Factors Associated With Quality of Life Among Posttreatment Cancer Survivors in Korea

Background Identification of factors associated with quality of life (QOL) among cancer survivors is crucial for identifying potential targets for intervention.We aimed to provide evidence of factors associated with the QOL among posttreatment cancer survivors in Korea.We performed a systematic literature search from January 2000 to September 2022 using PubMed, EMBASE, CINAHL, PsycINFO, and Korean databases (RISS, SCIENCEON). We evaluated study quality using the Joanna Briggs Institute Quality Appraisal Checklists for Analytical Cross-sectional Studies and performed statistical analysis using the R 3.0 software (R Foundation for Statistical Computing, Vienna, Austria) package. We analyzed the pooled effect sizes of potential QOL correlates by the random-effects model.This meta-analysis included 31 studies with 8934 participants. The pooled estimates were significantly large for economic status (r = -0.53); significantly medium for fatigue (r = -0.39), anxiety (r = -0.29), depression (r = -0.42), self-efficacy (r = 0.37), and social support (r = 0.30); and significantly small for education level (r = -0.18), job status (r = -0.09), cancer stage (r = -0.20), and time since diagnosis (r = -0.26).Low education level, having no job, low economic status, advanced cancer stage, short disease period, fatigue, anxiety, and depression were significantly associated with worse QOL, whereas self-efficacy and social support were significantly associated with better QOL.The findings have potential implications for identifying "at-risk survivors" of deteriorated QOL and for suggesting powerful strategies (eg, enhancing self-efficacy or social support) for improving QOL.Cancer, a leading cause of death worldwide, accounted for nearly 10 million deaths in 2020.1 Cancer is also a foremost public health concern and a leading cause of death in South Korea (hereinafter referred to as Korea).2 More than 250 000 patients were newly diagnosed with cancer in 2019, and the prevalence of cancer continues to rise.3 Because of advances in early detection and treatment, however, the cancer survival rate has also improved. Korea experienced a remarkable increase in its 5-year relative cancer survival rate from 42.9% in 1993-1995 to 70.7% in 2015-2019.3 Since 2018, the number of cancer survivors exceeded 2 million, indicating that 1 in 25 people (4.2% of the entire population) has had a cancer diagnosis.3 As the number of cancer survivors continues to grow, so does their quality of life (QOL).Cancer and its treatments can cause various long-term and late effects among survivors. Prevalence reported for Korean cancer survivors include 43.6% for pain, 66.1% to 71.1% for fatigue, 58.9% for sleep disturbance, 39.5% to 47.2% for anxiety, 24.9% to 36.7% for depression, and 67.8% for distress.4-6 According to national data analysis, 25.9% of newly diagnosed cancer patients lost their job within 1 year of diagnosis, and 47% within 5 years.7 Such physical, psychological, and social sequelae ultimately deteriorate QOL. Many studies have demonstrated that the QOL of posttreatment cancer survivors was significantly lower than that of the general population.8-12 Approximately 20% of disease-free Korean cancer survivors were found to suffer problematic QOL levels.8The numerous Korean studies that have examined the impact of cancer and its treatment on survivor QOL have identified factors associated with it. Identification of such factors is crucial for identifying potential targets for intervention. 13 Examined factors, however, have been quite broad and have included sociodemographic, disease-related, and treatment-related symptoms as well as psychosocial and lifestyle factors. In addition, findings have not been consistent.14 Because QOL studies among Korean cancer survivors have accumulated over the past 20 years, there is a need to evaluate all the evidence to determine which factors to prioritize in a cancer survivorship program.Meta-analysis is a powerful statistical technique that can help explain variability and produce more precise estimates of the associations among the concepts involved. To the best of our knowledge, there is no previous meta-analysis on factors associated with QOL in posttreatment cancer survivors in Korea. Although there are several meta-analyses of QOL among cancer survivors,15-17 the results are not specific to Korea, but QOL can be influenced by culture and socioenvironmental factors.18,19 Accordingly, we aimed in this study to conduct a meta-analysis on factors associated with QOL among Korean cancer survivors living in Korea. We trust that a comprehensive understanding derived from this study will enable healthcare providers to develop more effective survivor care programs that will improve the QOL of Korean cancer survivors.This systematic review and meta-analysis report is based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guideline.20Background Identification of factors associated with quality of life (QOL) among cancer survivors is crucial for identifying potential targets for intervention.We aimed to provide evidence of factors associated with the QOL among posttreatment cancer survivors in Korea.We performed a systematic literature search from January 2000 to September 2022 using PubMed, EMBASE, CINAHL, PsycINFO, and Korean databases (RISS, SCIENCEON). We evaluated study quality using the Joanna Briggs Institute Quality Appraisal Checklists for Analytical Cross-sectional Studies and performed statistical analysis using the R 3.0 software (R Foundation for Statistical Computing, Vienna, Austria) package. We analyzed the pooled effect sizes of potential QOL correlates by the random-effects model.This meta-analysis included 31 studies with 8934 participants. The pooled estimates were significantly large for economic status (r = -0.53); significantly medium for fatigue (r = -0.39), anxiety (r = -0.29), depression (r = -0.42), self-efficacy (r = 0.37), and social support (r = 0.30); and significantly small for education level (r = -0.18), job status (r = -0.09), cancer stage (r = -0.20), and time since diagnosis (r = -0.26).Low