Background
Methods
Setting and participants
Patient-reported health outcomes
Predictor variables
Statistical analyses
Results
Study sample
Characteristic | All | |
---|---|---|
N | % | |
Age, years | ||
< 45 | 1569 | 30 |
45–54 | 1577 | 30 |
55–64 | 1369 | 26 |
≥ 65 | 732 | 14 |
Missing | 2 | <1 |
Sex | ||
Male | 1618 | 31 |
Female | 3631 | 69 |
Marital status | ||
Married | 4047 | 77 |
Unmarried | 1202 | 23 |
Level of education | ||
0–6 years (primary) | 1932 | 37 |
7–12 years (secondary) | 2169 | 41 |
> 12 years (tertiary) | 1148 | 22 |
Country of residence | ||
Cambodia | 131 | 3 |
Indonesia | 673 | 13 |
Laos | 56 | 1 |
Malaysia | 1361 | 26 |
Myanmar | 554 | 11 |
Philippines | 458 | 9 |
Thailand | 838 | 16 |
Vietnam | 1178 | 22 |
Household income (of mean national income) | ||
Low | 1643 | 31 |
Med | 1048 | 20 |
High | 1815 | 35 |
Do not know/missing | 743 | 14 |
Health insurance status | ||
Yes | 2249 | 43 |
None | 2999 | 57 |
Missing | 1 | < 1 |
Experienced economic hardship in the year before diagnosis | ||
Yes | 2643 | 50 |
No | 2605 | 50 |
Missing | 1 | < 1 |
Paid work (patient level) before diagnosis (self-employed or for a wage) | ||
Yes | 2481 | 47 |
No | 2768 | 53 |
Cancer site | ||
Mouth and pharynx | 571 | 11 |
Esophagus | 49 | < 1 |
Stomach | 143 | 3 |
Colon and rectum | 552 | 11 |
Liver | 26 | < 1 |
Pancreas | 26 | < 1 |
Trachea, bronchus and lung | 226 | 4 |
Melanoma | 18 | < 1 |
Breast | 1654 | 32 |
Cervix | 598 | 11 |
Uterus | 127 | 2 |
Ovary | 123 | 2 |
Prostate | 27 | < 1 |
Bladder | 20 | < 1 |
Lymphomas and multiple myeloma | 241 | 5 |
Leukemia | 195 | 4 |
Other malignant neoplasms | 617 | 12 |
Missing | 36 | < 1 |
Cancer (TNM) stage at diagnosis | ||
Stage I | 437 | 8 |
Stage II | 1190 | 23 |
Stage III | 984 | 19 |
Stage IV | 561 | 11 |
None (hematological cancers) | 436 | 8 |
Missing | 1641 | 31 |
Treatmenta
| ||
Surgery | 2931 | 56 |
Radiotherapy | 2438 | 46 |
Chemotherapy | 3550 | 68 |
Hormonal therapy | 496 | 9 |
Pre-existing chronic conditions (as reported in medical files) | ||
0 | 4032 | 77 |
1 | 839 | 16 |
≥ 2 | 352 | 7 |
Missing | 26 | < 1 |
Patient-reported health outcomes
All cancers (n = 5249) | ||
---|---|---|
HRQoL | ||
Cancer-specific HRQoL (EORTC QLQ-C30) | Mean | SD |
Global health | 66.2 | 22.0 |
Physical function | 79.0 | 22.8 |
