Abstract C055: Health-related quality of life among cancer survivors in Puerto Rico: Association with non-oncologic comorbidity burden

Abstract Background: Cancer is a leading cause of morbidity and mortality in Puerto Rico (PR), worsened by an ageing population and ongoing fiscal and healthcare system challenges. Health-related quality of life (HRQoL) is a key outcome in cancer survivorship, yet few studies have examined its association with non-oncologic comorbidity burden in Hispanic populations, particularly in PR. This study examined the association between the burden of non-oncologic comorbidity and HRQoL among cancer survivors undergoing active treatment in PR. Methods: Data were drawn from the START-PR study, an ongoing cross-sectional investigation evaluating the impact of social determinants of health on access and receipt of cancer care. The analysis included 550 cancer patients aged ≥21 years, excluding those with missing data on study covariates. HRQoL was evaluated using the 27-item Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire (0-4 scale), which measures physical, social, emotional, and functional well-being (total score range: 0-108; lower scores indicate poorer HRQoL). Scores were dichotomized at the sample median: ≤72= poor, >72= not poor. The FACT-G scale demonstrated excellent internal consistency (Cronbach's α=0.92). The burden of non-oncologic comorbidity was categorized according to the number of self-reported conditions: 0, 1, or ≥2. Logistic regression assessed the association between non-oncologic comorbidity burden and HRQoL, adjusting for age at cancer diagnosis, sex, education, cancer stage, exercise, residential area, smoking status, alcohol use, marital status, time since cancer diagnosis, and current cancer treatment status. The interactions between comorbidity burden, age at diagnosis, and sex were tested using the likelihood ratio test. Results: The patients were mainly women (71.1%), 40-64 years old at the time of cancer diagnosis (56.4%), with education beyond high school (72.7%), and diagnosed at a localized stage (63.8%). The most common types of cancer were breast (29.8%), colorectal (8.4%), and prostate (7.1%). Overall, 46.5% reported ≥2 comorbidities, and 30.6% reported one. Hypertension (45.8%), diabetes (23.8%), and arthritis (20.9%) were the most frequent comorbidities. The mean HRQoL score (SD) was 70.4 (19.2). Compared to patients without comorbidities, those with one comorbidity (OR=1.64, 95% CI: 1.02-2.63) and ≥2 comorbidities (OR=2.46, 95% CI: 1.58-3.81) had significantly higher odds of poor HRQoL. In adjusted models, the association remained significant for one comorbidity (OR=1.83; 95% CI: 1.11-3.02) and ≥2 comorbidities (OR=2.54; 95% CI: 1.58-4.09). Interactions by sex and age at diagnosis were not significant. Conclusions: Having at least one comorbidity was significantly associated with poor HRQoL among cancer survivors in PR, after adjusting for multiple covariates. These findings underscore the need for integrative survivorship care models that address comorbidities, particularly in underserved Hispanic/Latino populations. Citation Format: Daniela L. López-Vallejo, Marievelisse Soto-Salgado, Lorena González-Sepulveda, Natalia E. Domínguez-Betancourt, Cynthia M. Pérez-Cardona. Health-related quality of life among cancer survivors in Puerto Rico: Association with non-oncologic comorbidity burden [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr C055.