Health-related quality of life and psychological distress among cancer survivors in a middle-income country

Shridevi Subramaniam, Yek-Ching Kong, Karuthan Chinna, Merel Kimman, Yan-Zheng Ho, Nadiah Saat, Rozita Abdul Malik, Nur Aishah Taib, Matin Mellor Abdullah, Gerard Chin-Chye Lim, Nor-Saleha Ibrahim Tamin, Yin-Ling Woo, Kian-Meng Chang, Pik-Pin Goh, Cheng-Har Yip, Nirmala Bhoo-Pathy*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Objectives: Quality of life and psychological well-being are important patient-centered outcomes, which are useful in evaluation of cancer care delivery. However, evidence from low-income and middle-income countries remains scarce. We assessed health-related quality of life (HRQoL) and prevalence of psychological distress (anxiety or depression), as well as their predictors, among cancer survivors in a middle-income setting. Methods: Through the Association of Southeast Asian Nations Costs in Oncology study, 1490 newly diagnosed cancer patients were followed-up in Malaysia for 1 year. Health-related quality of life was assessed by using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30) and EuroQol-5 (EQ-5D) dimension questionnaires at baseline, 3 and 12 months. Psychological distress was assessed by using Hospital Anxiety and Depression Scale. Data were modeled by using general linear and logistic regressions analyses. Results: One year after diagnosis, the mean EORTC QLQ-C30 Global Health score of the cancer survivors remained low at 53.0 over 100 (SD 21.4). Fifty-four percent of survivors reported at least moderate levels of anxiety, while 27% had at least moderate levels of depression. Late stage at diagnosis was the strongest predictor of low HRQoL. Increasing age, being married, high-income status, hospital type, presence of comorbidities, and chemotherapy administration were also associated with worse HRQoL. The significant predictors of psychological distress were cancer stage and hospital type. Conclusion: Cancer survivors in this middle-income setting have persistently impaired HRQoL and high levels of psychological distress. Development of a holistic cancer survivorship program addressing wider aspects of well-being is urgently needed in our settings.
Original languageEnglish
Pages (from-to)2172-2179
Number of pages8
Issue number9
Publication statusPublished - 1 Sept 2018


  • cancer
  • middle income
  • oncology
  • psychological distress
  • quality of life
  • QLQ-C30
  • EQ-5D

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