{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T19:24:07Z","timestamp":1794338647437,"version":"4.9.0"},"reference-count":52,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2022,9,27]],"date-time":"2022-09-27T00:00:00Z","timestamp":1664236800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Cancer survivors have reduced health-related quality of life (HRQOL) and high levels of distress during and after active treatment, due to physical, psychological, and social problems. Understanding the prevalence and associations of HRQOL and distress in a patient population in the community is important when designing rehabilitation programs. This was a cross-sectional observational study conducted at a community-based cancer rehabilitation center, with the aim of investigating the prevalence and associations of HRQOL and distress in cancer patients. There were 304 patients who were recruited. We found low levels of HRQOL and high levels of distress in patients, with a mean FACT-G7 total score of 11.68, and a mean distress thermometer score of 3.51. In the multivariate regression model, significant factors for low HRQOL were metastatic disease (p = 0.025) and Malay ethnicity (p &lt; 0.001). Regression analyses also found that significant distress was associated with family health issues (p = 0.003), depression (p = 0.001), worry (p = 0.005), breathing (p = 0.007), getting around (p = 0.012) and indigestion (p = 0.039). A high prevalence of impaired HRQOL and distress was reported in cancer survivors even in a community rehabilitation setting. The physical and psychosocial well-being of cancer survivors should be monitored and managed as part of community-based cancer rehabilitation.<\/jats:p>","DOI":"10.3390\/curroncol29100551","type":"journal-article","created":{"date-parts":[[2022,9,27]],"date-time":"2022-09-27T21:23:27Z","timestamp":1664313807000},"page":"7012-7020","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Assessment of Health-Related Quality of Life and Distress in an Asian Community-Based Cancer Rehabilitation Program"],"prefix":"10.3390","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7682-539X","authenticated-orcid":false,"given":"Matthew Rong Jie","family":"Tay","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore"},{"name":"Singapore Cancer Society Rehabilitation Center, 52 Jurong Gateway Rd, Singapore 608550, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chin Jung","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore 308433, Singapore"},{"name":"Singapore Cancer Society Rehabilitation Center, 52 Jurong Gateway Rd, Singapore 608550, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui Zhen","family":"Aw","sequence":"additional","affiliation":[{"name":"Singapore Cancer Society Rehabilitation Center, 52 Jurong Gateway Rd, Singapore 608550, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,9,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2108","DOI":"10.1158\/1055-9965.EPI-12-0740","article-title":"Mental and physical health-related quality of life among U.S. cancer survivors: Population estimates from the 2010 National Health Interview Survey","volume":"21","author":"Weaver","year":"2012","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"295","DOI":"10.3322\/caac.21186","article-title":"Impairment-driven cancer rehabilitation: An essential component of quality care and survivorship","volume":"63","author":"Silver","year":"2013","journal-title":"CA Cancer J. Clin."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e350","DOI":"10.3747\/co.27.5875","article-title":"The importance of humour in oncology: A survey of patients undergoing radiotherapy","volume":"27","author":"Samant","year":"2020","journal-title":"Curr. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1583","DOI":"10.1007\/s11136-020-02729-6","article-title":"Longitudinal change of quality of life in the first five years of survival among disease-free Chinese breast cancer survivors","volume":"30","author":"Lei","year":"2021","journal-title":"Qual. Life Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S5","DOI":"10.1097\/PHM.0b013e31820be4ae","article-title":"Cancer rehabilitation with a focus on evidence-based outpatient physical and occupational therapy interventions","volume":"90","author":"Silver","year":"2011","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_6","first-page":"1","article-title":"Cancer Supportive and Survivorship Care in Singapore: Current Challenges and Future Outlook","volume":"4","author":"Loh","year":"2018","journal-title":"J. Glob. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"la Cour, K., and Cutchin, M.P. (2013). Developing community based rehabilitation for cancer survivors: Organizing for coordination and coherence in practice. BMC Health Serv. Res., 13.","DOI":"10.1186\/1472-6963-13-339"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1229","DOI":"10.6004\/jnccn.2019.0048","article-title":"Distress Management, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology","volume":"17","author":"Riba","year":"2019","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1002\/1099-1611(200101\/02)10:1<19::AID-PON501>3.0.CO;2-6","article-title":"The prevalence of psychological distress by cancer site","volume":"10","author":"Zabora","year":"2001","journal-title":"Psychooncology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2297","DOI":"10.1038\/sj.bjc.6601887","article-title":"High levels of untreated distress and fatigue in cancer patients","volume":"90","author":"Carlson","year":"2004","journal-title":"Br. J. Cancer"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3793","DOI":"10.3390\/curroncol29060304","article-title":"Screening for Distress and Health Outcomes in Head and Neck Cancer","volume":"29","author":"Gascon","year":"2022","journal-title":"Curr. