Psychosocial Factors and Impact Of Cancer In British Long-Term Haematological Cancer Survivors
Authors: Korszun Ania , Sarker Shah-Jalal , Chowdhury Kashfia , Clark Charlotte , Greaves Paul , Johnson Rachel , Kingston Judith , Levitt Gill , Matthews Janet , White Peter , Lister Andrew , Gribben John 
Published: October 2019

Abstract

Background
Long-term cancer survivors can experience a variety of adverse physical late effects of cancer therapy. However, psychological, e.g. depression and anxiety, and social problems can also have profoundly adverse effects on patients’ quality of life (QOL) that may not be adequately addressed in the management of long-term survivors.
This study examines the effect and interaction of several disease-related, social and psychological factors on QOL in 718 British long-term haematological cancer survivors (5-40 years), who had all been treated at a single centre over 50 years.

Objectives
(1) to measure the prevalence of psychological distress (depression, anxiety), functioning, and fatigue in this survivor group compared to rates in the UK population and other survivor groups,
(2) to investigate the effect of cancer and cancer treatment on QOL and psychological and social functioning,
(3) to identify psychosocial factors associated with poorer QOL outcome.

Patients and Methods
Ethical approval obtained from the National Research Ethics Service Ref: 11/NE/0095
All patients, aged ≥18 years at time of entry into study, with a confirmed diagnosis of haematological malignancy and alive ≥5 years since initial diagnosis, and who had received treatment at St. Bartholomew’s Hospital, London (n=1,279) were sent a questionnaire comprising questions on physical health and validated psychosocial, functional and QOL scales, including negative and positive impact of cancer (IOC). Responses were received from 718 (response rate = 56%) patients (280 Hodgkin’s Lymphoma (HL), 326 Non-Hodgkin’s lymphoma (NHL) [109 Diffuse Large B- Lymphoma (DLBCL), 128 Follicular Lymphoma (FL), 89 other NHL (ONHL)], and 112 Acute Leukaemia (AL)).

Statistical Analysis
QOL measures were compared to normal population and other cancer survivor groups. Two separate hierarchical regression analyses were conducted to examine the combined association of the disease type, socio-demographics, psychological and other factors, including cancer recurrence, on negative and positive IOC scores respectively.

Results
Survivors had poorer QOL than the general population and 15% had levels of psychological distress indicative of a clinical depressive disorder, 18% high levels of fatigue and 10% moderate to severe impairment in functioning; all these groups showed poorer QOL. There were no statistically significant differences in psychological distress (P=0.76), fatigue levels (P=0.23) or levels of functioning (P=0.74) across different cancer diagnostic groups.
Higher Negative IOC scores were significantly associated (P<0.001) with the presence of medical comorbidity, depression, low or medium level of social support, a high level of fatigue and functional impairment. Greater age at diagnosis and number of years since diagnosis were significantly (P<0.001) associated with less negative IOC. Higher positive impact scores were associated with an AL diagnosis (P=0.01) ; lower positive IOC scores were associated with white ethnicity (P<0.001), a high level of education (P=0.003), not having a partner (P=0.01), depression(P=0.04), and a low level of social support (P=0.01).

Conclusion
The impact of cancer on survivors’ lives is influenced by a variety of factors. By using a simple means of screening for medical comorbidity, depression and fatigue the group that needs most support could be identified early, allowing appropriate interventions to improve QOL-related measures and promote well-being by addressing both negative and positive impact of cancer.

Acknowledgments
We are grateful for the support of
Macmillan Cancer Support
Greg Woolf Foundation
Cancer Research UK
Barts and The London NHS Trust

Disclosures:
No relevant conflicts of interest to declare.