Exploring the interconnectedness between health-related quality of life factors among long-term adolescent and young adult cancer survivors (AYAs): a network analysis

Abstract

Purpose: Adolescent and young adult cancer survivors (AYAs) are at increased risk of long-term and late effects, and experience unmet needs, impacting their health-related quality of life (HRQoL). In order to provide and optimize supportive care and targeted interventions for this unique population, it is important to study HRQoL factors' interconnectedness on a population level. Therefore, this network analysis was performed with the aim to explore the interconnectedness between HRQoL factors, in the analysis described as nodes, among long-term AYAs.

Methods: This population-based cohort study used cross-sectional survey data of long-term AYAs, who were identified by the Netherlands Cancer Registry (NCR). Participants completed a one-time survey (SURVAYA study), including the EORTC survivorship questionnaire (QLQ-SURV111) to assess their long-term HRQoL outcomes and sociodemographic characteristics. The NCR provided the clinical data. Descriptive statistics and a network analysis, including network clustering, were performed.

Results: In total, 3596 AYAs (on average 12.4 years post diagnosis) were included in our network analysis. The network was proven stable and reliable and, in total, four clusters were identified, including a worriment, daily functioning, psychological, and sexual cluster. Negative health outlook, part of the worriment cluster, was the node with the highest strength and its partial correlation with health distress was significantly different from all other partial correlations.

Conclusion: This study shows the results of a stable and reliable network analysis based on HRQoL data of long-term AYAs, and identified nodes, correlations, and clusters that could be intervened on to improve the HRQoL outcomes of AYAs.

Keywords: Adolescents and young adults; Cancer; HRQoL; Network analysis; Questionnaire study; Survivorship.

Fig. 1

The (cluster) network of HRQoL outcomes of long-term AYA cancer survivors. In this partial correlation network model, the nodes (PF: physical functioning, CF: cognitive functioning, EF: emotional functioning, RF: role functioning, BI: body image, SA: symptom awareness, SF: sexual functioning, FA: fatigue, SL: sleep problems, PA: pain, Sif: social interference, HD: health distress, NHO: negative health outlook, SI: social isolation, SC: symptom checklist, SP: sexual problems, FD: financial difficulties, WF: worried about family getting cancer, TD: people treating you differently, QL: overall quality of life) represent all the HRQoL scales of the QLQ-SURV111 and the edges (links connecting two nodes) represent the regularized partial correlation coefficients after controlling for all other nodes. The blue color indicates a positive partial correlation and a red color a negative partial correlation between two nodes. The thickness of the edge visualizes the strength of the partial correlation between two nodes. The four clusters that we identified within our network model include in orange the worriment cluster, in yellow the daily functioning cluster, in pink the psychological cluster, and in green the sexual cluster

Fig. 2

Bootstrapped confidence intervals of estimated edge weights. Each horizontal line represents one edge of the network, ordered from the edge with the highest edge weight to the edge with the lowest edge weight. The red line indicates the sample values and the gray lines are the bootstrapped CIs. The larger the gray line the less certain the edge value is

Fig. 3

Correlational stability plot of centrality indices by case-dropping subset bootstrap. Correlations between centrality indices of network sampled with persons dropped and the original sample. Lines indicate the means and areas indicate the range from the 2.5th quantile to the 97.5th quantile

Fig. 4

Central indices of the network. Centrality indices are shown as standardized z-scores. PF: physical functioning, CF: cognitive functioning, EF: emotional functioning, RF: role functioning, BI: body image, SA: symptom awareness, SF: sexual functioning, FA: fatigue, SL: sleep problems, PA: pain, Sif: social interference, HD: health distress, NHO: negative health outlook, SI: social isolation, SC: symptom checklist, SP: sexual problems, FD: financial difficulties, WF: worried about family getting cancer, TD: people treating you differently, QL: overall quality of life