Emotional function | 76.2 | 24.8 |
Role function | 74.8 | 28.8 |
Cognitive function | 86.2 | 20.7 |
Social function | 73.7 | 26.6 |
Fatigue | 24.7 | 25.2 |
Nausea/vomiting | 10.7 | 18.9 |
Pain | 21.4 | 25.4 |
Dyspnea | 13.9 | 22.8 |
Insomnia | 21.2 | 27.5 |
Appetite loss | 20.0 | 27.9 |
Constipation | 11.3 | 21.4 |
Diarrhea | 7.8 | 17.1 |
Generic HRQoL (EQ-5D) | ||
Index score | 0.74 | 0.23 |
Psychological distress | N | % |
HADS-A: Anxiety | 1933 | 37 |
HADS-D: Depression | 2394 | 46 |
HRQoL | Psychological distress | |||||||
---|---|---|---|---|---|---|---|---|
Generic HRQoL | Cancer-specific HRQoL (EORTC QLQ-C30) | |||||||
EQ-5D indexa
| Physical function | Emotional function | Global health | Pain | Fatigue | Anxiety | Depression | |
Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | Mean (SD) | N (%) | N (%) | |
Age group, years | ||||||||
< 45 | 0.76 (0.22) | 81.9 (21.5) | 77.8 (24.0) | 67.0 (23.0) | 19.2 (24.1) | 21.6 (24.0) | 570 (36) | 678 (43) |
45–54 | 0.75 (0.22) | 80.9 (21.9) | 76.7 (24.2) | 67.5 (21.1) | 20.7 (25.7) | 23.5 (24.6) | 513 (33) | 663 (42) |
55–64 | 0.73 (0.23) | 77.9 (22.1) | 75.8 (24.4) | 65.9 (21.0) | 22.1 (24.9) | 26.1 (24.9) | 519 (38) | 644 (47) |
≥ 65 | 0.67 (0.25) | 70.5 (26.1) | 72.6 (28.0) | 62.6 (23.3) | 31.4 (28.3) | 31.4 (28.3) | 330 (45) | 408 (56) |
Sex | ||||||||
Female | 0.75 (0.22) | 80.1 (21.7) | 76.8 (24.4) | 66.2 (18.1) | 20.2 (24.5) | 23.9 (24.8) | 1262 (35) | 1560 (43) |
Male | 0.71 (0.24) | 76.5 (24.8) | 75.0 (25.5) | 62.3 (20.0) | 24.1 (27.0) | 26.6 (26.0) | 671 (42) | 834 (52) |
Marital status | ||||||||
Married | 0.74 (0.23) | 79.2 (22.5) | 76.5 (24.3) | 66.7 (21.6) | 21.5 (25.3) | 24.6 (25.0) | 1501 (37) | 1845 (46) |
Not married | 0.73 (0.23) | 78.3 (23.6) | 75.5 (26.3) | 64.9 (23.5) | 21.1 (25.7) | 24.9 (26.1) | 432 (36) | 549 (46) |
Level of education | ||||||||
0–6 years (primary) | 0.73 (0.23) | 77.8 (24.1) | 77.1 (24.8) | 68.1 (21.6) | 21.5 (26.1) | 24.2 (25.7) | 641 (33) | 849 (44) |
7–12 years (secondary) | 0.74 (0.23) | 79.1 (21.8) | 75.4 (24.2) | 64.3 (21.4) | 22.1 (24.8) | 25.7 (24.7) | 908 (42) | 1088 (50) |
> 12 years (tertiary) | 0.75 (0.22) | 80.8 (22.2) | 76.3 (25.8) | 66.8 (23.5) | 19.9 (25.2) | 23.7 (25.4) | 384 (33) | 457 (40) |
Household income | ||||||||
