title: Trajectory of overall health from self-report and factors contributing to health declines among cancer survivors.
abstract: OBJECTIVE
  This study aims to quantify trajectories of overall health pre- and post-diagnosis of cancer, trajectories of overall health among cancer-free individuals, and factors affecting overall health status.
  
  
  METHODS
  Overall health status, derived from self-rated health report, of Atherosclerosis Risk in Communities cohort participants diagnosed with incident cancer [lung (n = 400), breast (n = 522), prostate (n = 615), colorectal (n = 303)], and cancer-free participants (n = 11,634) over 19 years was examined. Overall health was evaluated in two ways: (1) overall health was assessed until death or follow-up year 19 (survivorship model) and (2) same as survivorship model except that a self-rated health value of zero was used for assessments after death to follow-up year 19 (cohort model). Mean overall health at discrete times was used to generate overall health trajectories. Differences in repeated measures of overall health were assessed using linear growth models.
  
  
  RESULTS
  Overall health trajectories declined dramatically within one-year of cancer diagnosis. Lung, breast, and colorectal cancer were associated with a significant decreased overall health score (β) compared to the cancer-free group (survivorship model: lung-7.00, breast-3.97, colorectal-2.12; cohort model: lung-7.63, breast-5.07, colorectal-2.30). Other predictors of decreased overall health score included low education, diabetes, cardiovascular disease, and age.
  
  
  CONCLUSIONS
  All incident cancer groups had declines in overall health during the first year post-diagnosis, which could be due to cancer diagnosis or intensive treatments. Targeting factors related to overall health declines could improve health outcomes for cancer patients.
authors.affiliation: Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA, jessica.petrick@unc.edu.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Petrick
authors.forename: Randi E
authors.initials: RE
authors.lastname: Foraker
authors.forename: Anna M
authors.initials: AM
authors.lastname: Kucharska-Newton
authors.forename: Bryce B
authors.initials: BB
authors.lastname: Reeve
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Platz
authors.forename: Sally C
authors.initials: SC
authors.lastname: Stearns
authors.forename: Xuesong
authors.initials: X
authors.lastname: Han
authors.forename: B Gwen
authors.initials: BG
authors.lastname: Windham
authors.forename: Debra E
authors.initials: DE
authors.lastname: Irwin
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000453:epidemiology; D015179:Colorectal Neoplasms / Q000453:epidemiology; D003324:Coronary Artery Disease / Q000150:complications*; D005260:Female; D006304:Health Status; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000453:epidemiology*; D057566:Self Report; D015996:Survival Rate; D017741:Survivors / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology