Health status of middle-aged and elderly cancer survivors in China

doi:10.5246/jcps.2023.09.061

Abstract

Abstract:

There is a growing population of cancer survivors, and their health poses a significant challenge for the Chinese healthcare system. However, research related to this topic remains limited. In the present study, we presented an overview of the health status of middle-aged and elderly cancer survivors in China and investigated the association between cancer history and health status. To conduct our research, we utilized data from the China Health and Retirement Longitudinal Study (CHARLS), where we identified cancer survivors and individuals without a history of cancer. We evaluated the self-reported health, depression levels, and activities of daily living of both groups using survey data collected in 2018. We performed intergroup analysis using chi-squared tests and logistic regression. The analysis included 447 cancer survivors and 19 051 respondents without a history of cancer. In comparison to those without cancer history, cancer survivors exhibited higher rates of poor health (90.2% vs. 76.6%, P < 0.001), depression (43.6% vs. 34.3%, P < 0.001), and inadequate daily activities (46.5% vs. 29.1%, P < 0.001). After adjusting for respondents’ demographic characteristics, disease status, and health behaviors, we found that a history of cancer was significantly associated with worse self-reported health (OR 1.62; 95% CI, 1.38–1.96, P < 0.001), a higher risk of depression (OR 1.21; 95% CI, 1.10–1.34, P < 0.001), and insufficient activities of daily living (OR 1.43; 95% CI, 1.29–1.58, P < 0.001). Our findings indicated that cancer survivors aged over 45 in China experience poorer physical and psychological conditions, underscoring the need for considerate support and care.

Key words: Cancer survivors, Health status, Depression, CHARLS

Supporting:

Haoxin Du, Qi Bao, Huangqianyu Li, Yichen Zhang, Haishaerjiang Wushouer, Luwen Shi, Xiaodong Guan. Health status of middle-aged and elderly cancer survivors in China[J]. Journal of Chinese Pharmaceutical Sciences, 2023, 32(9): 744-754.