Low (0–75%) | 0.71 (0.23) | 76.5 (24.9) | 74.0 (25.8) | 64.9 (23.2) | 23.3 (27.0) | 25.4 (26.4) | 712 (43) | 818 (50) |
Med (75–125%) | 0.72 (0.23) | 78.3 (21.8) | 76.0 (24.3) | 65.1 (22.1) | 21.5 (24.9) | 23.6 (24.2) | 420 (40) | 526 (50) |
High (> 125%) | 0.78 (0.22) | 81.6 (21.2) | 78.0 (24.4) | 67.1 (20.7) | 18.7 (23.8) | 24.0 (24.5) | 510 (28) | 685 (38) |
Health insurance | ||||||||
Yes | 0.75 (0.22) | 78.6 (24.2) | 76.9 (24.8) | 68.0 (21.4) | 22.7 (26.3) | 25.9 (26.1) | 813 (36) | 1022 (46) |
No | 0.73 (0.23) | 79.3 (21.6) | 75.7 (24.8) | 64.9 (22.4) | 20.4 (24.6) | 23.8 (24.5) | 1120 (38) | 1372 (46) |
Economic hardship | ||||||||
Yes | 0.73 (0.23) | 77.1 (24.9) | 75.2 (25.9) | 67.8 (22.0) | 23.6 (27.5) | 26.6 (27.1) | 949 (36) | 1217 (46) |
No | 0.75 (0.22) | 80.9 (20.2) | 77.3 (23.6) | 64.7 (22.0) | 19.2 (22.8) | 22.8 (23.0) | 984 (38) | 1177 (45) |
Paid work | ||||||||
Yes | 0.75 (0.22) | 80.9 (22.2) | 77.0 (24.9) | 67.3 (21.8) | 19.5 (25.1) | 22.7 (24.8) | 787 (32) | 996 (40) |
No | 0.72 (0.23) | 77.2 (23.2) | 75.5 (24.7) | 65.3 (22.2) | 23.1 (25.6) | 26.5 (25.5) | 1146 (42) | 1398 (51) |
Cancer stage at diagnosis | ||||||||
Stage I | 0.81 (0.20) | 85.7 (15.8) | 82.3 (18.9) | 74.2 (18.3) | 12.5 (18.0) | 16.6 (19.5) | 99 (23) | 141 (32) |
Stage II | 0.79 (0.21) | 83.6 (18.6) | 79.9 (22.8) | 71.5 (18.9) | 15.7 (21.1) | 20.0 (22.0) | 323 (27) | 424 (36) |
Stage III | 0.75 (0.22) | 79.6 (23.3) | 76.0 (25.3) | 69.0 (21.6) | 20.4 (26.1) | 24.0 (25.6) | 296 (30) | 400 (41) |
Stage IV | 0.65 (0.24) | 69.8 (29.0) | 63.4 (34.7) | 57.0 (23.8) | 32.6 (32.0) | 36.6 (32.3) | 265 (47) | 327 (58) |
None (hematological cancers) | 0.67 (0.23) | 77.4 (18.6) | 77.9 (18.6) | 44.7 (26.8) | 21.1 (21.0) | 22.1 (19.6) | 308 (71) | 313 (72) |
Treatmentb
| ||||||||
Surgery | 0.78 (0.22) | 82.1 (21.2) | 78.7 (25.2) | 69.9 (20.5) | 17.9 (24.5) | 22.1 (25.3) | 1051 (36) | 1051 (36) |
No surgery | 0.68 (0.23) | 74.8 (24.1) | 72.9 (24.1) | 61.4 (23.2) | 25.7 (25.8) | 27.9 (24.9) | 1123 (51) | 1322 (60) |
Radiotherapy | 0.73 (0.22) | 78.6 (22.5) | 76.1 (24.4) | 67.0 (21.7) | 20.1 (24.9) | 25.3 (25.0) | 881 (36) | 1123 (46) |
No radiotherapy | 0.74 (0.23) | 79.2 (22.9) | 76.2 (25.3) | 65.5 (22.5) | 22.5 (25.8) | 24.0 (25.5) | 1026 (38) | 1248 (46) |
Chemotherapy | 0.73 (0.23) | 78.6 (22.7) | 75.2 (25.2) | 65.0 (22.9) | 21.7 (25.6) | 25.3 (25.6) | 1330 (38) | 1652 (47) |
