Quality of Life Determinants in Older Latino and Anglo Advanced Cancer Patients

Background/Purpose: Improving the quality of life of persons with advanced cancer has been recognized as a national health care priority. However, little is known about the factors that influence the quality of life among older persons with advanced cancer, particularly older minority patients.

Older patients in advanced stages of cancer tend to experience different types of physical and psychosocial distress which may significantly influence their quality of life. This study aims to identify the demographic, clinical and psychosocial factors that impact quality of life among older Latino and Anglo advanced cancer patients. 

Methods: Baseline data from a longitudinal study of older Latinos and cross-sectional data from a survey of older Anglos were used for the study. All participants (N = 150) were Medicare beneficiaries with advanced cancer (stage 3 or 4 with locally advanced, recurrent or metastatic cancer) receiving treatment at MD Anderson Cancer Center. The primary outcome, quality of life, was assessed by the Functional Assessment of Cancer Therapy-General and dichotomized into “poor/fair” and “good/very good”.  The instrument also assessed clinical factors (the ECOG Scale to assess patients’ functional status; the Edmonton Symptom Assessment Scale and EQ-5D to assess symptom burden); psychosocial factors (social support, cancer fatalism, medical mistrust, religiosity) and demographic factors (age, gender, ethnicity, education and income). Independent t-test and chi-square tests were conducted to examine bivariate associations between the dependent and independent variables. Logistic regression analysis using the Forward-LR data entry method was then conducted to identify factors most likely to predict the quality of life in the sample.     

Results: One hundred and fifty Latino and Anglos participants completed the survey. Fifty-two percent of participants reported “good/very good” quality of life. The final regression model accounts for 38.8% to 51.8% of the variance in quality of life and had a success rate of 78.6%. The five significant predictors influencing  participants’ quality of life included: usual activities (odds ratio [OR] 4.66; 95% confidence interval [CI] 1.75-12.40); pain/discomfort (OR 3.30; CI 1.28-8.84); anxiety/depression (OR 3.59; CI 1.38-9.32); symptom distress (OR 2.62; CI 1.05-6.56); and social support (OR .90; CI .83-.98).

Conclusions/Implications: This study revealed that clinical factors (usual activities, pain/discomfort, anxiety/depression, symptom distress) had the most significant influence on quality of life.  Social support was the most significant psychosocial determinant. These results emphasize the importance of appropriately managing clinical symptoms to improve the quality of life of older Latino and Anglo advanced cancer patients and the value of good social support. With a growing number of minority populations in the United States, it is imperative that providers understand the unique factors that affect specific ethnic groups to improve their quality of life. Future research should focus on developing culturally-responsive strategies to improve quality of life in vulnerable populations and expand this line of research to other ethnic and age groups.