Zhang Yuehan, Thandrayen Joanne, Soga Kay, Weber Marianne, Koczwara Bogda, Laidsaar-Powell Rebekah, Lim Chloe Yi Shing, Joshy Grace, Banks Emily
National Centre for Epidemiology and Population Health (NCEPH), College of Law, Governance, and Policy, The Australian National University, Canberra, ACT, 2600, Australia.
Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
BMC Med. 2025 May 19;23(1):290. doi: 10.1186/s12916-025-04111-0.
Although most people with cancer now survive long-term, evidence on long-term person-centred outcomes in survivors is limited, particularly relative to people without cancer. We quantified changes in physical and psychological outcomes among adults aged ≥ 45 years from pre- to post-cancer-diagnosis, for multiple cancer types and compared to changes in people without cancer.
Questionnaire data from the Australian population-based 45 and Up Study were linked to cancer registrations, hospitalisations and deaths; those without cancer at baseline (2006-2009) and participating in a follow-up survey (by 2015) were included (n = 142,682). Generalised linear models quantified changes in physical functioning (MOS-PF score, range = 0-100) and psychological distress (Kessler-10 score, range = 10-50) between surveys in people diagnosed and not diagnosed with cancer between surveys, adjusting for confounding factors.
Overall, 9313 individuals had incident cancer (12.2/1000 person-years; median follow-up = 5.2 years). Among those without cancer, 30.0% had moderate or severe physical functioning limitations at baseline, increasing to 40.6% at follow-up; corresponding figures were 35.2% and 52.3%, respectively, in participants with incident cancer. Around 80% of those with and without incident cancer had low psychological distress at baseline and follow-up. Compared to those without cancer, cancer survivors had greater average physical functioning declines (mean-score: 77.5 versus 82.9 at follow-up; mean-change: - 8.31 versus - 4.71; adjusted-difference - 2.55 (95%CI = - 2.97-2.13)) and slightly greater increases in psychological distress (mean-score: 13.6 versus 13.5 at follow-up; mean-change: 0.24 versus - 0.04; adjusted-difference 0.21 (95%CI = 0.12-0.31)). Physical outcomes varied by cancer type with greater deterioration with multiple myeloma, lung cancer and leukaemia and lesser declines with breast, colorectal and prostate cancers. Greater deterioration in physical and psychological outcomes were observed in cancer survivors with more advanced disease at diagnosis and recent cancer treatment at follow-up; psychological outcomes in those not receiving recent treatment did not differ from cancer-free participants.
On average, cancer survivors experienced greater declines in physical wellbeing than people without cancer and minimal differences in psychological distress. Those not receiving recent cancer treatment and those with many common cancer types had physical and psychological outcomes comparable to people without cancer. Additional targeted support may particularly benefit those receiving treatment, with specific cancer types, and advanced disease.
尽管现在大多数癌症患者能长期存活，但关于癌症幸存者以患者为中心的长期结局的证据有限，尤其是与无癌症者相比。我们对45岁及以上成年人在癌症诊断前后的身体和心理结局变化进行了量化，涉及多种癌症类型，并与无癌症者的变化进行了比较。
将基于澳大利亚人群的45岁及以上研究的问卷数据与癌症登记、住院和死亡数据相链接；纳入基线时（2006 - 2009年）无癌症且参与随访调查（截至2015年）的人群（n = 142,682）。广义线性模型对在两次调查期间被诊断和未被诊断为癌症的人群在身体功能（MOS-PF评分，范围 = 0 - 100）和心理困扰（凯斯勒10项量表评分，范围 = 10 - 50）方面的变化进行了量化，并对混杂因素进行了调整。
总体而言，9313人患了新发癌症（12.2/1000人年；中位随访时间 = 5.2年）。在无癌症者中，30.0%在基线时有中度或重度身体功能受限，随访时增至40.6%；在患新发癌症的参与者中，相应比例分别为35.2%和52.3%。在基线和随访时，约80%有和没有新发癌症的人心理困扰程度较低。与无癌症者相比，癌症幸存者的身体功能平均下降幅度更大（随访时平均评分：77.5对82.9；平均变化：-8.31对-4.71；调整后差异 -2.55（95%CI = -2.97 - 2.13）），心理困扰的增加幅度略大（随访时平均评分：13.6对13.5；平均变化：0.24对-0.04；调整后差异0.21（95%CI = 0.12 - 0.31））。身体结局因癌症类型而异，多发性骨髓瘤、肺癌和白血病患者的身体功能恶化更严重，而乳腺癌、结直肠癌和前列腺癌患者的下降幅度较小。在诊断时疾病进展更严重且随访时接受近期癌症治疗的癌症幸存者中，身体和心理结局的恶化更明显；未接受近期治疗者的心理结局与无癌症参与者无差异。
平均而言，癌症幸存者的身体健康下降幅度比无癌症者更大，心理困扰差异最小。未接受近期癌症治疗者以及患有多种常见癌症类型者的身体和心理结局与无癌症者相当。额外的针对性支持可能对接受治疗者、特定癌症类型患者以及疾病进展期患者特别有益。
