research paper
Psychosocial factors associated with impact of cancer in longterm haematological cancer survivors
Ania Korszun,1 Shah-Jalal Sarker,2 Kashfia Chowdhury,2 Charlotte Clark,1 Paul Greaves,3 Rachel Johnson,3 Judith Kingston,3 Gill Levitt,4 Janet Matthews,3 Peter White,1 Andrew Lister3 and John Gribben3 1
Centre for Psychiatry, Wolfson Institute of
Preventive Medicine, Queen Mary University of London, 2Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, 3Centre for HaematoOncology, Barts Cancer Institute, Barts and The London Medical School, Queen Mary University of London, and 4Oncology Great Ormond Street Hospital Trust, London, UK Received 16 August 2013; accepted for publication 1 November 2013 Correspondence: Professor Ania Korszun, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK. E-mail: [email protected]
Summary To assess the impact of cancer (IOC) on subsequent quality of life (QOL), 718 long-term haematological cancer survivors completed validated psychosocial, functional and QOL scales, including IOC. Fifteen percent reported significant psychological distress, 18% high levels of fatigue and 10% moderate to severe functional impairment. These groups of participants also showed poorer QOL. There were no significant differences in psychological distress (P = 076), fatigue (P = 023) or functional impairment (P = 074) across different cancer subtypes. Two separate hierarchical regression analyses examined the combined association of disease-type, psychosocial and other factors on negative and positive IOC scores respectively. Higher negative IOC scores were significantly associated (P ≤ 0001) with medical comorbidity, psychological distress, lower social support, high fatigue levels and functional impairment. Paediatric patients (diagnosed at 15 are highly suggestive of a depressive disorder. Past studies report good validity when used in cancer patients (Ibbotson et al, 1994; Mitchell et al, 2010). 3 Chalder fatigue questionnaire (CFQ) (Chalder et al, 1993): an established measure assessing fatigue severity over the past month. It consists of 11 items with a total score range of 0–33. Fatigue scores were dichotomized using a cut-off of 188 on the basis of one standard deviation (SD) above the mean fatigue score reported in the general population (Cella & Chalder, 2010). 791
A. Korszun et al
Fig 1. Consort diagram for study participants.
4 Social support inventory (SSI) (Mitchell et al, 2003): a 7-item validated instrument for assessing social support. It identifies items regarding structural (partner), instrumental (tangible help) and emotional (caring) support and correlates well with the much longer Perceived Social Support Scale. The categories range from 1 (none of the time) to 5 (all of the time), with item 7 (living with spouse) scored 4 for ‘yes’ and 2 for ‘no’. The total score was divided into tertiles for analyses, indicating high (score of 25), medium (scores of 20–24), and low levels of social support (score below 20). High social support was the reference group. 5 Work and social adjustment scale (WSAS) (Mundt et al, 2002): a reliable and valid 5-item measure of impaired functioning. Each item is rated as 0–8 points (ranging 792
from no impairment to severe impairment) giving a total range of 0–40. A WSAS score above 20 indicates moderate to severe impairment, scores between 10–20 significant but less severe impairment and scores below 10 are associated with little or no impairment (Mundt et al, 2002). 6 Socio-demographic and clinical characteristics: these included participants’ self-reported age, sex, educational attainment [classified as low (no qualifications from school), medium (qualification from school or equivalent Higher National Certificate or vocational training), or high (High vocational training, university or professional qualification)], ethnicity, relationship status and whether they had past history of depression and other medical conditions (including heart disease, high blood pressure, lung disease, non-haematological cancer or arthritis). ª 2013 John Wiley & Sons Ltd British Journal of Haematology, 2014, 164, 790–803
Impact of Cancer in Haematological Cancer Survivors Clinical details (date of diagnosis, stage of cancer and primary and follow-up treatments, recurrences, i.e. recorded to have had treatment for a second event) were obtained from Barts Medical Oncology Unit database.
