title: The effects of age on health-related quality of life in cancer populations: A pooled analysis of randomized controlled trials using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 involving 6024 cancer patients.
abstract: BACKGROUND
  Cancer incidence increases exponentially with advancing age, cancer patients live longer than in the past, and many new treatments focus on stabilizing disease and HRQOL. The objective of this study is to examine how cancer affects patients' HRQOL and whether their HRQOL is age-dependent.
  
  
  METHODS
  Data from 25 EORTC randomized controlled trials was pooled. EORTC QLQ-C30 mean scores for the cancer cohort and five general population cohorts were compared to assess the impact of cancer on patients' HRQOL. Within the cancer cohort, multiple linear regressions (two-sided level P-value = 0.05 adjusted for multiple testing.) were used to investigate the association between age and HRQOL, adjusted for gender, WHO performance status (PS), distant metastasis and stratified by cancer site. A difference of 10 points on the 0-100 scale was considered clinically important.
  
  
  RESULTS
  Cancer patients generally have worse HRQOL compared to the general population, but the specific HRQOL domains impaired vary with age. When comparing the cancer versus the general population, young cancer patients had worse financial problems, social and role functioning, while the older cancer groups had more appetite loss. Within the cancer cohort, HRQOL was worse with increasing age for physical functioning and constipation, and better with increasing age for social functioning, insomnia and financial problems (all p < 0.05).
  
  
  CONCLUSIONS
  HRQOL is impaired in cancer patients compared to the general population, but the impact on specific HRQOL domains varies by age. Within the cancer population, some HRQOL components improve with age while others deteriorate. Optimal care for older cancer patients should target HRQOL domains most relevant to this population.
authors.affiliation: European Centre for Disease Prevention and Control, Surveillance and Response Support, Epidemiological Methods Unit, Tomtebodavagen 11A, 171 83 Stockholm, Sweden. Electronic address: chquinten@gmail.com.
authors.forename: Chantal
authors.initials: C
authors.lastname: Quinten
authors.affiliation: Quality of Life Department, EORTC Headquarters, Avenue E. Mounier 83/11, 1200 Brussels, Belgium. Electronic address: corneel.coens@eortc.be.
authors.forename: Corneel
authors.initials: C
authors.lastname: Coens
authors.affiliation: Quality of Life Department, EORTC Headquarters, Avenue E. Mounier 83/11, 1200 Brussels, Belgium. Electronic address: irina.ghislain@eortc.be.
authors.forename: Irina
authors.initials: I
authors.lastname: Ghislain
authors.affiliation: Quality of Life Department, EORTC Headquarters, Avenue E. Mounier 83/11, 1200 Brussels, Belgium. Electronic address: efstathios.zikos@eortc.be.
authors.forename: Efstathios
authors.initials: E
authors.lastname: Zikos
authors.affiliation: Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. Electronic address: m.a.sprangers@amc.uva.nl.
authors.forename: Mirjam A G
authors.initials: MA
authors.lastname: Sprangers
authors.affiliation: The Princess Margaret Hospital, University of Toronto, 610 University Avenue, Toronto, ON M5G 2M9, Canada. Electronic address: jolie.ringash@rmp.uhn.on.ca.
authors.forename: Jolie
authors.initials: J
authors.lastname: Ringash
authors.affiliation: Quality of Life Department, EORTC Headquarters, Avenue E. Mounier 83/11, 1200 Brussels, Belgium. Electronic address: francesca.martinelli@eortc.be.
authors.forename: Francesca
authors.initials: F
authors.lastname: Martinelli
authors.affiliation: Clinical Research, Abbott Vascular International BVBA, Park Lane, Culliganlaan 2B, 1831 Diegem, Belgium. Electronic address: ediebahdivine@gmail.com.
authors.forename: Divine E
authors.initials: DE
authors.lastname: Ediebah
authors.affiliation: Quantative Solutions, Parkstraat 1b, 4818 SJ Breda, The Netherlands. Electronic address: j.maringwa@wequantify.com.
authors.forename: John
authors.initials: J
authors.lastname: Maringwa
authors.affiliation: Gillings School of Global Public Health, University of North Caroline at Chapel Hill, 1101-D Mc Gavran-Greenberg Building, 135 Dauer Drive, CB 7411, Chapel Hill, NC 27599-7411, United States. Electronic address: bbreeve@email.unc.edu.
authors.forename: Bryce B
authors.initials: BB
authors.lastname: Reeve
authors.affiliation: Medical University Graz, Auenbruggerplatz 14, AT 8036 Graz, Austria. Electronic address: elfriede.greimel@klinikum-graz.at.
authors.forename: Eva
authors.initials: E
authors.lastname: Greimel
authors.affiliation: Cancer Australia Chair in Cancer Quality of Life, School of Psychology and Sydney Medical School, University of Sydney, New South Wales 2006, Australia. Electronic address: madeleine.king@sydney.edu.au.
authors.forename: Madeleine T
authors.initials: MT
authors.lastname: King
authors.affiliation: Research Support Services, Oslo University Hospital, Sogn Arena, Pb 4950 Nydalen, NO-0424 Oslo, Norway. Electronic address: kbj@ous-hf.no.
authors.forename: Kristin
authors.initials: K
authors.lastname: Bjordal
authors.affiliation: Child and Adolescent Psychiatry and Psychotherapy, Leipzigerstrasse 44, University of Magdeburg, 39120 Magdeburg, Germany. Electronic address: hans-henning.flechtner@med.ovgu.de.
authors.forename: Hans-Henning
authors.initials: HH
authors.lastname: Flechtner
authors.affiliation: Medical Ethics, Philosophical Faculty, University of Regensburg, Universitaetstrasse 31, 93040 Regensburg, Germany. Electronic address: joseph.schmucker-von-koch@psk.uni-regensburg.de.
authors.forename: Joseph
authors.initials: J
authors.lastname: Schmucker-Von Koch
authors.affiliation: VU Medical Center, De Boelelaan 1118, 1081 HZ Amsterdam, The Netherlands; Medical Center Haaglanden, P.O. Box 432, Lijnbaan 2, NL 2501 CK The Hague, The Netherlands. Electronic address: m.taphoorn@mchaaglanden.nl.
authors.forename: Martin J B
authors.initials: MJ
authors.lastname: Taphoorn
authors.affiliation: Tumor Biology Center University Hospital Freiburg, Breisacherstrasse 117, 79106 Freiburg, Germany. Electronic address: weis@tumorbio.uni-freiburg.de.
authors.forename: Joachim
authors.initials: J
authors.lastname: Weis
authors.affiliation: Department of General Medical Oncology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium. Electronic address: hans.wildiers@uzleuven.be.
authors.forename: Hans
authors.initials: H
authors.lastname: Wildiers
authors.affiliation: Faculty of Medicine and Health, Leeds Institute of Cancer & Pathology, University of Leeds, Bexley Wing (Level 4), St James's Hospital, Beckett Street, Leeds LS9 7TH, UK. Electronic address: G.Velikova@leeds.ac.uk.
authors.forename: Galina
authors.initials: G
authors.lastname: Velikova
authors.affiliation: Quality of Life Department, EORTC Headquarters, Avenue E. Mounier 83/11, 1200 Brussels, Belgium. Electronic address: andrew.bottomley@eortc.be.
authors.forename: Andrew
authors.initials: A
authors.lastname: Bottomley
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology*; D001315:Australia; D005060:Europe; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D009369:Neoplasms / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D009520:New Zealand; D009656:North America; D011379:Prognosis; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013019:South Africa; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
keywords: Cancer burden; General population; Health-related quality of life; Increasing age; Normative data