Outcomes/Effectiveness Research

Cancer survivors often have long-term health limitations and lost productivity associated with their disease

Early diagnosis and treatment have led to improved survival of cancer patients. These cancer survivors have worse health, more lost productivity, and poorer quality of life than similar individuals who have not had cancer, according to a new study by K. Robin Yabroff, Ph.D., M.B.A., of the National Cancer Institute (NCI), William F. Lawrence, M.D., M.S., of the Center for Outcomes and Evidence, Agency for Healthcare Research and Quality, and their NCI colleagues.

The researchers identified a total of 1,823 cancer survivors and 5,469 matched controls from the 2000 National Health Interview Survey. They compared multiple measures of disease burden among the two groups and stratified subgroups by tumor site and time since diagnosis.

Cancer survivors had poorer quality of life than matched controls, indicated by lower utility values (0.74 vs. 0.80 with 1.0 representing perfect health) and more lost work days, and they were more likely to report fair or poor health (31 vs. 18 percent). These findings were consistent across tumor site and time since diagnosis. Contrary to expectations, long-term cancer survivors, even 11 or more years after diagnosis, had significantly lower utility values and more health problems than controls across multiple measures.

Some studies have reported few differences in health limitations between long-term disease-free cancer survivors and controls. However, even survivors without recurrences may experience lasting effects of initial treatment. For example, several studies have reported that men undergoing surgery for localized prostate cancer may continue to experience incontinence and impotence well beyond the initial treatment period. In the current study, survivors of lung and other short-survival cancers or of cancer at multiple sites reported greater burden than did survivors of breast, colorectal, prostate, and all other cancers. Other factors, such as systemic treatment, influenced health limitations for survivors.

More details are in "Burden of illness in cancer survivors: Findings from a population-based national sample," by Drs. Yabroff and Lawrence, Steven Clauser, Ph.D., and others, in the September 1, 2004, Journal of the National Cancer Institute 96(17), pp. 1322-1330.

Reprints (AHRQ Publication No. 04-R068) are available from the AHRQ Publications Clearinghouse.

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