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1002\/pon.1059","article-title":"Screening for psychological distress in Turkish cancer patients","volume":"16","author":"Ozalp","year":"2007","journal-title":"Psychooncology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3200","DOI":"10.3390\/curroncol29050260","article-title":"Psychological Problems among Head and Neck Cancer Patients in Relation to Utilization of Healthcare and Informal Care and Costs in the First Two Years after Diagnosis","volume":"29","author":"Jansen","year":"2022","journal-title":"Curr. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.6004\/jnccn.2019.7358","article-title":"Update on the Implementation of NCCN Guidelines for Distress Management by NCCN Member Institutions","volume":"17","author":"Donovan","year":"2019","journal-title":"J. Natl. Compr. Cancer Netw."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1002\/pon.3430","article-title":"Validation of the distress thermometer worldwide: State of the science","volume":"23","author":"Donovan","year":"2014","journal-title":"Psychooncology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2575","DOI":"10.3390\/curroncol29040211","article-title":"Assessing the Relationship between Socioeconomic Status, Race, and Psychological Distress in Cancer Survivors: A Population Based Study","volume":"29","author":"Chidobem","year":"2022","journal-title":"Curr. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1016\/j.jad.2018.11.089","article-title":"Psychological distress in cancer patients in a large Chinese cross-sectional study","volume":"245","author":"Rao","year":"2019","journal-title":"J. Affect Disord."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1016\/j.genhosppsych.2011.02.008","article-title":"Prevalence and associated factors of psychological distress among Korean cancer patients","volume":"33","author":"Kim","year":"2011","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"ACTION Study Group (2017). Health-related quality of life and psychological distress among cancer survivors in Southeast Asia: Results from a longitudinal study in eight low- and middle-income countries. BMC Med., 15.","DOI":"10.1186\/s12916-016-0768-2"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1007\/s00520-021-06422-3","article-title":"Distress among cancer patients attending rehabilitation in the community","volume":"30","author":"Kuo","year":"2022","journal-title":"Support Care Cancer"},{"key":"ref_21","unstructured":"Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health (2022, September 07). Office of Cancer Survivorship\u2014Definitions, Available online: http:\/\/cancercontrol.cancer.gov\/ocs\/statistics\/definitions.html."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1093\/annonc\/mds539","article-title":"The FACT-G7: A rapid version of the functional assessment of cancer therapy-general (FACT-G) for monitoring symptoms and concerns in oncology practice and research","volume":"24","author":"Yanez","year":"2013","journal-title":"Ann. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1200\/JCO.1993.11.3.570","article-title":"The functional assessment of cancer therapy scale: Development and validation of the general measure","volume":"11","author":"Cella","year":"1993","journal-title":"J. Clin. Oncol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3750","DOI":"10.1002\/cncr.32981","article-title":"Validation of the 7-item Functional Assessment of Cancer Therapy-General (FACT-G7) as a short measure of quality of life in patients with advanced cancer","volume":"126","author":"Mah","year":"2020","journal-title":"Cancer"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2902","DOI":"10.1002\/cncr.28758","article-title":"Ambulatory cancer and US general population reference values and cutoff scores for the functional assessment of cancer therapy","volume":"120","author":"Pearman","year":"2014","journal-title":"Cancer"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1002\/cncr.23622","article-title":"Screening and referral for psychosocial distress in oncologic practice: Use of the Distress Thermometer","volume":"113","author":"Tuinman","year":"2008","journal-title":"Cancer"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1055","DOI":"10.1016\/j.comppsych.2014.01.008","article-title":"The Distress Thermometer as an ultra-short screening tool: A first validation study for mixed-cancer outpatients in Singapore","volume":"55","author":"Lim","year":"2014","journal-title":"Compr. Psychiatry"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3687","DOI":"10.1200\/JCO.2012.41.7238","article-title":"Troublesome symptoms in cancer survivors: Fatigue, insomnia, neuropathy, and pain","volume":"30","author":"Pachman","year":"2012","journal-title":"J. Clin. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2025","DOI":"10.1007\/s00520-015-2994-0","article-title":"Unmet needs mediate the relationship between symptoms and quality of life in breast cancer survivors","volume":"24","author":"Cheng","year":"2016","journal-title":"Support Care Cancer"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Chui, P.L., Abdullah, K.L., Wong, L.P., and Taib, N.A. (2015). Quality of Life in CAM and Non-CAM Users among Breast Cancer Patients during Chemotherapy in Malaysia. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0139952"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1186\/s12955-016-0428-4","article-title":"Most prevalent unmet supportive care needs and quality of life of breast cancer patients in a tertiary hospital in Malaysia","volume":"14","author":"Edib","year":"2016","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"532","DOI":"10.11622\/smedj.2019099","article-title":"Factors influencing quality of life of Asian breast cancer patients and their caregivers at diagnosis: Perceived medical and psychosocial needs","volume":"61","author":"Chow","year":"2020","journal-title":"Singap. Med. J."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Leow, M.K., Griva, K., Choo, R., Wee, H.L., Thumboo, J., Tai, E.S., and Newman, S. (2013). Determinants of Health-Related Quality of Life (HRQoL) in the Multiethnic Singapore Population\u2014A National Cohort Study. