The impact of cancer type, treatment, and distress on health-related quality of life: cross-sectional findings from a study of Australian cancer patients

  • David J. T. Marco
  • Victoria M. WhiteEmail author
Original Article



This study examined the mediating effects of cancer type, treatment, and distress on health-related quality of life (HRQoL) for early diagnosis cancer patients. Results were interpreted with respect to established thresholds for clinical meaningfulness.


A cross-sectional design was used. Patients completed surveys collecting demographics, cancer type, treatment, comorbid conditions, distress (HADS), and HRQoL (FACT-G). Hierarchical multivariate regressions examined associations between cancer type, treatment, and distress on HRQoL. Established minimum differences were used to identify clinically meaningful changes in HRQoL.


Of the 1183 patients surveyed, 21% were classified as having elevated anxiety and 13% had elevated depression. Our sample reported significantly lower physical and emotional well-being compared to population norms. Patients with prostate, melanoma, gynaecological, and urological cancers had higher HRQoL scores than those with colorectal cancer. However, when effects for treatment type and distress were considered, differences between cancer types became non-significant. Anxiety and depression were associated with lower HRQoL scores as was chemotherapy. Only depression, anxiety, and chemotherapy were associated with clinically meaningful decreases in HRQoL scores.


While statistically significant differences in HRQoL were found between different cancer types, only chemotherapy, anxiety, and depression produced clinically meaningful poorer HRQoL scores. In practice, clinically meaningful differences could promote a shift in resources toward interventions where a positive effect on patient well-being is appreciated by both the patient and health professional.


Cancer Treatment Distress Quality of life Patient-reported outcomes Clinically meaningful differences 



We would like to acknowledge contributions from Dr. Mariko Carey and Dr. Sandra Ieropoli for developing the survey tool and overseeing data collection. We would also like to acknowledge the contribution of Ms. Helen Farrugia, Head of the Victorian Cancer Registry. We give our thanks and respect to the time and effort our survey participants gave to the project.


Funding for this study was provided by the Cancer Council Victoria (institutional funding).

Compliance with ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflicts of interest.

Supplementary material

520_2018_4625_MOESM1_ESM.docx (33 kb)
ESM 1 (DOCX 32.8 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Centre for Palliative CareSt Vincent’s HospitalMelbourneAustralia
  2. 2.Department of MedicineUniversity of MelbourneMelbourneAustralia
  3. 3.School of PsychologyDeakin UniversityMelbourneAustralia
  4. 4.Centre for Behavioural Research in Cancer, Cancer Council VictoriaMelbourneAustralia

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