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. 2024 Jul 12;22(6):e247012.
doi: 10.6004/jnccn.2024.7012.

Patient-Reported Quality of Life at Diagnosis in Adolescent and Young Adults With Cancer

Goldy C George  1 , Clark Andersen  2 , Xiaohui Tang  3 , Elizabeth Rodriguez  3   4 , Midhat Jafry  3   4 , Maria C Swartz  5 , Sairah Ahmed  3 , Carlos H Barcenas  6 , J Andrew Livingston  7 , Michael E Roth  5 , Michelle A T Hildebrandt  3
Affiliations

Patient-Reported Quality of Life at Diagnosis in Adolescent and Young Adults With Cancer

Goldy C George et al. J Natl Compr Canc Netw. .

Abstract

Background: The overall landscape of health-related quality of life (HRQoL) has not been thoroughly investigated in adolescents and young adults (AYAs) with cancer. Data are also lacking on how well HRQoL at the time of cancer diagnosis can prognosticate long-term survival in AYA survivors.

Patients and methods: We included 3,497 survivors of AYA cancer (age 15-39 years at diagnosis) who completed the Short-Form 12 Health Survey (SF-12) HRQoL questionnaire at diagnosis. Physical component summary (PCS) and mental component summary (MCS) scores were generated, with scores <50 representing poor HRQoL. Differences in HRQoL by patient characteristics and tumor type were investigated using violin plots and t tests/analysis of variance. The effect of HRQoL on overall survival was assessed using Kaplan-Meier plots and Cox proportional hazards models.

Results: Overall mean PCS and MCS scores in this racially/ethnically diverse cohort (64% White, 19% Hispanic, 10% Black, and 7% other race/ethnicity) were 43.6 and 46.7, respectively. Women with breast cancer reported the most favorable PCS (50.8), and those with cervical cancer reported the lowest MCS (42.8). Age at diagnosis was associated positively with PCS (P<.001) and inversely with MCS (P<.001). Females had higher PCS yet lower MCS than males (both P<.001). Marginalized racial and ethnic populations reported lower PCS than White patients (P<.001). Physical and mental HRQoL were prognostic and associated with increased risk of poor survival (hazard ratio, 1.95; 95% CI, 1.72-2.21 for physical HRQoL, and 1.26; 95% CI, 1.13-1.40 for mental HRQoL).

Conclusions: Physical and mental HRQoL at diagnosis vary across patient characteristics in AYA cancer survivors. Poor HRQoL at diagnosis may be a prognosticator of diminished overall survival among AYA cancer survivors.

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Conflict of interest statement

CONFLICTS OF INTEREST

The authors declare no conflicts of interest.

Figures

Figure 1:
Figure 1:. PCS and MCS scores at diagnosis and overall survival in AYA cancer patients.
A) Distribution of PCS scores; B) Survival curves stratified by PCS +/− 50; C) Distribution of MCS scores; D) Survival curves stratified by MCS +/−50. Solid line – PCS/MCS ≥50, dotted line – PCS/MCS <50.
Figure 2:
Figure 2:. PCS and MCS scores and overall survival in AYA cancer patients by tumor type.
A) Overall survival by tumor type; B) Survival curves stratified by PCS +/−50; C) Survival curves stratified by MCS +/−50. Solid line – PCS/MCS ≥50, dotted line – PCS/MCS <50.
Figure 3:
Figure 3:. PCS and MCS scores and overall survival in AYA cancer patients by race/ethnicity.
A) Overall survival by race/ethnicity; B) Survival curves stratified by PCS +/−50; C) Survival curves stratified by MCS +/−50. Solid line – PCS/MCS ≥50, dotted line – PCS/MCS <50.
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