Table I. Patient characteristics. Factors
Patient characteristics
Disease type
Disease HL Indolent NHL Aggressive NHL AL Years since diagnosis 5–9 10–19 20–29 30+ Mean (SD) Age at diagnosis (years) 0–16 17–34 35–50 50+ Mean (SD) Sex Male Female Ethnicity Non-white White Education Low Medium High Relationship status Married/living with partner Widowed/divorced/seperated/single History of depression No Yes Comorbidity None 1 2 >2 HADS ≤15 >15 Social support High Medium Low Fatigue Normal High Level of function Normal Some impairment Moderate to severe impairment Recurrence No Yes
Statistical methods When calculating scale scores for a patient, the mean of nonmissing items for that patient was imputed to replace missing items if the percentage of missing items forming the scale was
Psychosocial factors associated with impact of cancer in longterm haematological cancer survivors
Ania Korszun,1 Shah-Jalal Sarker,2 Kashfia Chowdhury,2 Charlotte Clark,1 Paul Greaves,3 Rachel Johnson,3 Judith Kingston,3 Gill Levitt,4 Janet Matthews,3 Peter White,1 Andrew Lister3 and John Gribben3 1
Centre for Psychiatry, Wolfson Institute of
Preventive Medicine, Queen Mary University of London, 2Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, 3Centre for HaematoOncology, Barts Cancer Institute, Barts and The London Medical School, Queen Mary University of London, and 4Oncology Great Ormond Street Hospital Trust, London, UK Received 16 August 2013; accepted for publication 1 November 2013 Correspondence: Professor Ania Korszun, Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK. E-mail: [email protected]
Summary To assess the impact of cancer (IOC) on subsequent quality of life (QOL), 718 long-term haematological cancer survivors completed validated psychosocial, functional and QOL scales, including IOC. Fifteen percent reported significant psychological distress, 18% high levels of fatigue and 10% moderate to severe functional impairment. These groups of participants also showed poorer QOL. There were no significant differences in psychological distress (P = 076), fatigue (P = 023) or functional impairment (P = 074) across different cancer subtypes. Two separate hierarchical regression analyses examined the combined association of disease-type, psychosocial and other factors on negative and positive IOC scores respectively. Higher negative IOC scores were significantly associated (P ≤ 0001) with medical comorbidity, psychological distress, lower social support, high fatigue levels and functional impairment. Paediatric patients (diagnosed at 15 are highly suggestive of a depressive disorder. Past studies report good validity when used in cancer patients (Ibbotson et al, 1994; Mitchell et al, 2010). 3 Chalder fatigue questionnaire (CFQ) (Chalder et al, 1993): an established measure assessing fatigue severity over the past month. It consists of 11 items with a total score range of 0–33. Fatigue scores were dichotomized using a cut-off of 188 on the basis of one standard deviation (SD) above the mean fatigue score reported in the general population (Cella & Chalder, 2010). 791
A. Korszun et al
Fig 1. Consort diagram for study participants.
4 Social support inventory (SSI) (Mitchell et al, 2003): a 7-item validated instrument for assessing social support. It identifies items regarding structural (partner), instrumental (tangible help) and emotional (caring) support and correlates well with the much longer Perceived Social Support Scale. The categories range from 1 (none of the time) to 5 (all of the time), with item 7 (living with spouse) scored 4 for ‘yes’ and 2 for ‘no’. The total score was divided into tertiles for analyses, indicating high (score of 25), medium (scores of 20–24), and low levels of social support (score below 20). High social support was the reference group. 5 Work and social adjustment scale (WSAS) (Mundt et al, 2002): a reliable and valid 5-item measure of impaired functioning. Each item is rated as 0–8 points (ranging 792
from no impairment to severe impairment) giving a total range of 0–40. A WSAS score above 20 indicates moderate to severe impairment, scores between 10–20 significant but less severe impairment and scores below 10 are associated with little or no impairment (Mundt et al, 2002). 6 Socio-demographic and clinical characteristics: these included participants’ self-reported age, sex, educational attainment [classified as low (no qualifications from school), medium (qualification from school or equivalent Higher National Certificate or vocational training), or high (High vocational training, university or professional qualification)], ethnicity, relationship status and whether they had past history of depression and other medical conditions (including heart disease, high blood pressure, lung disease, non-haematological cancer or arthritis). ª 2013 John Wiley & Sons Ltd British Journal of Haematology, 2014, 164, 790–803
Impact of Cancer in Haematological Cancer Survivors Clinical details (date of diagnosis, stage of cancer and primary and follow-up treatments, recurrences, i.e. recorded to have had treatment for a second event) were obtained from Barts Medical Oncology Unit database.
Table I. Patient characteristics. Factors
Patient characteristics
Disease type
Disease HL Indolent NHL Aggressive NHL AL Years since diagnosis 5–9 10–19 20–29 30+ Mean (SD) Age at diagnosis (years) 0–16 17–34 35–50 50+ Mean (SD) Sex Male Female Ethnicity Non-white White Education Low Medium High Relationship status Married/living with partner Widowed/divorced/seperated/single History of depression No Yes Comorbidity None 1 2 >2 HADS ≤15 >15 Social support High Medium Low Fatigue Normal High Level of function Normal Some impairment Moderate to severe impairment Recurrence No Yes
Statistical methods When calculating scale scores for a patient, the mean of nonmissing items for that patient was imputed to replace missing items if the percentage of missing items forming the scale was
