Background: Diagnosis of cancer is a traumatic event that can have a significant negative impact on a patient’s physical and emotional wellbeing. While there is a substantial improvement in treatment, it comes with several side effects that can affect a patient’s quality of life. This study aims to examine the changes in HRQL after a primary cancer diagnosis by comparing with 1) before cancer diagnosis and 2) cancer-free similar groups.
Methods: This study included 1256 incidence cancer cases from a large cohort (born: 1946-51) of the Australian Longitudinal Study on Women’s Health between 1996 and 2017- ascertained using the linked Australian Cancer Database. The control group was women without a history of cancer. HRQL was measured using the Short Form-36 (SF-36) questionnaire at the survey before and after a cancer diagnosis. Univariable changes in each domain of the HRQL between before and after cancer diagnosis were tested using McNeymar’s test, and generalised estimating equations were used to estimate the adjusted changes controlling for sociodemographic and other health conditions.
Results: Of 1256 women who completed a survey before and after a cancer diagnosis, 44.3% were diagnosed with breast cancer, 15.4% with melanoma and 10.2% with colorectal cancer. We found a significant decline in mean scores of the HRQL across all domains after a cancer diagnosis (p<0.001). When adjusting for sociodemographic and other health conditions, compared to pre-diagnosis, there was a significant negative change following diagnosis of cancer across all domains of the HRQL, with the worst effect for general health (β = -10.8, 95%CI: -12.5 to -9.2) followed by social functioning (β = -10.2, 95%CI: -12.2 to -8.3) and physical functioning (β = -9.8, 95%CI: -11.4 to -8.2). We observed a significant interaction effect of time and cancer type, revealing that the changes in the HRQL domains differed by cancer type (p<0.01). In the cancer-free control, the overtime changes were also significant for several domains at p<0.05, but the magnitude was relatively moderate.
Conclusion:
This study estimated the changes in the HRQL across different domains after a cancer diagnosis in a cohort of Australian women. Our findings can help women cancer patients, their families and clinicians make treatment decisions regarding how to best maximise factors related to better HRQL. Further studies with clinical and prognosis factors associated with a patient’s quality of life are needed to confirm our findings.