Risk as a pattern over time: Delineation of time‐dependent risk factors in biological, psychological, and social variables in cancer patients

Abstract

BackgroundSurvival in cancer patients is associated with a multitude of biological, social, and psychological factors. Although it is well established that all these factors add to overall mortality, it is not well understood how the predictive power of these parameters changes in a comprehensive model and over time.MethodsPatients who attended the authors’ outpatient clinic were invited to participate. The authors followed 5180 mixed cancer patients (51.1% female; mean age, 59.1 years [SD = 13.8]) for up to 16 years and analyzed biological (age, sex, cancer site, anemia), psychological (anxiety, depression), and social variables (marital status, education, employment status) potentially predicting overall survival in a Cox proportional hazards model.ResultsThe median survival time for the entire sample was 4.3 years (95% confidence interval, 4.0–4.7). The overall survival probabilities for 1 and 10 years were 76.8% and 38.0%, respectively. Following an empirical approach, the authors split the time interval into five periods: acute, subacute, short‐term, medium‐term, and long‐term. A complex pattern of variables predicted overall survival differently in the five periods. Biological parameters were important throughout most of the time, social parameters were either time‐independent predictors or tended to be more important in the longer term. Of the psychological parameters, only depression was a significant predictor and lost its predictive power in the long‐term.ConclusionsThe findings of this study allow the development of comprehensive patient‐specific models of risk and resilience factors addressing biopsychosocial needs of cancer patients, paving the way for a personalized treatment plan that goes beyond biomedical cancer care.

Prevalence and biopsychosocial indicators of fatigue in cancer patients

“…It should be noted, however, that the present analysis identified independent effects of Hb level, depression, and pain, implying that targeting anemia alone is not sufficient to successfully treat fatigue. Effective pain management and depression treatment should be equally considered, especially since depression is highly prevalent in oncology patients 42 and has a negative impact on overall survival 43,44 . Moreover, elevated pain, fatigue, and depression levels are likely to result in an overall increase of symptom burden in oncological patients 2 .…”

The impact of COVID-19 and socioeconomic status on psychological distress in cancer patients

“…The COVID-19 pandemic had and still has a significant impact on mental health in various groups of people all over the world ( Lafta & Mawlood, 2022 ; Maunder et al., 2021 ; Roy et al., 2021 ). People with a cancer diagnosis are at particular risk of developing comorbid mental disorders ( Zeilinger, Oppenauer et al., 2022 ) that not only affect quality of life, but also have a significant impact on physical outcomes and survival ( Gaiger et al., 2022 ; Knefel et al., 2023 ; Unseld et al., 2021 ).…”