Health-related quality of life and its socio-economic and cultural predictors among advanced cancer patients: evidence from the APPROACH cross-sectional survey in Hyderabad-India

Background Patients with advanced cancer often experience poor health-related quality-of-life (HRQoL) due to cancer and treatment-related side-effects. With India's palliative care landscape in its infancy, there is a concern that advanced cancer patients, especially individuals who are from disadvantaged populations experience poor HRQoL outcomes. We aim to assess HRQoL of advanced cancer patients in terms of general well-being (physical, functional, emotional, and social/family well-being), pain experiences, psychological state, and spiritual well-being, and determine the relationship between belonging to a disadvantaged group and HRQoL outcomes. We hypothesize that patients from disadvantaged or minority backgrounds, identified in this paper as financially distressed, female, lower years of education, lower social/family support, minority religions, and Non-General Castes, would be associated with worse HRQoL outcomes compared to those who are not from a disadvantaged group. Methods We administered a cross-sectional survey to 210 advanced cancer patients in a regional cancer center in India. The questionnaire included standardized instruments for general well-being (FACT-G), pain experiences (BPI), psychological state (HADS), spiritual well-being (FACT-SP); socio-economic and demographic characteristics. Results Participants reported significantly lower general well-being (mean +/- SD) (FACT-G = 62.4 +/- 10.0) and spiritual well-being (FACT-SP = 32.7 +/- 5.5) compared to a reference population of cancer patients in the U.S. Patients reported mild to moderate pain severity (3.2 +/- 1.8) and interference (4.0 +/- 1.6), normal anxiety (5.6 +/- 3.1) and borderline depressive symptoms (9.7 +/- 3.3). Higher financial difficulty scores predicted most of the HRQoL domains (p <= 0.01), and being from a minority religion predicted lower physical well-being (p <= 0.05) and higher pain severity (p <= 0.05). Married women reported lower social/family well-being (p <= 0.05). Pain severity and interference were significant predictors of most HRQoL domains. Conclusions Advanced cancer patients, especially those with lower financial well-being and belonging to minority religions, reported low physical, functional, emotional, social/family, and spiritual well-being, and borderline depressive symptoms. Future studies should be directed at developing effective interventions supporting vulnerable groups such as those with financial distress, and those belonging to minority religions.