Psychosocial factors associated with quality of life in cancer survivors: umbrella review

Cancer is a severe disease affecting millions of people worldwide (19.3 million new cases in 2020) (Sung et al. 2021). It has one of the highest mortality rates (Sung et al. 2021). However, due to advances in early cancer screening, detection, and treatment, the number of cancer survivors is rapidly increasing. Cancer survivorship has been defined in several ways, leading to different definitions (Marzorati et al. 2017). In one of the first definitions survivorship was described as a process consisting of 3 phases, acute survival phase, extended survival phase, and permanent survivorship (Mullan 1985). Later survivorship trajectories were expanded to 4 stages by adding the transitional survival phase. The “acute survival phase” starts with the diagnosis, the “transitional survival phase” is characterized by the end of treatment and the time when survivors are distancing from the medical team, the “extended survival phase” involves survivors in remission or with no evidence of disease, and the “permanent survivorship phase” begins when survivors are cancer free, but still experiencing long-term health and psychological issues (Vaz-Luis et al. 2022). However, despite the treatment and recovery, survivors still face numerous challenges, as cancer may leave a great impact on many aspects of survivors’ lives (Harrington et al. 2010). More specifically, cancer survivors face physical dysfunctions, psychological and social problems, that lead to an overall decrease in well-being and quality of life (QoL) (Ligt et al. 2019). The World Health Organization (WHO) defines QoL as “an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns” (“The World Health Organization quality of life assessment (WHOQOL): Position paper from the World Health Organization” 1995). However, QoL is a complex and multifaceted concept and is defined and measured differently depending on a number of circumstances. Yet, many scientists measuring QoL follow a policy of incorporating physical function, mental status, and the ability to engage in normative social interactions (Spitzer 1987; Post 2014).<br/><br/>A recent study showed that overall QoL in cancer survivors has been broadly and significantly affected by psychological aspects and social support (Park et al. 2021). Indeed, psychosocial factors associated with quality of life represent a complex set of variables that impact an individual’s emotional, social, and psychological well-being. These factors depending on different circumstances (i.e., sociodemographic, clinical, cultural, etc.) can have both a positive and negative impact on survivors’ well-being and cause various modifications in QoL. The identification of psychosocial factors associated with QoL may have theoretical and clinical implications for supporting cancer survivors in their cancer journey and providing quality cancer care aimed to improve not only the clinical outcomes but also the QoL of cancer survivors. Therefore, this umbrella review(UR) highlights the importance of investigating possible moderators of QoL in cancer survivors.<br/><br/>Reviewing the literature, it can be stated that in recent years, given the increasing number of cancer survivors and their extended life expectancy, there is also a growing interest in QoL during this phase of cancer care. However, there is still no umbrella review compiling evidence from multiple existing reviews on psychosocial factors associated with QoL in cancer survivors. Thus, the aim of this UR is to provide a comprehensive overview of the QoL and its psychosocial determinants in cancer survivors.