Figures/Tables 2

References 35

[1]	Chen, W.Q.; Zheng, R.; Baade, P.; Zhang, S.W.; Zeng, H.; Bray, F.; Jemal, A.; Yu, X.; He, J. Cancer statistics in China, 2015. CA Cancer J. Clin. 2016, 66, 115–132.
[2]	International Agency for Research on Center of World Health Organization. https://gco.iarc.fr/today/online-analysis-map (accessed June 1).
[3]	Liu, X.T.; Wong, H.; Liu, K. Outcome-based health equity across different social health insurance schemes for the elderly in China. BMC Health Serv. Res. 2016, 16, 9.
[4]	Wu, C.C.; Li, M.N.; Meng, H.B.; Liu, Y.K.; Niu, W.H.; Zhou, Y.; Zhao, R.; Duan, Y.M.; Zeng, Z.Y.; Li, X.L.; Li, G.Y.; Xiong, W.; Zhou, M. Analysis of status and countermeasures of cancer incidence and mortality in China. Sci. China Life Sci. 2019, 62, 640–647.
[5]	Miller, K.D.; Nogueira, L.; Mariotto, A.B.; Rowland, J.H.; Yabroff, K.R.; Alfano, C.M.; Jemal, A.; Kramer, J.L.; Siegel, R.L. Cancer treatment and survivorship statistics, 2019. CA Cancer J. Clin. 2019, 69, 363–385.
[6]	World Health Organization-Mental health. https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response.
[7]	Keating, N.L.; Nørredam, M.; Landrum, M.B.; Huskamp, H.A.; Meara, E. Physical and mental health status of older long-term cancer survivors. J. Am. Geriatr. Soc. 2005, 53, 2145–2152.
[8]	Yao, N.L.; Zhang, N.; Wang, J.L.; Anderson, R.T.; Liu, X.T.; Lyu, J.R.; Du, X.W.; Sun, X.J. Experiences with cancer survey in China. Cancer. 2019, 125, 3068–3078.
[9]	Sulicka, J.; Pac, A.; Puzianowska-Kuźnicka, M.; Zdrojewski, T.; Chudek, J.; Tobiasz-Adamczyk, B.; Mossakowska, M.; Skalska, A.; Więcek, A.; Grodzicki, T. Health status of older cancer survivors—results of the PolSenior study. J. Cancer Surviv. 2018, 12, 326–333.
[10]	Atere-Roberts, J.; Gray, S.C.; Hall, I.J.; Smith, J.L. Racial and ethnic disparities in health status, chronic conditions, and behavioral risk factors among prostate cancer survivors, United States, 2015. Prev. Chronic. Dis. 2021, 18, 200523.
[11]	Suh, E.; Stratton, K.L.; Leisenring, W.M.; Nathan, P.C.; Ford, J.S.; Freyer, D.R.; McNeer, J.L.; Stock, W.; Stovall, M.; Krull, K.R.; Sklar, C.A.; Neglia, J.P.; Armstrong, G.T.; Oeffinger, K.C.; Robison, L.L.; Henderson, T.O. Late mortality and chronic health conditions in long-term survivors of early-adolescent and young adult cancers: a retrospective cohort analysis from the Childhood Cancer Survivor Study. Lancet Oncol. 2020, 21, 421–435.
[12]	Tobin, J.; Cockburn, M.; Unger, J.B.; Finch, B.K.; Hamilton, A.S.; Ritt-Olson, A.; Milam, J.E. Acculturation, mental health, and wellbeing among hispanic/latinx young adult survivors of childhood cancer. J. Adolesc. Young Adult Oncol. 2022, 11, 223–228.
[13]	Balcerek, M.; Sommerhäuser, G.; Schilling, R.; Hölling, H.; Klco-Brosius, S.; Borgmann-Staudt, A. Health-related quality of life of children born to childhood cancer survivors in Germany. Psycho-Oncology. 2021, 30, 1866–1875.
[14]	Zhao, Y.H.; Hu, Y.S.; Smith, J.P.; Strauss, J.; Yang, G.H. Cohort profile: the China health and retirement longitudinal study (CHARLS). Int. J. Epidemiol. 2014, 43, 61–68.
[15]	Andresen, E.M.; Malmgren, J.A.; Carter, W.B.; Patrick, D.L. Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am. J. Prev. Med. 1994, 10, 77–84.
[16]	Best, A.L.; Alcaraz, K.I.; McQueen, A.; Cooper, D.L.; Warren, R.C.; Stein, K. Examining the mediating role of cancer-related problems on spirituality and self-rated health among African American cancer survivors: a report from the American Cancer Society’s Studies of Cancer Survivors-II. Psycho-Oncology. 2015, 24, 1051–1059.
[17]	Petrick, J.L.; Foraker, R.E.; Kucharska-Newton, A.M.; Reeve, B.B.; Platz, E.A.; Stearns, S.C.; Han, X.S.; Windham, B.G.; Irwin, D.E. Trajectory of overall health from self-report and factors contributing to health declines among cancer survivors. Cancer Causes. Control. 2014, 25, 1179–1186.
