The physical and psychological aspects of quality of life mediates the effect of radiation-induced urgency syndrome on disability pension in gynecological cancer survivors

Adnan Noor Baloch; Mats Hagberg; Sara Thomée; Gunnar Steineck; Helena Sandén

doi:10.1002/cam4.6356

The physical and psychological aspects of quality of life mediates the effect of radiation-induced urgency syndrome on disability pension in gynecological cancer survivors

Cancer Med. 2023 Aug;12(16):17377-17388. doi: 10.1002/cam4.6356. Epub 2023 Jul 24.

Authors

Adnan Noor Baloch¹, Mats Hagberg², Sara Thomée³, Gunnar Steineck⁴, Helena Sandén²

Affiliations

¹ Biostatistics, School of Public Health & Community Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
² Occupational & Environmental Medicine, School of Public Health & Community Medicine, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
³ Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
⁴ Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.

Abstract

Background: Radiation-induced fecal urgency syndrome is highly prevalent in gynecological cancer survivors. It is associated with decreased quality of life (QoL) and with disability pension. The literature remains unclear about the mediating role of physical and psychological aspects of QoL in the association between urgency syndrome and disability pension. Identifying the pathways between urgency syndrome and disability pension may help to create effective and timely interventions for increasing QoL and reducing disability pension among gynecological cancer survivors.

Methods: We used patient-reported outcome measures from working-age gynecological cancer survivors (n = 247) and data on their disability pension from the official register. The mediating role of physical and psychological aspects of QoL was studied by utilizing mediation analysis based on the counterfactual framework, appropriate for binary outcome, binary mediator with an exposure-mediator interaction. The total effect (TE) was divided into direct and indirect effects using single mediation analysis. Adjusted relative risks and percentage mediated (95% confidence intervals) were calculated. All statistical tests were two-sided.

Results: Urgency syndrome increased the risk of disability pension both directly and indirectly (via QoL). Satisfaction with sleep mediated half of the TE (RR = 2.2 (1.1-4.1)) of urgency syndrome on disability pension. Physical health also mediated a similar proportion of the TE (RR = 2.1 (1.2-3.9)). The proportions mediated were higher for physical aspects of QoL (35%-71%) than for psychological aspects (2%-47%).

Conclusions: The investigated aspects of the self-assessed QoL of gynecological cancer survivors may play a role in these women's continuing work-life. It appears that physical health, satisfaction with sleep, psychological well-being, and other investigated aspects of QoL mediate the urgency syndrome-disability pension association.

Trial registration: ClinicalTrials.gov NCT03961217.

Keywords: cancer survivorship; disability pension; early retirement; gynecological cancer; quality of life; return to work.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cancer Survivors*
Disabled Persons*
Female
Humans
Neoplasms*
Pensions
Quality of Life

Associated data

ClinicalTrials.gov/NCT03961217