Social inequality in cancer survivorship: Educational differences in health-related quality of life among 27,857 cancer survivors in Denmark

IF 2.9 2区医学 Q2 ONCOLOGY

Cancer Medicine Pub Date : 2023-09-29 DOI:10.1002/cam4.6596

Anne Katrine Graudal Levinsen, Trille Kristina Kjaer, Lau Caspar Thygesen, Thomas Maltesen, Erik Jakobsen, Ismail Gögenur, Michael Borre, Peer Christiansen, Robert Zachariae, Peter Christensen, Søren Laurberg, Peter de Nully Brown, Lisbet Rosenkrantz Hölmich, Christoffer Johansen, Susanne K. Kjær, Lonneke van de Poll-Franse, Lena Saltbæk, Susanne Oksbjerg Dalton

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引用次数: 1

Abstract

Background

With a growing population of cancer survivors in Denmark, the evaluation of health-related quality of life (HRQoL) has become increasingly important. We describe variations in HRQoL between educational groups in a national population of cancer survivors.

Methods

We conducted a cross-sectional questionnaire study among breast, prostate, lung, and colon cancer survivors diagnosed in 2010–2019 in Denmark. We used the EORTC QLQ-C30 to assess HRQoL including physical, role, emotional, cognitive, social functioning, and symptoms (fatigue, nausea and vomiting, pain, dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties). Information on educational level and clinical data were extracted from national registers and clinical databases. Levels of impaired functioning and severe symptoms were identified using newly established thresholds for clinical importance. Multivariate logistic regression was used to examine associations between education and HRQoL. All statistical tests were 2-sided.

Results

In total, 27,857 (42%) participated in the study. Up to 72% and 75% of cancer survivors with short education (≤9 years) reported impaired functioning and severe symptoms, respectively. Cancer survivors with short compared to long education (>12 years) were more likely to report impaired functioning and severe symptoms, with for example significantly higher odds ratios (ORs) for impaired physical function (breast OR = 2.41, 99% CI = 2.01–2.89; prostate OR = 1.81, 99% CI = 1.48–2.21; lung OR = 2.97, 99% CI = 1.95–4.57; and colon cancer OR = 1.69, 99% CI = 1.28–2.24).

Conclusions

Cancer survivors with short education are at greater risk of impaired HRQoL than survivors with long education 2–12 years after diagnosis. This underscores the need for systematic screening and symptom management in cancer aftercare, in order to reach all cancer survivors, also cancer survivors with short education.

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癌症幸存者的社会不平等：丹麦27857名癌症幸存者在健康相关生活质量方面的教育差异。

背景：随着丹麦癌症幸存者人数的不断增加，健康相关生活质量（HRQoL）的评估变得越来越重要。我们描述了癌症幸存者全国人群中不同教育群体之间的HRQoL变化。方法：我们对2010-2019年在丹麦诊断的乳腺癌、前列腺癌、肺癌和结肠癌幸存者进行了横断面问卷调查。我们使用EORTC QLQ-C30来评估HRQoL，包括身体、角色、情绪、认知、社交功能和症状（疲劳、恶心呕吐、疼痛、呼吸困难、失眠、食欲不振、便秘、腹泻和经济困难）。有关教育水平和临床数据的信息是从国家登记册和临床数据库中提取的。使用新建立的临床重要性阈值来确定功能受损和严重症状的水平。多元逻辑回归用于检验教育与HRQoL之间的相关性。所有的统计检验都是双侧的。结果：共有27857人（42%）参与了这项研究。高达72%和75%的癌症幸存者接受过短期教育（≤9 年）分别报告功能受损和严重症状。癌症幸存者短期教育与长期教育（>12 年）更有可能报告功能受损和严重症状，例如身体功能受损的比值比（OR）显著更高（乳腺OR = 2.41199%CI = 2.01-2.89；前列腺OR = 1.81199%CI = 1.48-2.21；肺OR = 2.97,99%CI = 1.95-4.57；和结肠癌癌症OR = 1.69，99%CI = 1.28-2.24）。结论：癌症接受短期教育的幸存者比接受长期教育的幸存者有更大的HRQoL受损风险2-12 诊断后数年。这强调了在癌症后期护理中进行系统筛查和症状管理的必要性，以惠及所有癌症幸存者，也包括受教育时间较短的癌症幸存者。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Cancer Medicine ONCOLOGY-

CiteScore

5.50

自引率

2.50%

发文量

907

审稿时长

19 weeks

期刊介绍： Cancer Medicine is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research from global biomedical researchers across the cancer sciences. The journal will consider submissions from all oncologic specialties, including, but not limited to, the following areas: Clinical Cancer Research Translational research ∙ clinical trials ∙ chemotherapy ∙ radiation therapy ∙ surgical therapy ∙ clinical observations ∙ clinical guidelines ∙ genetic consultation ∙ ethical considerations Cancer Biology: Molecular biology ∙ cellular biology ∙ molecular genetics ∙ genomics ∙ immunology ∙ epigenetics ∙ metabolic studies ∙ proteomics ∙ cytopathology ∙ carcinogenesis ∙ drug discovery and delivery. Cancer Prevention: Behavioral science ∙ psychosocial studies ∙ screening ∙ nutrition ∙ epidemiology and prevention ∙ community outreach. Bioinformatics: Gene expressions profiles ∙ gene regulation networks ∙ genome bioinformatics ∙ pathwayanalysis ∙ prognostic biomarkers. Cancer Medicine publishes original research articles, systematic reviews, meta-analyses, and research methods papers, along with invited editorials and commentaries. Original research papers must report well-conducted research with conclusions supported by the data presented in the paper.