Therapy to Reduce Physical and Emotional Symptoms in Hospitalized Hematological Cancer Patients. (2019) · cites this paper as [47]
The Results report significantly greater declines in physical health for seven of nine cancer types among older patients, supporting the health-related quality-of-life portion of the claim. But the comparison was with matched people without cancer, not “nonsurvivors,” and the study does not establish this finding for cancer survivors generally. The mental-health portion carries a different citation and is not assessed here. (LLM, conf=0.86)
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- Authors
- Reeve, B. B., Potosky, A. L., Smith, A. W., Han, P. K., Hays, R. D., Davis, W. W., Arora, N. K., Haffer, S. C., & Clauser, S. B.
- Affiliations
- National Institutes of Health (US)
- Georgetown University (US)
- University of California, Los Angeles (US)
- United States Department of Health and Human Services (US)
- Venue
- JNCI Journal of the National Cancer Institute
- Publisher
- Oxford University Press (OUP)
- Published
- 2009-06-09
- Volume
- 101
- Issue
- 12
- Pages
- 860-868
- ISSN
- 0027-8874 (ISSN-L)
- 1460-2105
- PMC
- PMC2720781
- OpenAlex
- W2124540500
- Cited by
- 211
- References
- 46
- Citations by year
- 2026: 7 · 2025: 7 · 2024: 6 · 2023: 15 · 2022: 6 · 2021: 9 · 2020: 9 · 2019: 17 · 2018: 10 · 2017: 12 · 2016: 20 · 2015: 14 · 2014: 21 · 2013: 22 · 2012: 18
- FWCI
- 5.99
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JNCI Journal of the National Cancer Institute (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Financial Impacts of Cancer
- Health Sciences › Medicine › Geriatrics and Gerontology › Frailty in Older Adults
- Keywords
- health-related quality of life, cancer, older adults, physical function, cancer survivors, lung cancer, breast cancer, prostate cancer, colorectal cancer, non-Hodgkin lymphoma, kidney cancer, bladder cancer, melanoma, endometrial cancer, physical health decline, Medicare beneficiaries, SF-36, Medicare Health Outcomes Survey, comorbidities
- MeSH terms
- Aged, Analysis of Variance, Female, Medicare, Health Status, Health Surveys, Humans, Male, Medical Record Linkage, Mental Health, Neoplasms, Prospective Studies, Quality of Life, Severity of Illness Index, United States, Comorbidity, Case-Control Studies, Cost of Illness, SEER Program, Benchmarking
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