CoRPS-Center of Research on Psychology in Somatic diseases, Department of Medical and Clinical Psychology, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands,
J Cancer Surviv. 2013 Dec;7(4):602-13. doi: 10.1007/s11764-013-0299-1. Epub 2013 Aug 6.
The aim of this study was to assess the difference in explained variance of Health-Related Quality of Life (HRQoL) between comorbidity, sociodemographic characteristics and cancer characteristics. This association was assessed among thyroid cancer, colorectal cancer, and (non-)Hodgkin's lymphoma patients.
Data from three large population-based surveys on survivors of thyroid cancer, colorectal cancer, and (non-)Hodgkin's lymphoma were used. Cancer-specific HRQoL was assessed with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) of which physical function, emotional function, fatigue, and pain were included in the analyses. Comorbidity was assessed using the Self-reported Comorbidity Questionnaire. The association between comorbidity and HRQoL was assessed with multivariate linear regression models. Semi-partial R (2) was reported to assess the amount of variance in HRQoL explained by comorbidity in comparison with sociodemographic and cancer characteristics.
In total, 3,792 cancer survivors were included in this analysis. The variance in HRQoL subscales explained by comorbidity was higher compared with sociodemographic and cancer characteristics for physical function (11-17 vs. 2-4 and 1-2 %, respectively) and emotional function (7-17 vs. 1-3 and 1-3 %, respectively), regardless of cancer type. In addition, comorbidity explained 7-20 and 11-13 % of the variance in pain and fatigue, respectively, compared to 0-4 % for both sociodemographic and cancer characteristics. Osteoarthritis and back pain were strongly associated with physical function and pain, while depression was strongly associated with emotional function. Depression and back pain were strongly associated with fatigue.
This study showed that comorbidity explained more variance in physical and emotional function, pain, and fatigue in comparison with sociodemographic and cancer characteristics in cancer survivors, regardless of cancer type. Our findings emphasize the importance of adjusting for the presence of comorbid diseases when assessing HRQoL in cancer survivors.
Cancer survivors suffering from comorbid diseases experience lower levels of health-related quality of life. Clinicians should become more aware of the impact of comorbidity on HRQoL and provide necessary psychological support to assist self-management of comorbid diseases.
本研究旨在评估共病、社会人口统计学特征和癌症特征对健康相关生活质量（HRQoL）的解释差异。本研究评估了甲状腺癌、结直肠癌和（非）霍奇金淋巴瘤患者之间的这种关联。
本研究使用了三项针对甲状腺癌、结直肠癌和（非）霍奇金淋巴瘤幸存者的大型人群调查数据。使用欧洲癌症研究与治疗组织（EORTC）生活质量问卷核心 30 项（QLQ-C30）评估癌症特异性 HRQoL，其中包括身体功能、情绪功能、疲劳和疼痛。使用自我报告的共病问卷评估共病。使用多变量线性回归模型评估共病与 HRQoL 之间的关联。报告半偏部分 R²（2），以评估与社会人口统计学和癌症特征相比，共病对 HRQoL 的解释程度。
本研究共纳入 3792 名癌症幸存者。与社会人口统计学和癌症特征相比，共病对身体功能（11-17%比 2-4%和 1-2%，分别）和情绪功能（7-17%比 1-3%和 1-3%，分别）的 HRQoL 亚量表的解释程度更高，无论癌症类型如何。此外，与社会人口统计学和癌症特征的 0-4%相比，共病分别解释了疼痛和疲劳方差的 7-20%和 11-13%。骨关节炎和背痛与身体功能和疼痛强烈相关，而抑郁与情绪功能强烈相关。抑郁和背痛与疲劳强烈相关。
本研究表明，与社会人口统计学和癌症特征相比，共病在癌症幸存者中对身体和情绪功能、疼痛和疲劳的解释程度更高，无论癌症类型如何。我们的研究结果强调了在评估癌症幸存者的 HRQoL 时，调整共病的重要性。
患有共病的癌症幸存者经历更低水平的健康相关生活质量。临床医生应该更加意识到共病对 HRQoL 的影响，并提供必要的心理支持，以协助共病的自我管理。
