Physical disability and psychological distress demonstrate marked progression after diagnosis of cancer

1. In this Australian cohort of adults, individuals diagnosed with cancer experienced greater declines in physical functioning and slightly higher psychological distress compared to people without cancer

2. This finding was especially pronounced among those with advanced disease or recent treatment. 

Evidence Rating Level: 1 (Excellent) 

Cancer survival rates are improving worldwide due to better early detection and treatment. In Australia, the 5-year survival rate for all cancers rose from 50.2% in 1989-1993 to 70.6% in 2015-2019. While cancer survivors are generally more likely to experience physical limitations and mild psychological distress, outcomes vary widely by cancer type, stage, and treatment status. Previous research has been limited by short follow-up periods, a focus on single cancer types, and a lack of pre-diagnosis data or control groups without cancer. This study addresses those gaps by using large-scale, population-based data to compare physical and psychological changes from before to after cancer diagnosis with matched changes in people without cancer. After removing ineligible individuals who had cancer at baseline, the main focus was on those who were newly diagnosed with cancer between the first and follow-up surveys. The primary outcomes were how much physical limitations (assessed using the Medical Outcomes Study Physical Functioning [MOS-PF] score) and psychological distress (assessed using the Kessler-10 [K10]) changed between baseline to follow-up. After meeting eligibility criteria, 142,682 participants were included in the study. Over 5.2 years, 9,313 participants were diagnosed with cancer while 133,369 were not. Participants diagnosed with cancer experienced a greater deterioration in physical function over time compared to those without cancer (40.6% vs. 52.3%). Compared to people without cancer, cancer survivors had larger declines in physical functioning (average follow-up score: 77.5 vs 82.9; average change: -8.31 vs -4.71; adjusted difference -2.55, 95% CI: -2.97 to -2.13) and slightly more psychological distress (average follow-up score: 13.6 versus 13.5 at follow-up; mean-change: 0.24 versus − 0.04; adjusted-difference 0.21 (95%CI = 0.12–0.31)). Physical health declined more for people with multiple myeloma, lung cancer, and leukemia, and less for those with breast, colorectal, or prostate cancer. Survivors with advanced disease or those still undergoing treatment experienced greater declines in physical and psychological well-being. However, psychological well-being was similar between cancer-free individuals and survivors who were not receiving treatment at follow-up. In conclusion, participants newly diagnosed with cancer experienced a significantly greater decline in physical function and slightly decreased psychological well-being compared to participants without cancer. 

Click to read the study in BMC Medicine

Image: PD

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