[18]	Ganz, P.A.; Desmond, K.A.; Leedham, B.; Rowland, J.H.; Meyerowitz, B.E.; Belin, T.R. Quality of life in long-term, disease-free survivors of breast cancer: a follow-up study. J. Natl. Cancer Inst. 2002, 94, 39–49.
[19]	Potosky, A.L.; Legler, J.; Albertsen, P.C.; Stanford, J.L.; Gilliland, F.D.; Hamilton, A.S.; Eley, J.W.; Stephenson, R.A.; Harlan, L.C. Health outcomes after prostatectomy or radiotherapy for prostate cancer: results from the prostate cancer outcomes study. J. Natl. Cancer Inst. 2000, 92, 1582–1592.
[20]	Stewart, D.E.; Wong, F.; Duff, S.; Melancon, C.H.; Cheung, A.M. "what doesn’t kill You makes You stronger": an ovarian cancer survivor survey. Gynecol. Oncol. 2001, 83, 537–542.
[21]	Beatty, L.J.; Koczwara, B.; Rice, J.; Wade, T.D. A randomised controlled trial to evaluate the effects of a self-help workbook intervention on distress, coping and quality of life after breast cancer diagnosis. Med. J. Aust. 2010, 193, S68–S73.
[22]	Kim, D.Y.; Kim, J.H.; Park, S.W. Aerobic capacity correlates with health-related quality of life after breast cancer surgery. Eur. J. Cancer Care. 2019, 28, e13050.
[23]	van’t Spijker, A.; Trijsburg, R.W.; Duivenvoorden, H.J. Psychological sequelae of cancer diagnosis. Psychosom. Med. 1997, 59, 280–293.
[24]	Greup, S.R.; Kaal, S.E.J.; Jansen, R.; Manten-Horst, E.; Thong, M.S.Y.; van der Graaf, W.T.A.; Prins, J.B.; Husson, O. Post-traumatic growth and resilience in adolescent and young adult cancer patients: an overview. J. Adolesc. Young Adult Oncol. 2018, 7, 1–14.
[25]	Zebrack, B.; Gurney, J.; Oeffinger, K.; Whitton, J.; Packer, R.; Mertens, A.; Turk, N.; Castleberry, R.; Dreyer, Z.; Robison, L.; Zeltzer, L. Psychological outcomes in long-term survivors of childhood brain cancer: a report from the childhood cancer survivor study. J. Clin. Oncol. 2004.
[26]	McGrath, R.P.; Clark, B.C.; Erlandson, K.M.; Herrmann, S.D.; Vincent, B.M.; Hall, O.T.; Hackney, K.J. Impairments in individual autonomous living tasks and time to self-care disability in middle-aged and older adults. J. Am. Med. Dir. Assoc. 2019, 20, 730–735.e3.
[27]	Hai, S.; Gao, Q.; Gwee, X.; Chua, D.Q.L.; Yap, K.B.; Ng, T.P. Malnutrition risk, physical function decline and disability in middle-aged and older adults followed up in the Singapore longitudinal ageing study. Clin. Interv. Aging. 2021, 16, 1527–1539.
[28]	Grov, E.K.; Fosså, S.D.; Dahl, A.A. Activity of daily living problems in older cancer survivors: a population-based controlled study. Health Soc. Care Community. 2010, 18, 396–406.
[29]	Elliott, B.A.; Renier, C.M.; Haller, I.V.; Elliott, T.E. Health-related quality of life (HRQoL) in patients with cancer and other concurrent illnesses. Qual. Life Res. 2004, 13, 457–462.
[30]	Rijken, M.; van Kerkhof, M.; Dekker, J.; Schellevis, F.G. Comorbidity of chronic diseases. Qual. Life Res. 2005, 14, 45–55.
[31]	Doege, D.; Thong, M.S.Y.; Koch-Gallenkamp, L.; Bertram, H.; Eberle, A.; Holleczek, B.; Pritzkuleit, R.; Waldeyer-Sauerland, M.; Waldmann, A.; Zeissig, S.R.; Jansen, L.; Brenner, H.; Arndt, V. Health-related quality of life in long-term disease-free breast cancer survivors versus female population controls in Germany. Breast Cancer Res. Treat. 2019, 175, 499–510.
[32]	Mandelblatt, J.; Edge, S.; Meropol, N.; Senie, R.; Tsangaris, T.; Grey, L.; Peterson, B.; Hwang, Y.; Kerner, J.; Weeks, J. Predictors of long-term outcomes in older breast cancer survivors: perceptions versus patterns of care. J. Clin. Oncol. 2003.
[33]	Kornblith, A.B.; Ligibel, J. Psychosocial and sexual functioning of survivors of breast cancer. Semin. Oncol. 2003, 30, 799–813.
[34]	Rivers, B.M.; August, E.M.; Gwede, C.K.; Hart, A. Jr, Donovan, K.A.; Pow-Sang, J.M.; Quinn, G.P. Psychosocial issues related to sexual functioning among African-American prostate cancer survivors and their spouses. Psycho-oncology. 2011, 20, 106–110.
[35]	Lahart, I.M.; Metsios, G.S.; Nevill, A.M.; Carmichael, A.R. Physical activity for women with breast cancer after adjuvant therapy. Cochrane Database Syst. Rev. 2018, 1, CD011292.