Nationwide Analysis of Sociodemographic Disparities in Health‐Related Quality of Life of Colon Cancer Survivors

ABSTRACT Background Health‐related quality of life (HRQOL) measures patients' overall well‐being and can help guide survivorship care. Evidence comparing individual patients' HRQOL pre‐ and post‐diagnosis is limited due to the unpredictable nature of cancer onset. Our study aims to evaluate trends in HRQOL in elderly colon cancer patients and identify predictors of HRQOL change across two key transitions: (1) pre‐ to post‐diagnosis, and (2) at diagnosis versus 2 years later, with the goal of identifying at‐risk patients for a significant HRQOL decrease. Methods Utilizing the SEER‐Medicare Health Outcomes Survey (SEER‐MHOS), patients diagnosed with colon cancer between 1998 and 2019, ≥ 65 years old, and at least two HRQOL surveys were identified and grouped. Group 1 comprised patients with an initial survey pre‐diagnosis and a follow‐up survey within 1 year from diagnosis, while Group 2 included patients with an initial survey within 1 year from diagnosis and a follow‐up survey 2 years later. Bayesian linear regression identified predictors of physical (PCS) and mental (MCS) score changes, incorporating demographic, socioeconomic, comorbidity, and cancer‐related variables. Results The analysis included 1139 patients (Group 1: 571; Group 2: 568). PCS and MCS scores decreased substantially at diagnosis (4.4 and 2.2 points, respectively) compared to baseline but changed minimally from baseline (−0.3 and +0.6 points, respectively) 2 years post‐diagnosis. Advanced disease stage and baseline ADL limitations were the strongest predictors of HRQOL decline, both from pre‐ to post‐diagnosis and from diagnosis to 2 years later. Conversely, positive baseline health perception was protective (probability of direction > 90% for all estimates). Conclusions Among colon cancer patients, patient‐reported baseline health perception and functional limitations emerged as critical determinants of HRQOL trajectories, outweighing socioeconomic and treatment‐related factors. These factors remain consistent upon diagnosis and during survivorship. Assessment of these factors could estimate HRQOL outcomes and facilitate early identification of at‐risk patients.