Social inequality in cancer survivorship: Educational differences in health-related quality of life among 27,857 cancer survivors in Denmark

Anne Katrine Graudal Levinsen*, Trille Kristina Kjaer, Lau Caspar Thygesen, Thomas Maltesen, Erik Jakobsen, Ismail Gögenur, Michael Borre, Peer Christiansen, Robert Zachariae, Peter Christensen, Søren Laurberg, Peter de Nully Brown, Lisbet Rosenkrantz Hölmich, Christoffer Johansen, Susanne K. Kjær, Lonneke van de Poll-Franse, Lena Saltbæk, Susanne Oksbjerg Dalton

*Corresponding author af dette arbejde

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

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Abstract

Background
With a growing population of cancer survivors in Denmark, the evaluation of health-related quality of life (HRQoL) has become increasingly important. We describe variations in HRQoL between educational groups in a national population of cancer survivors.

Methods
We conducted a cross-sectional questionnaire study among breast, prostate, lung, and colon cancer survivors diagnosed in 2010–2019 in Denmark. We used the EORTC QLQ-C30 to assess HRQoL including physical, role, emotional, cognitive, social functioning, and symptoms (fatigue, nausea and vomiting, pain, dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties). Information on educational level and clinical data were extracted from national registers and clinical databases. Levels of impaired functioning and severe symptoms were identified using newly established thresholds for clinical importance. Multivariate logistic regression was used to examine associations between education and HRQoL. All statistical tests were 2-sided.

Results
In total, 27,857 (42%) participated in the study. Up to 72% and 75% of cancer survivors with short education (≤9 years) reported impaired functioning and severe symptoms, respectively. Cancer survivors with short compared to long education (>12 years) were more likely to report impaired functioning and severe symptoms, with for example significantly higher odds ratios (ORs) for impaired physical function (breast OR = 2.41, 99% CI = 2.01–2.89; prostate OR = 1.81, 99% CI = 1.48–2.21; lung OR = 2.97, 99% CI = 1.95–4.57; and colon cancer OR = 1.69, 99% CI = 1.28–2.24).

Conclusions
Cancer survivors with short education are at greater risk of impaired HRQoL than survivors with long education 2–12 years after diagnosis. This underscores the need for systematic screening and symptom management in cancer aftercare, in order to reach all cancer survivors, also cancer survivors with short education.
OriginalsprogEngelsk
TidsskriftCancer Medicine
Vol/bind12
Udgave nummer19
Sider (fra-til)20150-20162
Antal sider13
ISSN2045-7634
DOI
StatusUdgivet - 2023

Bibliografisk note

Funding Information:
We thank the Danish National Clinical Quality Cancer Databases for access to their data: the Danish Breast Cancer Cooperative Group Database, the Danish Prostate Cancer Database, the Danish Lung Cancer Registry, and the Danish Colorectal Cancer Group Database. We thank the Novo Nordisk Foundation, the Danish Cancer Society and Helsefonden for funding our research. The funders did not play a role in the design of the study; the collection, analysis, and interpretation of the data; the writing of the manuscript; and the decision to submit the manuscript for publication.

Funding Information:
This work was supported by the Novo Nordisk Foundation (number NNF18OC0052543); the Danish Cancer Society “Videnskabelige Udvalg” (number R269‐A15811); and Helsefonden (number 20‐B‐0434).

Funding Information:
We thank the Danish National Clinical Quality Cancer Databases for access to their data: the Danish Breast Cancer Cooperative Group Database, the Danish Prostate Cancer Database, the Danish Lung Cancer Registry, and the Danish Colorectal Cancer Group Database. We thank the Novo Nordisk Foundation, the Danish Cancer Society and Helsefonden for funding our research. The funders did not play a role in the design of the study; the collection, analysis, and interpretation of the data; the writing of the manuscript; and the decision to submit the manuscript for publication.

Publisher Copyright:
© 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

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