Background
Methods
Participants
Questionnaires
Demographics and medical information
Ethics
Statistical analysis
Results
Patient characteristics
Enrolled | Consent only | Not enrolled |
p-value
| |
---|---|---|---|---|
838 | 289 | 1044 | ||
Age, mean (SD), years | 63.6 (13.5) | 60.5 (17.1) | 64.7 (16.4) |
<0.001
a
|
Gender, n (%), women | 443 (53) | 162 (56) | 591 (57) | 0.25 |
Symptoms at referral, n (%) | ||||
Weight loss | 297 (35) | 111 (38) | 346 (33) | 0.23 |
Pain | 122 (15) | 57 (20) | 161 (15) | 0.11 |
Suspicion of major illness/cancer | 127 (15) | 5 (2) | 30 (3) |
<0.001
c
|
Abnormal blood tests | 106 (13) | 36 (12) | 118 (11) | 0.63 |
Fatigue | 105 (13) | 40 (14) | 151 (14) | 0.48 |
Pathological lymph node | 72 (9) | 24 (8) | 71 (7) | 0.31 |
Anemia | 71 (8) | 28 (10) | 74 (7) | 0.28 |
Feeling ill | 41 (5) | 16 (6) | 34 (3) | 0.09 |
Night sweats | 46 (5) | 20 (7) | 43 (4) | 0.12 |
Loss of appetite/nausea | 35 (4) | 25 (9) | 45 (4) | 0.01a
|
Fever | 34 (4) | 10 (3) | 34 (3) | 0.65 |
Abdominal disorder | 31 (4) | 18 (6) | 43 (4) | 0.18 |
Increased contact to health system | 2 (0.2) | 1 (0.3) | 0 | 0.48 |
Recurrent deep venous thrombosis | 1 (0.1) | 1 (0.3) | 0 | 0.62 |
Increased use of medication | 0 | 0 | 0 | |
Other | 177 (21) | 72 (25) | 90 (9) |
<0.001
b
|
Cancer diagnosis, n (%) | 188 (22) | 35 (12) |
<0.001
a
|
Cancer | ||||
---|---|---|---|---|
All patients n=838 | yes n=188 | no n=650 |
p-value | |
Age, mean (SD), years | 63.6 (13.5) | 68.9 (10.5) | 62.0 (13.8) |
<0.001
|
Gender, n (%), men | 395 (47) | 107 (57) | 288 (44) |
0.002
|
Co-morbidity, n (%) | ||||
0 | 393 (47) | 12 (6) | 381 (58) | |
1 | 258 (31) | 111 (59) | 147 (23) | |
≥2 | 187 (22) | 65 (35) | 122 (19) |
<0.001
|
Duration of symptoms, weeks, median (IQR) | 12 (6–26) | 10 (4–20) | 12 (8–26) |
<0.001
|
Missing, n (%) | 168 (20) | 43 (23) | 123 (19) | |
Exposures, n (%) | 158 (19) | 29 (15) | 129 (20) | 0.18 |
Missing, n (%) | 5 (0.6) | 0 | 5 (1) | |
Smoking, n (%) | ||||
Never smoked | 368 (44) | 77 (41) | 291 (45) | |
Former smoker | 221 (26) | 60 (32) | 161 (25) | |
Smoker | 208 (25) | 39 (21) | 169 (26) | |
Missing, n (%) | 41 (5) | 12 (6) | 29 (4) | 0.11 |
Marital status, n (%) | ||||
Married/co-inhabitant | 565 (67) | 120 (64) | 445 (68) | |
Separated/divorced | 97 (12) | 30 (16) | 67 (10) | |
Widow/widower | 92 (11) | 28 (15) | 64 (10) | |
Unmarried/single | 80 (9) | 9 (5) | 71 (11) | |
Missing, n (%) | 4 (0.5) | 1 (0.5) | 3 (0.5) |
0.005
|
Education, n (%) | ||||
Compulsory <12 years | 178 (21) | 31 (16) | 147 (23) | |
Short <15 years/skilled worker | 285 (34) | 67 (36) | 218 (34) | |
Medium academic/trade | 234 (28) | 57 (30) | 177 (27) | |
Long academic/university level | 131 (16) | 32 (17) | 99 (15) | |
Missing, n (%) | 10 (1) | 1 (0.5) | 9 (1) | 0.37 |
Occupation, n (%) | ||||
Employed | 289 (35) | 46 (25) | 243 (37) | |
Retired/disability pay | 516 (62) | 139 (74) | 377 (58) | |
Unemployed | 29 (3) | 3 (1) | 26 (4) | |
Missing, n (%) | 4 (0.5) | 0 | 4 (9.6) |
0.001
|
Cancer in family, n (%) | 162 (19) | 36 (19) | 126 (19) | |
Missing, n (%) | 20 (2) | 4 (2) | 16 (2) | 0.96 |
Previous cancer in patient, n (%) | 72 (9) | 0 | 72 (11) | |
