Hrqol Among Cancer Survivors

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Ann Behav Med. Author manuscript; available in PMC 2011 February 16.
Published in final edited form as: Ann Behav Med. 2010 February ; 39(1): 91–97. doi:10.1007/s12160-010-9163-y.

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Perceived risk, trust and health-related quality of life among cancer survivors
Erika A. Waters,PhD, MPH1,2, Neeraj K. Arora, PhD1, William M. P. Klein, PhD1,2, and Paul K. J. Han, MD, MPH1 1 Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD
2

Cancer Prevention Fellowship Program, Office of Preventive Oncology, National Cancer Institute, Bethesda, MD
3

Department of Psychology, University of Pittsburgh, Pittsburgh, PA

AbstractBackground—To design effective interventions that improve cancer survivors’ health-related quality of life (HRQoL), it is necessary to understand how HRQoL is related to cancer cognitions and interpersonal/social factors Purpose—This study investigated whether perceived risk of recurrence is associated with HRQoL and whether trust in the follow-up care physician moderates the perceived risk/HRQoL relationship.Method—A cross-sectional survey of cancer survivors (N=408). Results—Higher perceived risk was associated with worse mental and physical HRQoL. Higher trust was associated with better mental (but not physical) HRQoL. The inverse association between perceived risk and mental HRQoL was eliminated among those with high trust in their physicians. Trust did not moderate the perceived risk/physicalHRQoL relationship. Conclusions—Addressing survivors’ perceived risk of recurrence and improving the providerpatient relationship may enhance interventions to improve mental HRQoL among cancer survivors. However, the causal relationships among the constructs should be explicated. Keywords Perceived risk; Trust; Health-Related Quality of Life; Cancer survivors; Fear of recurrence Quality of life (QoL)is defined broadly as “an individual’s assessment of his or her own general well-being” (p. 67, 1). Health-related quality of life (HRQoL) includes a patient’s mental and physical functioning (2). Addressing mental and physical health-related quality

Correspondence should be addressed to Erika A. Waters, Department of Surgery, Washington University School of Medicine, 660 S. Euclid, St. Louis,MO 63110, Tel: 314-747-5705, Fax: 314-454-7941, waterse@wudosis.wustl.edu. To alleviate concerns about dichotomizing continuous variables, we reanalyzed the data after transforming perceived risk, worry and trust to reduce their skews. The most effective transformation varied by construct (i.e., square root for worry and inverse for perceived risk and trust). Only one of the ten main effects andinteractions described in the results section differed based on whether the variables were dichotomized or transformed. Worry was not associated with PCS scores when the variables were dichotomized, but it was marginally related to PCS when it was continuous, b = 3.0, B = .09 (95% CI: −0.5−6.5), t = 1.7, p = .08. The 1.5-point difference in PCS scores (reported previously) is unlikely to beclinically significant (30,35). We report the dichotomized data for clarity of presentation. Furthermore, the extraordinarily skewed trust scores suggest that the 25% of participants who gave their physicians perfect trust ratings may be qualitatively different from participants who did not trust their physicians so completely.

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of life (HRQoL) needs is an essentialcomponent of follow-up care for the nation’s 10 million cancer survivors (1). There are many potential determinants of HRQoL. One of these, fear of the cancer re-occurring, is a widespread concern among cancer survivors (3– 4). Because fear and perceived risk are related to each other (5), it seems reasonable to conclude that perceived risk of recurrence among cancer survivors might also be associated...