Exploring functioning and health-related quality of life in patients referred to a diagnostic cancer pathway for non-specific serious symptoms

Abstract

Objective: To assess functioning and health-related quality of life (HRQoL) in patients referred to a cancer diagnostic pathway for non-specific serious symptoms, and to explore whether changes over 3 months differ among patients diagnosed with cancer, another serious diagnosis, or no serious diagnosis.

Methods: A prospective cohort study was conducted at a hospital-based cancer diagnostic clinic. Functioning and HRQoL were assessed at baseline and after 3 months using the 36-item WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) and the EuroQol 5-Domain 5-Level (EQ-5D-5L), respectively.

Results: A total of 347 patients were included, with 242 completing follow-up. At baseline, patients with another serious diagnosis reported the highest functioning difficulties (median WHODAS: 25) and lowest HRQoL (median EQ-5D-5L: 0.705). Functioning scores improved modestly across all groups at 3 months, with no statistically significant differences between them. However, HRQoL improved significantly only in patients with another serious diagnosis, compared to those with cancer or no serious diagnosis (p = 0.04).

Conclusion: Patients referred to a cancer diagnostic pathway for non-specific serious symptoms experience considerable functioning difficulties and reduced HRQoL at referral. While functioning improved modestly across all groups, only patients with another serious diagnosis showed a significant improvement in HRQoL. These findings highlight the need for early assessment and support for all patients in this pathway, irrespective of the final diagnosis, to ensure equitable care and timely rehabilitation when needed.

Keywords: Cancer; EQ5D; Functioning; Quality of life; WHODAS.