Missing, n (%) | 7 (1) | 0 | 7 (1) |
<0.001
|
Quality of life over time and in relation to the final diagnosis
Cancer | Not cancer | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Baseline | Follow-up | Difference within groupa
| Baseline | Follow-up | Difference within groupa
| Differences between groups at baselineb
| Differences between groups at follow-upb
| Difference between intra difference in groupsb
| ||||
EORCT |
n=125 |
n=125 |
p-value
|
n=549 |
n=549 |
p-value
|
p-value
|
ES
c
|
p-value
|
ES
c
|
p-value
|
ES
c
|
Global Health/QL, mean (SD) | 53 (23) | 56 (27) | 0.19 | 53 (24) | 60 (25) |
<0.001
| 0.95 | 0.01 | 0.24 | 0.13 | 0.08 | 0.16 |
Functional scales, mean (SD) | ||||||||||||
Physical functioning | 74 (24) | 70 (27) | 0.42 | 75 (23) | 76 (23) | 0.39 | 0.78 | 0.06 | 0.07 | 0.25 | 0.28 | 0.28 |
Role functioning | 57 (35) | 56 (36) | 0.64 | 63 (34) | 68 (32) |
<0.001
| 0.10 | 0.17 |
<0.001
| 0.38 | 0.06 | 0.22 |
Emotional functioning | 74 (21) | 73 (22) | 0.39 | 70 (24) | 75 (24) |
<0.001
| 0.07 | 0.19 | 0.13 | 0.08 |
<0.001
| 0.35 |
Cognitive functioning | 84 (21) | 80 (23) |
<0.01
| 79 (24) | 79 (22) | 0.35 |
<0.01
| 0.25 | 0.59 | 0.03 |
0.001
| 0.33 |
Social functioning | 82 (26) | 77 (30) | 0.06 | 79 (26) | 79 (28) | 0.44 | 0.11 | 0.11 | 0.62 | 0.08 |
0.03
| 0.22 |
Symptom scales/items, mean (SD) | ||||||||||||
Fatigue | 45 (31) | 44 (30) | 0.86 | 46 (28) | 40 (27) |
<0.001
| 0.47 | 0.07 | 0.24 | 0.13 |
0.003
| 0.26 |
Nausea and vomiting | 10 (17) | 11 (19) | 0.93 | 10 (17) | 8 (16) |
<0.001
| 0.75 | 0.01 | 0.08 | 0.18 | 0.08 | 0.20 |
Pain | 31 (31) | 30 (31) | 0.33 | 35 (32) | 32 (31) |
<0.01
| 0.24 | 0.12 | 0.37 | 0.08 | 0.98 | 0.04 |
Dyspnea | 27 (33) | 25 (30) | 0.52 | 22 (30) | 19 (27) |
<0.01
| 0.12 | 0.17 |
0.02
| 0.24 | 0.63 | 0.04 |
Insomnia | 31 (34) | 33 (33) | 0.53 | 34 (35) | 32 (33) | 0.31 | 0.39 | 0.09 | 0.88 | 0.01 | 0.30 | 0.12 |
Appetite loss | 33 (38) | 32 (36) | 0.92 | 29 (35) | 23 (32) |
<0.001
| 0.40 | 0.10 |
0.02
| 0.25 | 0.07 | 0.18 |
Constipation | 15 (28) | 19 (30) | 0.47 | 15 (26) | 14 (25) | 0.32 | 0.59 | 0.01 | 0.12 | 0.18 | 0.26 | 0.19 |
Diarrhea | 16 (27) | 14 (26) | 0.57 | 17 (28) | 14 (24) |
<0.001
| 0.65 | 0.04 | 0.64 | 0.01 | 0.36 | 0.06 |
Financial difficulties | 5 (15) | 9 (18) |
<0.01
| 9 (24) | 11 (25) |
0.04
| 0.07 | 0.20 | 0.94 | 0.09 | 0.13 | 0.12 |
Anxiety, depression, SOC and self-rated health over time and in relation to final diagnosis
Cancer | Not cancer | ||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
HADS | Range | Baseline | Follow-up | Difference within groupa
| Baseline | Follow-up | Difference within groupa
| Difference between groups at baselineb
| Difference between groups at follow-upb
| Difference between intra difference within groupsc
| |||
HADS Anxiety, n (%) |
n
=147
|
n
=147
|
p-value
|
n
=519
|
n
=519
|
p-value
|
p-value
|
ES
d
|
p-value
|
ES
d
|
p-value
|
ES
d
| |
Score <8 | 100 (68) | 107 (73) | 338 (65) | 373 (72) | |||||||||
Score ≥8 | 47 (32) | 39 (27) | 181 (35) | 146 (28) | |||||||||
Mean (SD) | 0–21 | 5.6 (4.4) | 5.4 (4.3) | 0.58 | 6.3 (4.5) | 5.4 (4.2) |
<0.001
| 0.09 | 0.16 | 0.84 | 0.02 |
0.01
| 0.20 |
