A new study from University of Alabama at Birmingham researchers sheds light on the factors that affect health-related quality of life in older adults with cancer. Published online in CANCER — a peer-reviewed journal of the American Cancer Society — the findings support the importance of addressing persistent symptoms, managing comorbidities, promoting leisure-time physical activity and addressing financial challenges.
Of the 15 million people living with cancer in the United States in 2016, 62 percent were 65 years or older. This proportion is growing, and soon three-quarters of cancer survivors will be in this age group. Understanding the most important factors that contribute to improving or maintaining good quality of life beyond the initial treatment period can help identify survivors who are most vulnerable and at risk for poor health outcomes.
To investigate the issue, Maria Pisu, Ph.D., associate professor in the Division of Preventive Medicine, Gabrielle Rocque, M.D., assistant professor of hematology and oncology and associate scientist at the UAB Comprehensive Cancer Center, and their colleagues at UAB surveyed 1,457 adults 65 years or older. Most of the respondents were not actively receiving cancer treatment at the time of the survey and were one year or more past their diagnosis. The survey explored factors in physical, psychological, social and spiritual domains that could impact quality of life.
Findings show that the physical and mental components of quality of life were likely affected by factors across different domains. The most important contributors associated with worse physical quality of life included more severe symptoms of pain, fatigue and disturbed sleep in the week leading up to the survey, as well as other medical conditions patients had besides cancer.
Being physically active appeared to be an important contributor to better physical quality of life. The most important contributors linked with worse mental quality of life were again the severity of symptoms such as fatigue and disturbed sleep. Other likely contributors included the need for emotional support and having financial hardship events.
“Quality of life studies tend to focus on one cancer at the time, on the period during treatment, and on specific cancer drugs or treatments,” Pisu said. “However, as people live longer after a cancer diagnosis, it is important to understand the contributions of other factors to quality of life regardless of cancer type or treatment.”
Pisu says cancer type and treatment received were not among the most important factors affecting quality of life in the group of survivors. She notes that the contribution of financial hardship to the mental component of quality of life was somewhat unexpected.
“Financial and economic hardships have usually been found to be less concerning for older adults,” she said.
Pisu says the approach to care for this population has to be one of comprehensive health promotion that includes appropriate management of symptoms and comorbid conditions and the promotion of healthy lifestyles.“Their care should recognize the importance of older survivors’ social contexts and the support needs they may have, including those related to financial challenges,” Pisu said.