Health-related quality of life and psychological distress among cancer survivors in a middle-income country
Shridevi Subramaniam
National Clinical Research Centre, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
Search for more papers by this authorYek-Ching Kong
National Clinical Research Centre, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
Search for more papers by this authorKaruthan Chinna
Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia
Search for more papers by this authorMerel Kimman
Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, AZ Maastricht, The Netherlands
Search for more papers by this authorYan-Zheng Ho
Hospital Queen Elizabeth, Kota Kinabalu, Sabah, Malaysia
Search for more papers by this authorNadiah Saat
National Clinical Research Centre, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
Search for more papers by this authorRozita Abdul Malik
Clinical Oncology Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
Search for more papers by this authorNur Aishah Taib
Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
Search for more papers by this authorMatin Mellor Abdullah
Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
Search for more papers by this authorGerard Chin-Chye Lim
Department of Radiotherapy & Oncology, National Cancer Institute, Putrajaya, Malaysia
Search for more papers by this authorNor-Saleha Ibrahim Tamin
Disease Control Division, Ministry of Health Malaysia, Putrajaya, Malaysia
Search for more papers by this authorYin-Ling Woo
Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
Search for more papers by this authorKian-Meng Chang
Department of Haematology, Ampang Hospital, Ampang, Selangor, Malaysia
Search for more papers by this authorPik-Pin Goh
National Clinical Research Centre, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
Search for more papers by this authorCheng-Har Yip
Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
Search for more papers by this authorCorresponding Author
Nirmala Bhoo-Pathy
Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
Correspondence
Nirmala Bhoo Pathy MD PhD, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
Email: [email protected]
Search for more papers by this authorShridevi Subramaniam
National Clinical Research Centre, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
Search for more papers by this authorYek-Ching Kong
National Clinical Research Centre, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
Search for more papers by this authorKaruthan Chinna
Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
School of Medicine, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Malaysia
Search for more papers by this authorMerel Kimman
Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, AZ Maastricht, The Netherlands
Search for more papers by this authorYan-Zheng Ho
Hospital Queen Elizabeth, Kota Kinabalu, Sabah, Malaysia
Search for more papers by this authorNadiah Saat
National Clinical Research Centre, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
Search for more papers by this authorRozita Abdul Malik
Clinical Oncology Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
Search for more papers by this authorNur Aishah Taib
Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
Search for more papers by this authorMatin Mellor Abdullah
Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
Search for more papers by this authorGerard Chin-Chye Lim
Department of Radiotherapy & Oncology, National Cancer Institute, Putrajaya, Malaysia
Search for more papers by this authorNor-Saleha Ibrahim Tamin
Disease Control Division, Ministry of Health Malaysia, Putrajaya, Malaysia
Search for more papers by this authorYin-Ling Woo
Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
Search for more papers by this authorKian-Meng Chang
Department of Haematology, Ampang Hospital, Ampang, Selangor, Malaysia
Search for more papers by this authorPik-Pin Goh
National Clinical Research Centre, Hospital Kuala Lumpur, Jalan Pahang, Kuala Lumpur, Malaysia
Search for more papers by this authorCheng-Har Yip
Subang Jaya Medical Centre, Subang Jaya, Selangor, Malaysia
Search for more papers by this authorCorresponding Author
Nirmala Bhoo-Pathy
Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
Correspondence
Nirmala Bhoo Pathy MD PhD, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
Email: [email protected]
Search for more papers by this authorAbstract
Objectives
Quality of life and psychological well-being are important patient-centered outcomes, which are useful in evaluation of cancer care delivery. However, evidence from low-income and middle-income countries remains scarce. We assessed health-related quality of life (HRQoL) and prevalence of psychological distress (anxiety or depression), as well as their predictors, among cancer survivors in a middle-income setting.
Methods
Through the Association of Southeast Asian Nations Costs in Oncology study, 1490 newly diagnosed cancer patients were followed-up in Malaysia for 1 year. Health-related quality of life was assessed by using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and EuroQol-5 (EQ-5D) dimension questionnaires at baseline, 3 and 12 months. Psychological distress was assessed by using Hospital Anxiety and Depression Scale. Data were modeled by using general linear and logistic regressions analyses.
Results
One year after diagnosis, the mean EORTC QLQ-C30 Global Health score of the cancer survivors remained low at 53.0 over 100 (SD 21.4). Fifty-four percent of survivors reported at least moderate levels of anxiety, while 27% had at least moderate levels of depression. Late stage at diagnosis was the strongest predictor of low HRQoL. Increasing age, being married, high-income status, hospital type, presence of comorbidities, and chemotherapy administration were also associated with worse HRQoL. The significant predictors of psychological distress were cancer stage and hospital type.
Conclusion
Cancer survivors in this middle-income setting have persistently impaired HRQoL and high levels of psychological distress. Development of a holistic cancer survivorship program addressing wider aspects of well-being is urgently needed in our settings.
CONFLICTS OF INTEREST
M. K., C. H. Y., and N. B. P. have received speaker fees and funding for travel and conference participation from Roche. All other authors declare no potential conflicts of interest.
Supporting Information
| Filename | Description |
|---|---|
| pon4787-sup-0001-Acknowledgement_Suppinfo.docWord document, 27 KB |
Data S1. Supporting info item |
| pon4787-sup-0002-eTable_1_SuppInfo_updated.docWord document, 141 KB |
Table S1. Demographic, socioeconomic and clinical characteristics of the study population and their associations with health-related quality of life and psychological distress one year after diagnosis as measured by EORTC QLQ-C30, EQ-5D and HADS. |
| pon4787-sup-0003-e-Methods_Supplementary_File.docxWord 2007 document , 86.8 KB |
Data S3. Supporting info item |
| pon4787sup-0004-efigure_1_Suppinfo_updated.jpgJPEG image, 596.3 KB |
Figure S1. Health-related quality of life and psychological distress based on cancer type (n = 1490) 1 year after diagnosis. A) EORTC QLQ-C30 function scales, B) EORTC QLQ-C30 symptom scales, C) HADS anxiety and depression: proportion of survivors with anxiety and depression, and D) EQ-5D domains: proportion of survivors with moderate or severe problems. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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