CHANGES IN HEALTH-RELATED QUALITY OF LIFE AMONG CANCER SURVIVORS: A POPULATION ANALYSIS

Purpose: There is no consensus in the literature about whether and when cancer survivors return to the same level of health-related quality of life (HRQOL) as those who have not had cancer.

Method: We analyzed Medical Expenditure Panel Survey (MEPS) data, a nationally representative health survey, for the calendar years 2008, 2010, and 2011. We identified 2892 cancer survivors with cancer remission and 48141 individuals who had no history of cancer. The Physical Component Summary (PCS), the Mental Component Summary (MCS), and the SF-6D scores were used to assess HRQOL. We examined the effect of time since cancer diagnosis on these HRQOL measurements, controlling for a range of measurable characteristics in MEPS data and accounting for the MEPS’s complex survey design.

Result: For cancer survivors with remission status, the average scores of PCS, MCS, and SF-6D were 42.77 (SE = 0.322), 49.49 (SE = 0.280), and 0.74 (SE = 0.003), respectively. Compared with people without cancer, cancer survivors within 2 years of cancer diagnosis had lower adjusted scores of PCS (-4.2; p<.001), MCS (-2.0; p=.049), and SF-6D (-0.03; p<.001). Cancer survivors 2 to 5 years after cancer diagnosis had a lower PCS score (-1.3, p=.036); no significant difference in PCS score was found between the no-cancer group and cancer survivors who were surveyed 5 or more years after cancer diagnosis. Results also showed no significant difference in the MCS and SF-6D scores between the no-cancer group and cancer survivors with cancer diagnosed after 2 years. We found that adjusted mean PCS and SF-6D scores were similar among survivors of melanoma and breast, prostate, colorectal, hematological, and cervical cancers, yet were significantly lower for survivors of short-survival and other cancers. The patterns were similar for adjusted mean MCS score, except that survivors of prostate and cervical cancers had better MCS scores.

Conclusion: For cancer survivors with remission status, the effect of time since cancer diagnosis on these HRQOL measurements depends on the measurement instrument and the types of cancer. The SF-6D utility score was decreased in the first 2 years, and then returned to a “normal” level. Our findings provide useful information of calculating the weight of quality adjusted life year in cost-effectiveness analyses.