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0067138"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1761","DOI":"10.1016\/S0277-9536(02)00171-5","article-title":"Quality of life in an urban Asian population: The impact of ethnicity and socio-economic status","volume":"56","author":"Thumboo","year":"2003","journal-title":"Soc. Sci. Med."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"3775","DOI":"10.1007\/s00520-016-3195-1","article-title":"Differences in quality of life between American and Chinese breast cancer survivors","volume":"24","author":"Lu","year":"2016","journal-title":"Supportive Care Cancer"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1007\/s10549-011-1592-1","article-title":"Unmet supportive care needs: A cross-cultural comparison between Hong Kong Chinese and German Caucasian women with breast cancer","volume":"130","author":"Lam","year":"2011","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2269","DOI":"10.1007\/s00520-011-1335-1","article-title":"Unmet spiritual care needs impact emotional and spiritual well-being in advanced cancer patients","volume":"20","author":"Pearce","year":"2012","journal-title":"Support Care Cancer"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1111\/j.1365-2354.2008.01021.x","article-title":"Quality of life among patients with primary, metastatic and recurrent cancer","volume":"18","author":"Siddiqi","year":"2009","journal-title":"Eur. J. Cancer Care"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1498","DOI":"10.1200\/JCO.2010.33.4631","article-title":"Relationship between deficits in overall quality of life and non-small-cell lung cancer survival","volume":"30","author":"Sloan","year":"2012","journal-title":"J. Clin. Oncol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"4035","DOI":"10.1007\/s00520-016-3217-z","article-title":"Quality of life and symptom burden in patients with metastatic breast cancer","volume":"24","author":"Hamer","year":"2016","journal-title":"Support Care Cancer"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"240","DOI":"10.5535\/arm.2012.36.2.240","article-title":"Quality of life, upper extremity function and the effect of lymphedema treatment in breast cancer related lymphedema patients","volume":"36","author":"Park","year":"2012","journal-title":"Ann. Rehabil. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"S415","DOI":"10.1016\/j.pmrj.2017.08.403","article-title":"A Focused Review of Safety Considerations in Cancer Rehabilitation","volume":"9","author":"Maltser","year":"2017","journal-title":"PM R"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2946","DOI":"10.1002\/cncr.28750","article-title":"Recommendations for the implementation of distress screening programs in cancer centers: Report from the American Psychosocial Oncology Society (APOS), Association of Oncology Social Work (AOSW), and Oncology Nursing Society (ONS) joint task force","volume":"120","author":"Pirl","year":"2014","journal-title":"Cancer"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1002\/pon.4464","article-title":"One in two cancer patients is significantly distressed: Prevalence and indicators of distress","volume":"27","author":"Mehnert","year":"2018","journal-title":"Psychooncology"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Ng, C.G., Mohamed, S., Kaur, K., Sulaiman, A.H., Zainal, N.Z., Taib, N.A., and MyBCC Study Group (2017). Perceived distress and its association with depression and anxiety in breast cancer patients. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0172975"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1016\/j.mcna.2017.06.005","article-title":"Anxiety and Depression in Cancer Survivors","volume":"101","author":"Yi","year":"2017","journal-title":"Med. Clin. N. Am."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1007\/s11764-009-0110-5","article-title":"An update of controlled physical activity trials in cancer survivors: A systematic review and meta-analysis","volume":"4","author":"Speck","year":"2010","journal-title":"J. Cancer Surviv."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1037\/0278-6133.26.6.660","article-title":"Systematic review and meta-analysis of psychological and activity-based interventions for cancer-related fatigue","volume":"26","author":"Jacobsen","year":"2007","journal-title":"Health Psychol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1007\/s00508-017-1266-z","article-title":"Improvement of quality of life and psychological distress after inpatient cancer rehabilitation: Results of a longitudinal observational study","volume":"129","author":"Riedl","year":"2017","journal-title":"Wien Klin. Wochenschr."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"455","DOI":"10.3233\/WOR-131755","article-title":"Cancer rehabilitation may improve function in survivors and decrease the economic burden of cancer to individuals and society","volume":"46","author":"Silver","year":"2013","journal-title":"Work"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1089\/jpm.2014.0012","article-title":"Comparison of three shortened questionnaires for assessment of quality of life in advanced cancer","volume":"17","author":"Chiu","year":"2014","journal-title":"J. Palliat. Med."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"e020512","DOI":"10.1136\/bmjopen-2017-020512","article-title":"Health-related quality of life in Asian patients with breast cancer: A systematic review","volume":"8","author":"Ho","year":"2018","journal-title":"BMJ Open"}],"container-title":["Current Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1718-7729\/29\/10\/551\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:40:35Z","timestamp":1760143235000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1718-7729\/29\/10\/551"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,27]]},"references-count":52,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["curroncol29100551"],"URL":"https:\/\/doi.org\/10.3390\/curroncol29100551","relation":{},"ISSN":["1718-7729"],"issn-type":[{"value":"1718-7729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,9,27]]}}}