HADS Depression, n (%) |
n
=146
|
n
=146
|
n
=517
|
n
=517
| |||||||||
Score <8 | 113 (77) | 113 (77) | 386 (75) | 397 (77) | |||||||||
Score ≥8 | 33 (23) | 33 (23) | 131 (25) | 120 (23) | |||||||||
Mean (SD) | 0–21 | 4.4 (4.1) | 4.5 (4.3) | 1.00 | 5.0 (4.1) | 4.5 (4.2) | 0.25 | 0.45 | 0.07 | 0.90 | 0.01 | 0.07 | 0.20 |
Sense of Coherence |
n
=133
|
n
=133
|
n
=471
|
n
=471
| |||||||||
SOC Total score, median (IQR) | 13–91 | 76 (68–83) | 75 (67–81) | 0.07 | 73 (61–80) | 73 (62–80) | 0.07 |
0.001
|
0.04
| 0.42 | |||
Self-rated Health | |||||||||||||
Self-rated Health currently, n (%) |
n
=145
|
n
=145
|
n
=523
|
n
=523
| |||||||||
(very) good | 36 (25) | 36 (25) | 0.13 | 96 (18) | 104 (20) | 0.68 | 0.06 | 0.12 | |||||
fair | 47 (32) | 51 (35) | 203 (39) | 216 (41) | 0.08 | 0.21 | |||||||
(very) poor | 62 (43) | 58 (40) | 1.00 | 224 (43) | 203 (39) | 0.23 | 0.49 | 0.85 | 0.22 | ||||
Self-rated Health compared to 3 months, n (%) |
n
=145
|
n
= 145
|
n
=522
|
n
=522
| |||||||||
(very) good | 10 (7) | 24 (17) | 0.12 | 44 (8) | 149 (29) |
<0.001
| 0.73 |
<0.01
| |||||
fair | 54 (37) | 60 (41) | 248 (48) | 264 (50) |
0.03
| 0.06 | |||||||
(very) poor | 81 (57) | 61 (42) |
0.02
| 230 (44) | 109 (21) |
<0.001
|
0.01
|
<0.001
|
<0.01
|
Predictors of quality of life, anxiety, and depression after a known diagnosis
Global QL | |||
---|---|---|---|
Coeff | 95 % CI |
p-value
| |
Intercept | 29.90 | (10.71; 49.09) | 0.002 |
Baseline global QL | 0.38 | (0.28; 0.48) |
<0.001
|
HADS Anxiety at baseline | 0.08 | (−0.42, 0.58) | 0.75 |
HADS Depression at baseline | −1.19 | (−1.81; −0.59) |
<0.001
|
SOC at baseline | 0.13 | (−0.04; 0.30) | 0.13 |
Self-rated health, currently at baseline | |||
(very) good | Reference | ||
fair | −3.13 | (−7.28; 1.03) | 0.14 |
(very) poor | −9.28 | (−14.25; −4.32) |
<0.001
|
Age | 0.21 | (0.04; 0.38) |
0.02
|
Co-morbidity | |||
0 | Reference | ||
1 | −5.14 | (−8.63; −1.66) |
0.004
|
≥2 | −6.28 | (−10.56; −2.01) |
0.004
|
Occupation | |||
Employed | Reference | ||
Unemployed | −8.32 | (−16.16; −0.49) |
0.04
|
Retired/disability/early retirement | −3.97 | (−8.14; 0.19) | 0.06 |
Anxiety | Depression | |||||
---|---|---|---|---|---|---|
OR | 95 % CI |
p-value
| OR | 95 % CI |
p-value
| |
Baseline global QL | 0.98 | (0.96; 0.99) |
0.01
| 0.99 | (0.97; 1.00) | 0.06 |
HADS Anxiety at baseline | ||||||
Score <8 | Reference | Reference | ||||
Score ≥8 | 9.80 | (5.79; 16.60) |
<0.001
| 1.63 | (0.92; 2.89) | 0.09 |
HADS Depression at baseline | ||||||
Score <8 | Reference | Reference | ||||
Score ≥8 | 1.31 | (0.71; 2.43) | 0.39 | 8.70 | (4.70; 16.10) |
<0.001
|
SOC at baseline | 0.96 | (0.93; 0.98) |
<0.001
| 0.96 | (0.94; 0.99) |
0.005
|
Self-rated health, currently at baseline | ||||||
(very) good | Reference | Reference | ||||
fair | 1.16 | (0.53; 2.54) | 0.71 | 2.31 | (0.88; 6.07) | 0.09 |
(very) poor | 1.29 | (0.59; 2.85) | 0.51 | 2.66 | (1.04; 6.78) |
0.04
|
Co-morbidity | ||||||
0 | Reference | Reference | ||||
1 | 1.38 | (0.74; 2.58) | 0.31 | 1.75 | (0.88; 3.46) | 0.11 |
≥2 | 0.85 | (0.42; 1.71) | 0.65 | 2.17 | (1.06; 4.45) |
0.03
|
Follow-up post diagnosis | 0.49 | (0.27; 0.88) |
0.02
| 1.02 | (0.54; 1.96) | 0.94 |