Association of dietary risks, behavioural and lifestyle factors, and the magnitude of disability burden among Australian cancer patients: An observational epidemiology study

1

Introduction

Cancer is a major public health issue that affects people all over the world and is a rapidly increasing concern now globally [1] . In 2015, it accounted for about 18% of the total Australian disease burden [2] . An estimated 145,000 new cancer cases were diagnosed in 2020, equating to one new case every four minutes in Australia [3] . Prevention efforts and population-based screening have led to improvements in the early detection of cancers. Developments in cancer treatments have led to improvements in cancer survival globally [45] . In Australia, between 2012 and 2016, 69% of people diagnosed with all types of cancers survived five years after the diagnosis, representing an increase of nearly 20% since 1987–1991 [5] . Those who survive cancer are often affected by a range of health issues such as physical disability and reduction in quality of life and psychological well-being, influencing their social and workforce participation [46] . A five-year follow-up study reported that 20% of cancer survivors experienced at least one type of disability [7] , whereas 50% of cancer survivors lived with a long-term work disability that limited the kind or amount of work they could do, with 18% of patients experiencing extreme work disability [8] . The magnitude of chronic comorbid conditions was significantly associated with a high risk of disability among cancer patients in Australia [9] .

Cancer can lead to substantial disability due to the severity of the disease and the effects of advanced treatment. The level of disability varies among cancer survivors [58] . A recent longitudinal study reported a prevalence of long-term disability of about 50% among Australian cancer survivors, and the extent of disability was higher again among individuals with higher levels of health burden [8] . Despite the severe burden of disability on the lives of those who survive cancer, investigations into the extent of disability and its association with other factors such as quality of life and functional impairments among cancer survivors, either for single cancer types or for older aged individuals is limited 1011121314 .

Earlier work has explored the association between modifiable lifestyle factors with the onset of cancer, and suggested that these factors contribute 30–50% of the cancer risk [15] . The most common lifestyle-related risk factors include tobacco use [16] , physical inactivity, alcohol consumption, high body mass index and unhealthy diet [5] . Some studies suggest that consuming a healthy diet could reduce cancer recurrence and lower cancer-specific deaths and disease burden 171819 . For instance, a seven-year follow-up study found that a healthy diet and regular physical activity would reduce mortality by 50% [20] . While it is important to recognise the improvement in cancer survivor rates, little is known about the magnitude of disability burden among cancer survivors and associated behavioural, lifestyle and dietary risk factors. This assessment will be useful to guide the development of tailored interventions to reduce the burden of disability.

This study aims to assess the burden and distribution of disability for a range of disability types, among Australian cancer patients and the association with lifestyle, behavioural and dietary risk factors.