Cancer survivors report poor quality of life

Washington -- Cancer survivors experience a poorer quality of life than do people who have never been diagnosed with cancer, according to a new study. The finding was true even for those who survived more than 10 years after their diagnosis.

"I was surprised," said lead author Robin Yabroff, PhD, an epidemiologist at the National Cancer Institute. "We have some follow-up studies in the pipeline to try to understand it a little bit better."

The study was published in the Sept. 1 Journal of the National Cancer Institute.

More and more people will likely be living with cancer in the near future as a result of earlier detection and more effective treatments. One million people in the United States will be diagnosed with cancer this year, and that number is expected to double by 2050 as the population increases and ages.

The researchers studied data collected in the 2000 National Health Interview Survey, an annual survey that asks respondents questions about their lives and health. They analyzed responses from more than 1,800 cancer survivors and nearly 5,500 control subjects matched for age, gender and level of education.

They found that cancer survivors were more likely to describe their health as poor or fair than were those who had never been diagnosed with cancer. Survivors were also more likely to report being unable to work because of their illness or to have lost more days of work due to illness during the previous year. The finding was true for all types of cancer and regardless of how many years had passed since the cancer was diagnosed.

The breadth of the data analyzed meant that some of the depth was sacrificed, said William F. Lawrence, MD, senior fellow in outcomes research at the Agency for Healthcare Research and Quality, who is also an author of the study. "So we can say that in the population there is a burden of illness in cancer survivors, but we don't know why," said Dr. Lawrence. "I'm sure the reasons will be different for different people."

A mixed review

Some people may have had a recurrence of their cancer while the poor health of others may be attributable to the residual effects of their cancer treatment, said the researchers. For example, they note that several studies have found that men undergoing surgery for localized prostate cancer may continue to experience incontinence and impotence after their initial treatment.

The main message to physicians who care for cancer patients is to know that this burden of illness persists, said Dr. Lawrence. "Clinicians need to ask their patients about how cancer impacts on their life overall and explore with the individual patient a way they can be helped."

But Deborah Armstrong, MD, a medical oncologist at Johns Hopkins' School of Medicine, said it wasn't surprising that people who are diagnosed with cancer have more problems with work and finances than those never diagnosed with cancer.

"It might have been fairer to compare these patients with those who have had a history of heart disease or diabetes." The researchers may then have tried to determine whether people with a history of cancer are more productive or have a better overall outcome compared with those with heart disease, for example, she said.

While it's always good to have the data, she said, the findings may not be beneficial to cancer patients. "I worry that people who have a diagnosis of cancer will have more trouble getting insurance or getting a job. I'm not sure it's going to have a positive outcome."

Bonnie Teschendorf, PhD, director of Quality of Life Science at the American Cancer Society, agreed that the fact that cancer survivors face greater burdens in their lives is not surprising, but she praised the study. "This is a very important study to begin to characterize what happens to people after they have left their treatment. It shows what happens in their lives after that," she said. "Once people leave medical care, it is more difficult to track them and find out what has happened and how it has impacted their lives."

The value of this study also comes, in part, from its national data, which are not easy to gather, she said.

Interest in the quality of life of the 9.8 million cancer survivors in the nation has increased over the past two or three years, she noted. The cancer society stepped up its attention to this population about two years ago with a special project.

There is also an effort to develop clinics that provide follow-up care to former cancer patients, and the new findings will provide an idea of who needs services and what those services might be, Dr. Teschendorf said.