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. 2019 Feb;12(2):79-88.
doi: 10.1158/1940-6207.CAPR-18-0277. Epub 2019 Jan 3.

Changes in Health and Wellbeing in the Years Leading up to a Cancer Diagnosis: A Prospective Cohort Study

Sarah E Jackson  1 , Kate Williams  2   3 , Rebecca J Beeken  2 , Andrew Steptoe  2
Affiliations

Changes in Health and Wellbeing in the Years Leading up to a Cancer Diagnosis: A Prospective Cohort Study

Sarah E Jackson et al. Cancer Prev Res (Phila). 2019 Feb.

Abstract

Emerging evidence suggests cancer survivors suffer impairments in health and wellbeing that predate their diagnosis. This study prospectively examined changes from 4 to 6 years prediagnosis to 0 to 2 years postdiagnosis. Data were from 477 cancer survivors and 5,451 cancer-free comparisons participating in the English Longitudinal Study of Ageing. We examined group-by-time interactions for self-rated health, quality of life (QoL), depression, life satisfaction and impairments in mobility, activities of daily living (ADL), and instrumental ADLs (IADL). All health and wellbeing markers worsened over time in both groups. A greater decline in cancer survivors' self-rated health was evident as early as 2 to 4 years prediagnosis (P < 0.001). Around diagnosis, there were greater declines in IADL impairment (P < 0.001), QoL (P < 0.001), and depression (P < 0.001) in cancer survivors than in controls. Mobility and ADL impairments were consistently more prevalent among cancer survivors (P < 0.001), and life satisfaction was consistently lower (P = 0.004), but the rate of change over time did not differ significantly between groups. These results suggest there may be early signs of deterioration in perceived health that precede development of symptoms leading to cancer diagnosis by many years. Some of the impaired wellbeing in cancer patients may be long-standing, while other changes are more acute and may require targeted support following diagnosis.

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Conflict of interest statement

Conflict of interest: All authors report no conflicts of interest.

Figures

Figure 1.
Figure 1.. Global health by group and time.
Figure 1 shows the mean self-rated health (with 95% confidence intervals) for each group at each time point (adjusted for age, sex, wealth and diagnosis wave). *p<.05, **p<.01, ***p<.001 for the difference between the cancer survivor group and comparison group at each time point.
Figure 2.
Figure 2.. Physical function by group and time.
Figure 2 shows the proportion with (A) mobility impairments, (B) ADL impairments and (C) IADL impairments (with 95% confidence intervals) for each group at each time point (adjusted for age, sex, wealth and diagnosis wave). *p<.05, **p<.01, ***p<.001 for the difference between the cancer survivor group and comparison group at each time point.
Figure 3.
Figure 3.. Quality of life by group and time.
Figure 3 shows the mean quality of life score (with 95% confidence intervals) for each group at each time point (adjusted for age, sex, wealth and diagnosis wave). Note: the y-axis begins at 37 rather than 0, to allow for easy visibility of results. *p<.05, **p<.01, ***p<.001 for the difference between the cancer survivor group and comparison group at each time point.
Figure 4.
Figure 4.. Psychological wellbeing by group and time.
Figure 4 shows (A) the proportion with depressive symptoms and (B) the mean life satisfaction score (with 95% confidence intervals) for each group at each time point (adjusted for age, sex, wealth and diagnosis wave). Note: the y-axis for Figure 4B begins at 16.5 rather than 0, to allow for easy visibility of results. *p<.05, **p<.01, ***p<.001 for the difference between the cancer survivor group and comparison group at each time point.
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