Characteristics of patients
About half of the patients in this study were men (53%) and the mean age was 53.4 years (SD 11.4, range 23 to 87). Men were younger than women (50.8 vs 56.3, p < 0.01). Eighty-six percent were from MSKCC, with most of the rest from NGH. About half were Caucasian and about one-third were African-American. While more than half had at least some college education, 20% had not graduated from high school. Forty-seven percent were currently employed. Two-thirds were physically active when interviewed, participating in physical activities such as walking, sports, aerobics, running or other activity more than once a week. Forty-eight percent had a previous diagnosis of cancer. These are mainly long-term cancer survivors, with a mean of 9.4 years since diagnosis (median 6.6 years, range 4 months to 38 years).
Diagnosis of cancer and years since diagnosis were the same in men and women. Among these patients, most had breast cancer (n = 17), followed by lymphoma (n = 14), colon cancer (n = 7), testicular cancer (n = 6), prostate cancer (n = 5) and leukemia (n = 5). Among all patients, other conditions were common: 72% had at least one chronic medical condition (heart disease, diabetes, hypertension, lung disease, thyroid disease, arthritis, rheumatoid arthritis, asthma, stroke or transitional ischemic attack, Crohn's disease, colitis, ulcers, or psoriasis); the highest prevalences were for hypertension (37%) and arthritis (22%). Forty-three percent had two or more of these conditions. Women were more likely than men to have heart disease and thyroid disease and to have two or more conditions.
One-quarter of the patients had been diagnosed with depression at some time and 15% were currently being treated for depression; more women than men ever had depression. Using responses to questions on the amount of beer, wine, and hard liquor drunk and the frequency of drinking each type of alcohol, we determined that 36% of respondents had a history of high alcohol consumption, defined as drinking an average of >2 drinks per day of beer, wine, or hard liquor for men and >1 drink per day for women [9
]. Among those with heavy use of alcohol, 22% continued to drink in the last year, while among those who had stopped drinking, the mean number of years since drinking was 8.8 ± 7.4 (range, 1–30 years). The most common route of infection was IV drug use, for 40%, with 30% infected through transfusions and 30% infected through other or unknown routes. The mean number of years since using IV drugs was 19, and none claimed to have used IV drugs in the past 1.5 years. Sixteen patients (11%) had a positive test for human immunodeficiency virus (HIV) by self-report. Four percent were treated for hepatitis C before completing the SF-36; the mean number of months between completing treatment and filling out the questionnaire was 11.7 ± 10.1 (range 1–27 months). An additional 18% were treated after filling out the SF-36. ALT levels close to the time of completing the SF-36 questionnaire (mean 19.7 days, range 0–163) were available for 137 patients: the median was 56 and 20% had ALT levels of 100 or above. Among the 81 patients who had liver biopsy, 42% had stage III-IV disease, including 12% with stage IV.
Comparison with population norms
Table shows the results for the summary measures, the PCS and MCS. Compared to the norm of 50 among the general U.S. population, patients with CHC scored lower on these measures, particularly the PCS. Compared to men in the general population, men with CHC scored below the norm for men on the PCS, but were equal to the norm on the MCS. In contrast, women with CHC scored below the norms for women on both these summary scales.
Mean scores (SD) on PCS and MCS for patients with CHC and general U.S. population
Domains of quality of life
Table shows scores for the individual domains. The first column shows transformed results, scaled to the norm of 50; transformation accounts for differences in the structure of the scales and allows for comparison between scales. The second column shows scores before transformation, to facilitate comparison to other studies. On the transformed scores, the CHC patients in our study had the highest scores for vitality and role-emotional (i.e., the extent to which emotional problems interfere with daily activities), and the lowest for general health.
Mean scores (SD) on eight domains
Factors associated with PCS and MCS
In univariate analysis, shown in Table , female gender, lower physical activity, history of heavy alcohol use and history of depression led to lower scores on both the PCS and MCS. Other variables that were associated with significantly lower PCS scores on univariate analysis were having less than a high school education, not working currently, and having two or more chronic conditions. Those with a high ALT level (i.e., ALT >100) close to the time of completing the SF-36 had lower scores on the PCS that were marginally significant. We included these variables in multivariate analyses of factors affecting the PCS score. In addition, because of our interest in quality of life among cancer patients with CHC, we included history of cancer in the models.
Patient characteristics and mean PCS and MCS scores (SD) according to patient characteristics
Results of multivariate models for the PCS incorporating these variables are shown in Table . History of cancer and having two or more other conditions were strongly associated with the PCS, and high ALT level, having fewer years of education, and low physical activity also had a significant effect on the PCS score. Although gender had an important effect in univariate analysis, it was strongly related to education and depression, with women having less education and higher prevalence of depression; with all these variables in the model, only education had an independent effect. Current employment and alcohol use were not significant in multivariate analysis. The variables in the model explained 39% of the variation in the PCS. Results of multivariate analysis differed by gender: among men, only a history of cancer was associated with the PCS, while among women, only chronic conditions affected the score. The variables included in the models explained more of the variance for women than for men.
F values for factors associated with PCS in multivariate analysis in total and by gender
In univariate analysis (Table ), the factors associated with the MCS were depression, level of physical activity, gender, and alcohol consumption. These factors and cancer history were included in multivariate models. Results, shown in Table , indicate that each of these factors, except history of cancer, was independently associated with MCS, explaining 23% of the variance. Among men, only physical activity was significant, and among women, depression and alcohol use were significant.
F values for factors associated with MCS in multivariate analysis in total and by gender
We also investigated several other factors for their association with the PCS and MCS, in both univariate and multivariate analyses. Variables not related to these quality of life measures included: age, race, marital status, hospital, HIV infection, route of transmission, treatment for CHC, stage of fibrosis, and measures of social support (attendance at religious services, attendance at meetings of community groups, and number of friends).