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

doi:10.1002/cam4.6596

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 for this work

Danish Cancer Institute
Zealand University Hospital, Roskilde
University of Copenhagen
Aarhus University Hospital
Danish Breast Cancer Group Center and Clinic for Late Effects
Rigshospitalet
Copenhagen University Hospital
The Netherlands Cancer Institute
Tilburg University

Research output: Contribution to journal › Journal article › Research › peer-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.

Original language	English
Journal	Cancer Medicine
Volume	12
Issue number	19
Pages (from-to)	20150-20162
ISSN	2045-7634
DOIs	https://doi.org/10.1002/cam4.6596
Publication status	Published - Oct 2023

Funding

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). 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.

Keywords

cancer survivorship
health-related quality of life
social inequality
Denmark/epidemiology
Cross-Sectional Studies
Humans
Quality of Life
Male
Surveys and Questionnaires
Socioeconomic Factors
Colonic Neoplasms
Cancer Survivors/psychology

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Levinsen, A. K. G., Kjaer, T. K., Thygesen, L. C., Maltesen, T., Jakobsen, E., Gögenur, I., Borre, M., Christiansen, P., Zachariae, R., Christensen, P., Laurberg, S., de Nully Brown, P., Hölmich, L. R., Johansen, C., Kjær, S. K., van de Poll-Franse, L., Saltbæk, L., & Dalton, S. O. (2023). Social inequality in cancer survivorship: Educational differences in health-related quality of life among 27,857 cancer survivors in Denmark. Cancer Medicine, 12(19), 20150-20162. https://doi.org/10.1002/cam4.6596

@article{a49b1ece198f473c86e7c62cd3603c2b,

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

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.",

keywords = "cancer survivorship, health-related quality of life, social inequality, Denmark/epidemiology, Cross-Sectional Studies, Humans, Quality of Life, Male, Surveys and Questionnaires, Socioeconomic Factors, Colonic Neoplasms, Cancer Survivors/psychology",

author = "Levinsen, \{Anne Katrine Graudal\} and Kjaer, \{Trille Kristina\} and Thygesen, \{Lau Caspar\} and Thomas Maltesen and Erik Jakobsen and Ismail G{\"o}genur and Michael Borre and Peer Christiansen and Robert Zachariae and Peter Christensen and S{\o}ren Laurberg and \{de Nully Brown\}, Peter and H{\"o}lmich, \{Lisbet Rosenkrantz\} and Christoffer Johansen and Kj{\ae}r, \{Susanne K.\} and \{van de Poll-Franse\}, Lonneke and Lena Saltb{\ae}k and Dalton, \{Susanne Oksbjerg\}",

note = "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: {\textcopyright} 2023 The Authors. Cancer Medicine published by John Wiley \& Sons Ltd.",

year = "2023",

month = oct,

doi = "10.1002/cam4.6596",

language = "English",

volume = "12",

pages = "20150--20162",

journal = "Cancer Medicine",

issn = "2045-7634",

publisher = "Wiley",

number = "19",

}

Levinsen, AKG, Kjaer, TK, Thygesen, LC, Maltesen, T, Jakobsen, E, Gögenur, I, Borre, M, Christiansen, P, Zachariae, R, Christensen, P, Laurberg, S, de Nully Brown, P, Hölmich, LR, Johansen, C, Kjær, SK, van de Poll-Franse, L, Saltbæk, L & Dalton, SO 2023, 'Social inequality in cancer survivorship: Educational differences in health-related quality of life among 27,857 cancer survivors in Denmark', Cancer Medicine, vol. 12, no. 19, pp. 20150-20162. https://doi.org/10.1002/cam4.6596

Social inequality in cancer survivorship: Educational differences in health-related quality of life among 27,857 cancer survivors in Denmark. / Levinsen, Anne Katrine Graudal; Kjaer, Trille Kristina; Thygesen, Lau Caspar et al.
In: Cancer Medicine, Vol. 12, No. 19, 10.2023, p. 20150-20162.

Research output: Contribution to journal › Journal article › Research › peer-review

TY - JOUR

T1 - Social inequality in cancer survivorship

T2 - Educational differences in health-related quality of life among 27,857 cancer survivors in Denmark

AU - Levinsen, Anne Katrine Graudal

AU - Kjaer, Trille Kristina

AU - Thygesen, Lau Caspar

AU - Maltesen, Thomas

AU - Jakobsen, Erik

AU - Gögenur, Ismail

AU - Borre, Michael

AU - Christiansen, Peer

AU - Zachariae, Robert

AU - Christensen, Peter

AU - Laurberg, Søren

AU - de Nully Brown, Peter

AU - Hölmich, Lisbet Rosenkrantz

AU - Johansen, Christoffer

AU - Kjær, Susanne K.

AU - van de Poll-Franse, Lonneke

AU - Saltbæk, Lena

AU - Dalton, Susanne Oksbjerg

N1 - 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.

PY - 2023/10

Y1 - 2023/10

N2 - 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.

AB - 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.

KW - cancer survivorship

KW - health-related quality of life

KW - social inequality

KW - Denmark/epidemiology

KW - Cross-Sectional Studies

KW - Humans

KW - Quality of Life

KW - Male

KW - Surveys and Questionnaires

KW - Socioeconomic Factors

KW - Colonic Neoplasms

KW - Cancer Survivors/psychology

U2 - 10.1002/cam4.6596

DO - 10.1002/cam4.6596

M3 - Journal article

C2 - 37772475

AN - SCOPUS:85173433563

SN - 2045-7634

VL - 12

SP - 20150

EP - 20162

JO - Cancer Medicine

JF - Cancer Medicine

IS - 19

ER -

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

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