No chemotherapy | 0.76 (0.23) | 79.7 (23.0) | 78.4 (23.9) | 69.0 (20.2) | 20.2 (24.7) | 23.1 (24.6) | 580 (36) | 732 (45) |
Pre-existing chronic conditions | ||||||||
0 | 0.74 (0.23) | 79.6 (22.4) | 76.8 (24.0) | 66.3 (22.0) | 21.1 (25.1) | 24.0 (24.8) | 1503 (37) | 1853 (46) |
1 | 0.74 (0.23) | 79.0 (22.8) | 77.2 (24.7) | 66.5 (21.7) | 20.4 (24.8) | 24.2 (24.9) | 266 (32) | 357 (43) |
≥ 2 | 0.67 (0.23) | 71.5 (25.1) | 67.5 (31.7) | 64.8 (23.7) | 27.5 (29.5) | 34.6 (29.3) | 159 (45) | 177 (50) |
Full model | EQ-5D index | Physical function | Emotional function | Global health | Pain | Fatigue | Anxiety | Depression |
---|---|---|---|---|---|---|---|---|
Age | −0.21 (−0.28 to −0.15) | −0.25 (−0.31 to −0.18) | −0.17 (−0.25 to −0.09) | −0.12 (−0.19 to −0.05) | 0.20 (0.12 to 0.28) | 0.27 (0.19 to 0.35) | 1.01 (1.00 to 1.02) | 1.01 (1.01 to 1.02) |
Sex | −1.13 (−2.90 to 0.63) | −0.91 (−2.64 to 0.82) | −3.15 (−5.18 to −1.13) | 0.73 (−1.01 to 2.47) | 0.44 (−1.50 to 2.38) | 1.16 (−0.79 to 3.11) | 1.43 (1.24 to 1.62) | 1.20 (1.02 to 1.37) |
Marital status | 0.65 (−1.17 to 2.48) | 1.94 (0.16 to 3.73) | 2.22 (0.13 to 4.31) | 1.36 (−0.44 to 3.15) | −1.42 (−3.42 to 0.59) | −2.04 (−4.05 to −0.03) | 1.18 (0.98 to 1.37) | 0.93 (0.75 to 1.12) |
Level of education | ||||||||
Primary | Ref | Ref | Ref | Ref | Ref | Ref | Ref | Ref |
Secondary | −2.70 (−4.55 to −0.86) | −2.17 (−3.98 to −0.37) | −5.16 (−7.27 to −3.04) | −5.63 (−7.45 to −3.81) | 3.17 (1.14 to 5.20) | 4.39 (2.36 to 6.43) | 2.24 (2.04 to 2.44) | 1.79 (1.60 to 1.97) |
Tertiary | −4.07 (−6.30 to −1.84) | −2.82 (−5.00 to −0.63) | −6.04 (−8.60 to −3.48) | −3.68 (−5.88 to −1.48) | 3.48 (1.02 to 5.94) | 5.44 (2.97 to 7.90) | 1.81 (1.56 to 2.05) | 1.34 (1.12 to 1.57) |
Household income | ||||||||
Low | Ref | Ref | Ref | Ref | Ref | Ref | Ref | Ref |
Medium | −0.83 (−2.90 to 1.24) | −0.20 (−2.23 to 1.83) | 0.87 (−1.50 to 3.24) | −0.39 (−2.43 to 1.65) | 0.22 (−2.06 to 2.50) | −0.27 (−2.56 to 2.01) | 0.90 (0.68 to 1.11) | 1.18 (0.98 to 1.39) |
High | 3.68 (1.78 to 5.58) | 2.51 (0.64 to 4.37) | 2.75 (0.57 to 4.94) | −0.09 (−1.97 to 1.79) | −2.49 (−4.59 to −0.39) | −0.39 (−2.49 to 1.71) | 0.48 (0.28 to 0.69) | 0.74 (0.55 to 0.93) |
