Factors associated with health-related quality of life in survivors of childhood-onset and adult-onset cancer compared to controls

Abstract Purpose This cross-sectional survey study explored health-related quality of life (HRQoL) across adult survivors of childhood- or adult-onset cancer in Australia, compared to controls with no history of cancer, and assessed factors associated with HRQoL among cancer survivors. Methods Participants completed a survey including clinical and demographic factors and HRQoL (assessed using EQ-5D-5L). Results Childhood cancer survivors (< 16 years at diagnosis, n = 403) and adult-onset cancer survivors (> 16 years at diagnosis, n = 656) participated, alongside 901 controls. Overall HRQoL was comparable between childhood cancer survivors and controls, whilst adult cancer survivors reported better HRQoL than controls. Over 50% of child and adult cancer survivors reported meaningful reductions in overall HRQoL compared to perfect health (i.e. EQ-5D-5L index < 0.92). Childhood survivors reported more mobility and activity limitations on the EQ-5D-5L domains compared to controls, whilst adult survivors reported fewer self-care issues. Childhood survivors' poorer HRQoL was significantly associated with cancer diagnosis and treatment, greater health issues, lower resilience, and smoking history. Adult survivors' poorer HRQoL was associated with older age, lower education, fewer health issues, lower resilience, and less physical activity. Conclusion This study provides a comprehensive examination of HRQoL among Australian cancer survivors, shedding light on age-specific differences and the multifaceted nature of associated factors. Implications for cancer survivors Factors associated with HRQoL highlight modifiable opportunities for targeted survivorship care interventions that may improve survivors’ long-term coping and adaptation, as well as broader physical health after cancer.