A National Study of Health Behaviors and Health-Related Quality of Life Among Survivors of Breast, Prostate, and Colorectal Cancer Compared to Propensity Score Matched Controls, as well as, Comparisons by Cancer Type & Gender
Date of Graduation
School of Pharmacy
Pharmaceutical Systems and Policy
The objectives of this study were to 1) compare the prevalence of specific measures of Health-Related Quality of Life (HRQOL) between breast, prostate, female, and male colorectal cancer survivors to propensity score matched controls, and to compare HRQOL by type of cancer and gender and 2) compare the prevalence of specific health conditions and health behaviors between breast, prostate, female, and male colorectal cancer survivors to propensity score matched controls, and to compare health behaviors by type of cancer and gender. A cross-sectional study was conducted using a sample of breast, prostate, and colorectal cancer survivors 18 years of age and older and > 1 year past diagnosis were selected from the 2009 BRFSS. A greedy algorithm and matching without replacement used propensity scores to match 3 controls to every 1 case on age, gender, race/ethnicity, income, insurance status, and region of the U.S. HRQOL measures compared were life satisfaction, perceived emotional support, activity limitations, perceived general, physical and mental health, and sleep quality. Health conditions compared were arthritis, asthma, heart disease, diabetes, hypertension, high cholesterol, stroke, activity limitations, and perceived general health. Health behaviors compared were flu immunization, physical check-up, cholesterol check, BMI, physical activity, fruit and vegetable consumption, smoking, and alcohol use. Chi-square tests were used to test for covariate balance and compared prevalence of health conditions and behaviors. Binomial and multinomial logistic regression models were used to estimate the probabilities of behaviors for cancer cases compared to controls. The final study sample consisted of 6,393 breast, 3,636 prostate, 1,111 female colorectal, and 824 male colorectal cancer survivors. Compared to matched controls, cancer survivors were up to 3.67 times more likely (95%CI: 2.09, 6.47) at 1 -- 5 years since diagnosis, and up to 1.91 times more likely (95%CI: 1.30, 2.79). Breast, female, and male colorectal cancer survivors were up to 2.62 times more likely (95%CI: 1.72, 3.99) to report activity limitations compared to matched controls. Additionally, colorectal cancer survivors were more likely to report worse physical health than their matched controls. Male colorectal and prostate cancer survivors were more likely to report worse mental health, and prostate cancer survivors were more likely to report a lack of emotional support and not enough sleep compared to their matched controls. Comparisons by cancer type found that male colorectal cancer survivors were more likely to report activity limitations and perceive their general and physical health to be worse than prostate cancer survivors. Gender comparisons found that females were more likely to hold poorer perceptions of their general, physical, and mental health, report not enough sleep, and not receiving enough emotional support, but more likely to be satisfied with life. Breast and prostate cancer survivors reported a greater prevalence of chronic health conditions than matched controls. Breast cancer survivors were more likely to engage in healthier behaviors 1 -- 5 years after diagnosis, but were more likely to be obese at > 5 years after diagnosis than controls. Male colorectal cancer survivors were less likely to engage in clinical preventive care at > 5 years after diagnosis than controls. Female colorectal and breast cancer survivors were less likely be overweight and/or obese, former and/or current smokers, drink any alcohol, and more likely to consume ≥ 5 servings of fruits and vegetables per day, but more likely to engage in none or insufficient levels of physical activity compared to male colorectal and prostate cancer survivors, respectively. All cancer survivor groups reported more limitations and held poorer perceptions of their general health. Differences between matched controls for other HRQOL measure vary by type of cancer, although compared to similar males without cancer, male cancer survivors reported worse outcomes on measures such as mental health, sleep, and emotional support. However, when female survivors were compared to male survivors, females reported worse outcomes for all measures except life satisfaction. Breast and prostate cancer survivors have more chronic health conditions compared to matched controls than do female and male colorectal cancer survivors. Breast cancer survivors are more likely to engage in healthy behaviors than their matched controls. Female cancer survivors engage healthier lifestyle behaviors, with the exception of physical activity, compared to male cancer survivors. (Abstract shortened by UMI.).
LeMasters, Traci J., "A National Study of Health Behaviors and Health-Related Quality of Life Among Survivors of Breast, Prostate, and Colorectal Cancer Compared to Propensity Score Matched Controls, as well as, Comparisons by Cancer Type & Gender" (2012). Graduate Theses, Dissertations, and Problem Reports. 4885.