Health-related quality of life and psychological distress among cancer survivors in Southeast Asia: results from a longitudinal study in eight low- and middle-income countries

Merel Kimman*, S. Jan, S. A. E. Peters, C. H. Yip, C. A. Ngelangel, N. Bhoo-Pathy, M. Woodward, Phetsamone Arounlangsy, Soe Aung, Soledad L. Balete, Nirmala Bhoo-Pathy, Bounthaphany Bounxouei, Dieu Bui, Jay Datukan, Agnes E. Gorospe, Cheng Har Yip, Yin Yin Htun, Prasit Khopaibul, Thanut Khuayjarernpanishk, Thiravud KhuhapremaMyo Khin, David Kingston, Tawin Klinwimol, Somkiet Lalitwongsa, Dhanoo Lawbundis, Conrado Lola, Leo Marbella, Khoa Mai Trong, Soe Oo Maung, Shu Mon, Win Pa Pa Naing, Corazon A. Ngelangel, Htun Lwin Nyein, Annielyn Beryl, Khin May Oo, Irisyl Orolfo-Real, Dung Pham Xuan, Seang Pharin, Pujianto, Oudayvone Rattanavong, Kouy Samnang, Somphob Sangkittipaiboon, Suleeporn Sangrajrang, Cherelina Santiago-Ferreras, San Shwe, Eav Sokha, Thanadej Sinthusake, Darunee Suanplu, Jitraporn Tanabodee, Hasbullah Thabrany, ACTION Study Grp, Writing Comm, Principal Investigators, Other Contributors, Executive Comm

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Background: A better understanding of health-related quality of life (HRQoL) and psychological distress in cancer survivors can raise awareness, promote the development of policies in cancer survivorship care, and facilitate better targeted use of limited resources in low-and middle-income countries (LMICs). The main objectives of this paper were therefore to assess HRQoL and the prevalence of psychological distress amongst cancer survivors in Southeast Asia and identify risk factors of these outcomes.

Methods: The ACTION study was a longitudinal study in eight LMICs in Southeast Asia with 5249 first time cancer survivors followed up at 1 year after diagnosis. HRQoL was assessed using the EORTC QLQ-C30 and EQ-5D. Psychological distress (anxiety and depression) was assessed using the Hospital Anxiety and Depression Scale. General linear models and multiple logistic regression were used to identify independent predictors of HRQoL and psychological distress.

Results: One year after diagnosis, the mean EORTC QLQ-C30 global health score for survivors was 66.2 out of 100 (SD 22.0), the mean index score on the EQ-5D was 0.74 (SD 0.23), 37% of survivors had at least mild levels of anxiety, and 46% showed at least mild levels of depression. Poorest HRQoL and highest prevalence of anxiety and depression were seen in patients with lung cancer and lymphomas, while highest scores and least psychological distress were seen in female patients with breast and cervical cancer. The most significant predictor of poor HRQoL and psychological distress outcomes was cancer stage at diagnosis. Age, co-morbidities, treatment, and several socioeconomic factors were associated with HRQoL and psychological distress.

Conclusions: Cancer survivors in LMICs in Southeast Asia have impaired HRQoL and substantial proportions have psychological distress. Patients with advanced cancer stages at diagnosis and those in a poor socioeconomic position were most at risk of such poor outcomes. Supportive interventions for cancer patients that address wider aspects of patient wellbeing are needed, as well as policies that address financial and other barriers to timely treatment.

Original languageEnglish
Article number10
Number of pages13
JournalBMC Medicine
Publication statusPublished - 13 Jan 2017


  • Health-related quality of life
  • Psychological distress
  • Cancer
  • Survivorship
  • Low- and middle-income countries
  • Southeast Asia
  • Observational study

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