Evaluating health utility in patients with melanoma, breast cancer, colon cancer, and lung cancer: a nationwide, population-based assessment.
BACKGROUND
Understanding the quality of life and health utility for cancer survivors is important; however, little data are available-particularly for long-term (>5 year) survivors. Using "health utility" scores as a proxy for quality of life may be advantageous because it is a single value. Utility scores range from 1.0 (perfect health) to 0 (death), and have been shown to be a good numerical summary of overall quality of life. Using a validated instrument for health utility (HALex), we calculated and report the scores of four different surgical cancers at multiple periods of follow-up, ranging from <1 year to >5 years after diagnosis.


METHODS
Patients diagnosed with either breast, colon, melanoma, or lung cancer were studied using the 1998 National Health Information Survey. Responses to several validated questions were collected and health utility scores were calculated. Different time periods were measured; acute (<1 year), short term (1-5 years), and long term (>5 years). Once a single health utility score was calculated, multivariate analyses were performed to identify important predictors of better versus worse health utility scores.


RESULTS
The total sample size was 692 (breast 377, colon 169, melanoma 92, lung 54). Mean ages at diagnosis for the cancer groups were 56, 61, 52, and 60 years, respectively. The mean health utility scores in the acute period after diagnosis were: breast 0.62, colon 0.67, melanoma 0.73, and lung 0.42. In this acute period, the mean utility score for lung cancer survivors was statistically lower versus the others in the acute period (P < 0.001). Although variable trends were noted in the short-term period, all cancers demonstrated an increase in mean scores in the long-term period; the percent increases were: breast 15% (P = 0.01), colon 12%, melanoma 7%, and lung 47%. Multivariate regression analyses identified important associations of health utility scores. Significant predictors of lower health utility included the presence of pain and the presence of co-existent diseases, most commonly joint problems, cardiovascular disease, and diabetes.


CONCLUSIONS
For four surgical cancers in three time periods after diagnosis, health utility scores were lowest immediately after treatment and improved over time. Long-term (>5 year) survivors had the highest scores. Additionally, our analyses show that a part of health utility in this cohort is determined by the presence of pain and co-existent diseases, which are often items that can be improved by quality clinical care.
D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000601:surgery; D015331:Cohort Studies; D003110:Colonic Neoplasms / Q000453:epidemiology* / Q000601:surgery; D003430:Cross-Sectional Studies; D005260:Female; D006306:Health Surveys; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology* / Q000601:surgery; D008297:Male; D008545:Melanoma / Q000453:epidemiology* / Q000601:surgery; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D011788:Quality of Life; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000601:surgery; D017741:Survivors