Physical disability and psychological distress before and after a diagnosis of cancer: evidence on multiple cancer types from a large Australian cohort study, compared to people without a cancer diagnosis

Background: Although most people with cancer now survive long-term, evidence on long-term person-centred outcomes in survivors is limited, particularly relative to people without cancer. We quantified changes in physical and psychological outcomes among adults aged ≥ 45 years from pre- to post-cancer-diagnosis, for multiple cancer types and compared to changes in people without cancer. 

Methods: Questionnaire data from the Australian population-based 45 and Up Study were linked to cancer registrations, hospitalisations and deaths; those without cancer at baseline (2006–2009) and participating in a follow-up survey (by 2015) were included (n = 142,682). Generalised linear models quantified changes in physical functioning (MOS-PF score, range = 0–100) and psychological distress (Kessler-10 score, range = 10–50) between surveys in people diagnosed and not diagnosed with cancer between surveys, adjusting for confounding factors. 

Results: Overall, 9313 individuals had incident cancer (12.2/1000 person-years; median follow-up = 5.2 years). Among those without cancer, 30.0% had moderate or severe physical functioning limitations at baseline, increasing to 40.6% at follow-up; corresponding figures were 35.2% and 52.3%, respectively, in participants with incident cancer. Around 80% of those with and without incident cancer had low psychological distress at baseline and follow-up. Compared to those without cancer, cancer survivors had greater average physical functioning declines (mean-score: 77.5 versus 82.9 at follow-up; mean-change: − 8.31 versus − 4.71; adjusted-difference − 2.55 (95%CI = − 2.97–2.13)) and slightly greater increases in psychological distress (mean-score: 13.6 versus 13.5 at follow-up; mean-change: 0.24 versus − 0.04; adjusted-difference 0.21 (95%CI = 0.12–0.31)). Physical outcomes varied by cancer type with greater deterioration with multiple myeloma, lung cancer and leukaemia and lesser declines with breast, colorectal and prostate cancers. Greater deterioration in physical and psychological outcomes were observed in cancer survivors with more advanced disease at diagnosis and recent cancer treatment at follow-up; psychological outcomes in those not receiving recent treatment did not differ from cancer-free participants. 

Conclusions: On average, cancer survivors experienced greater declines in physical wellbeing than people without cancer and minimal differences in psychological distress. Those not receiving recent cancer treatment and those with many common cancer types had physical and psychological outcomes comparable to people without cancer. Additional targeted support may particularly benefit those receiving treatment, with specific cancer types, and advanced disease.