Health insurance | 1.16 (−0.47 to 2.79) | −2.21 (−3.80 to −0.62) | 0.09 (−1.78 to 1.96) | 2.46 (0.85 to 4.06) | 3.88 (2.09 to 5.67) | 3.74 (1.94 to 5.54) | 1.13 (0.95 to 1.30) | 1.21 (1.05 to 1.38) |
Economic hardship | −0.63 (−2.23 to 0.98) | −3.28 (−4.86 to −1.71) | −2.35 (−4.19 to −0.50) | 2.44 (0.86 to 4.03) | 3.41 (1.64 to 5.18) | 3.85 (2.07 to 5.62) | 0.81 (0.64 to 0.99) | 0.94 (0.78 to 1.10) |
Paid work | 2.04 (0.40 to 3.68) | 3.11 (1.50 to 4.72) | 1.72 (−0.16 to 3.60) | 2.76 (1.14 to 4.37) | −3.17 (−4.98 to −1.37) | −3.25 (−5.06 to −1.44) | 0.66 (0.48 to 0.83) | 0.68 (0.51 to 0.84) |
Cancer stage at diagnosis | ||||||||
Stage I | Ref | Ref | Ref | Ref | Ref | Ref | ||
Stage II | −1.43 (−4.06 to 1.20) | −2.09 (−4.66 to 0.48) | −1.37 (−4.38 to 1.65) | −2.14 (−4.73 to 0.45) | 2.96 (0.07 to 5.86) | 2.79 (−0.11 to 5.69) | 1.30 (1.00 to 1.60) | 1.12 (0.86 to 1.39) |
Stage III | −3.42 (−6.18 to −0.66) | −4.45 (−7.15 to −1.75) | −4.77 (−7.94 to −1.61) | −4.09 (−6.81 to −1.37) | 6.32 (3.29 to 9.36) | 5.97 (2.93 to 9.02) | 1.30 (0.99 to 1.61) | 1.21 (0.93 to 1.49) |
Stage IV | −13.34 (−16.40 to −10.27) | −14.73 (−17.73 to −11.73) | −18.61 (−22.13 to −15.10) | −15.14 (−18.16 to −12.11) | 19.29 (15.91 to 22.67) | 20.01 (16.63 to 23.40) | 2.73 (2.40 to 3.07) | 2.29 (1.98 to 2.60) |
Hematological | −8.53 (−12.07 to −5.00) | −7.58 (−11.04 to −4.12) | −2.27 (−6.33 to 1.78) | −25.76 (−29.25 to −22.27) | 7.89 (3.99 to 11.78) | 5.68 (1.78 to 9.59) | 5.05 (4.67 to 5.44) | 3.06 (2.70 to 3.42) |
Treatment | ||||||||
Surgery | 7.10 (5.34 to 8.85) | 4.48 (2.77 to 6.20) | 4.22 (2.21 to 6.23) | 2.27 (0.54 to 4.00) | −4.81 (−6.74 to −2.88) | −3.29 (−5.22 to −1.35) | 0.39 (0.21 to 0.57) | 0.40 (0.23 to 0.58) |
Radiotherapy | −0.44 (−2.01 to 1.14) | −0.27 (−1.81 to 1.27) | 0.13 (−1.68 to 1.94) | 0.10 (−1.45 to 1.66) | 1.35 (−0.39 to 3.08) | 0.53 (−1.21 to 2.27) | 1.11 (0.94 to 1.28) | 1.05 (0.89 to 1.20) |
Chemotherapy | −3.47 (−5.29 to −1.65) | −0.58 (−2.36 to 1.20) | −1.56 (−3.65 to 0.52) | −1.20 (−3.00 to 0.59) | −0.45 (−2.45 to 1.56) | 0.41 (−1.60 to 2.42) | 0.93 (0.74 to 1.12) | 1.02 (0.84 to 1.20) |
No. of pre-existing chronic conditions | −2.32 (−3.44 to −1.19) | −2.51 (−3.61 to −1.41) | −2.92 (−4.21 to −1.63) | −0.22 (−1.33 to 0.89) | 2.30 (1.06 to 3.54) | 3.41 (2.17 to 4.65) | 1.17 (1.06 to 1.29) | 1.13 (1.02 to 1.24) |