Table 5.

Sociodemographic, Cancer Therapy, and Health Behaviors Affecting Health Status Domains

Risk Factors by Health Status Domains	Poor General Health*	Adverse Mental Health†	Functional Impairment‡	Activity Limitations§	Cancer-Related Pain‖	Cancer-Related Anxiety¶
High (5-6 domains)
Female	X	X	X	X	X	X
Low education/income level	X	X	X	X	X	X
Alkylating agent	X	X	X	X	X	X
Smoker	X	X	X		X	X
Low physical activity	X	X	X	X		X
Obese	X	X	X	X	X
Intermediate (3-4 domains)
Underweight	X		X	X	X
Anthracycline	X			X	X	X
Cystectomy	X		X	X	X
Age ≥ 25 years	X		X	X
Cranial radiation ≥ 30 Gy	X		X	X
Lower extremity amputation			X	X	X
Craniotomy		X	X	X
Low (1-2 domains)
Nonwhite race/ethnicity	X		X
Chest radiation	X			X
Upper extremity amputation			X		X
Abdominal radiation > 35 Gy					X
Thoracotomy					X

NOTE. Clinical factors independently associated with adverse health status by multivariable analysis. Suggested patient management is as follows:

^*Periodic (at least annual) clinical evaluation with risk-based screenings per Children's Oncology Group guidelines; management of comorbid health conditions; counseling regarding modifying lifestyle factors.

^†,¶Psychological assessment with attention to emotional health status. Referral to mental health services as indicated.

^‡,§Clinical assessment of functional and activity limitations. Referral to rehabilitation services (physical and/or occupational therapy) as indicated.

^‖Clinical assessment of chronic symptoms. Referral to pain rehabilitation services as indicated.

^*,¶Psychosocial assessment with attention to access to health care and resources and ability to manage practical concerns. Referral to social work services as indicated.