education level, having no job, low economic status, advanced cancer stage, short disease period, fatigue, anxiety, and depression were significantly associated with worse QOL, whereas self-efficacy and social support were significantly associated with better QOL.The findings have potential implications for identifying "at-risk survivors" of deteriorated QOL and for suggesting powerful strategies (eg, enhancing self-efficacy or social support) for improving QOL.Cancer, a leading cause of death worldwide, accounted for nearly 10 million deaths in 2020.1 Cancer is also a foremost public health concern and a leading cause of death in South Korea (hereinafter referred to as Korea).2 More than 250 000 patients were newly diagnosed with cancer in 2019, and the prevalence of cancer continues to rise.3 Because of advances in early detection and treatment, however, the cancer survival rate has also improved. Korea experienced a remarkable increase in its 5-year relative cancer survival rate from 42.9% in 1993-1995 to 70.7% in 2015-2019.3 Since 2018, the number of cancer survivors exceeded 2 million, indicating that 1 in 25 people (4.2% of the entire population) has had a cancer diagnosis.3 As the number of cancer survivors continues to grow, so does their quality of life (QOL).Cancer and its treatments can cause various long-term and late effects among survivors. Prevalence reported for Korean cancer survivors include 43.6% for pain, 66.1% to 71.1% for fatigue, 58.9% for sleep disturbance, 39.5% to 47.2% for anxiety, 24.9% to 36.7% for depression, and 67.8% for distress.4-6 According to national data analysis, 25.9% of newly diagnosed cancer patients lost their job within 1 year of diagnosis, and 47% within 5 years.7 Such physical, psychological, and social sequelae ultimately deteriorate QOL. Many studies have demonstrated that the QOL of posttreatment cancer survivors was significantly lower than that of the general population.8-12 Approximately 20% of disease-free Korean cancer survivors were found to suffer problematic QOL levels.8The numerous Korean studies that have examined the impact of cancer and its treatment on survivor QOL have identified factors associated with it. Identification of such factors is crucial for identifying potential targets for intervention.13 Examined factors, however, have been quite broad and have included sociodemographic, disease-related, and treatment-related symptoms as well as psychosocial and lifestyle factors. In addition, findings have not been consistent.14 Because QOL studies among Korean cancer survivors have accumulated over the past 20 years, there is a need to evaluate all the evidence to determine which factors to prioritize in a cancer survivorship program.Meta-analysis is a powerful statistical technique that can help explain variability and produce more precise estimates of the associations among the concepts involved. To the best of our knowledge, there is no previous meta-analysis on factors associated with QOL in posttreatment cancer survivors in Korea. Although there are several meta-analyses of QOL among cancer survivors,15-17 the results are not specific to Korea, but QOL can be influenced by culture and socioenvironmental factors.18,19 Accordingly, we aimed in this study to conduct a meta-analysis on factors associated with QOL among Korean cancer survivors living in Korea. We trust that a comprehensive understanding derived from this study will enable healthcare providers to develop more effective survivor care programs that will improve the QOL of Korean cancer survivors.This systematic review and meta-analysis report is based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guideline.20Background Identification of factors associated with quality of life (QOL) among cancer survivors is crucial for identifying potential targets for intervention.We aimed to provide evidence of factors associated with the QOL among posttreatment cancer survivors in Korea.We performed a systematic literature search from January 2000 to September 2022 using PubMed, EMBASE, CINAHL, PsycINFO, and Korean databases (RISS, SCIENCEON). We evaluated study quality using the Joanna Briggs Institute Quality Appraisal Checklists for Analytical Cross-sectional Studies and performed statistical analysis using the R 3.0 software (R Foundation for Statistical Computing, Vienna, Austria) package. We analyzed the pooled effect sizes of potential QOL correlates by the random-effects model.This meta-analysis included 31 studies with 8934 participants. The pooled estimates were significantly large for economic status (r = -0.53); significantly medium for fatigue (r = -0.39), anxiety (r = -0.29), depression (r = -0.42), self-efficacy (r = 0.37), and social support (r = 0.30); and significantly small for education level (r = -0.18), job status (r = -0.09), cancer stage (r = -0.20), and time since diagnosis (r = -0.26).Low education level, having no job, low economic status, advanced cancer stage, short disease period, fatigue, anxiety, and depression were significantly associated with worse QOL, whereas self-efficacy and social support were significantly associated with better QOL.The findings have potential implications for identifying "at-risk survivors" of deteriorated QOL and for suggesting powerful strategies (eg, enhancing self-efficacy or social support) for improving QOL.Cancer, a leading cause of death worldwide, accounted for nearly 10 million deaths in 2020.1 Cancer is also a foremost public health concern and a leading cause of death in South Korea (hereinafter referred to as Korea).2 More than 250 000 patients were newly diagnosed with cancer in 2019, and the prevalence of cancer continues to rise.3 Because of advances in early detection and treatment, however, the cancer survival rate has also improved. Korea experienced a remarkable increase in its 5-year relative cancer survival rate from 42.9% in 1993-1995 to 70.7% in 2015-2019.3 Since 2018, the number of cancer survivors exceeded 2 million, indicating that 1 in 25 people (4.2% of the entire population) has had a cancer diagnosis.3 As the number of cancer survivors continues to grow, so does their quality of life (QOL).Cancer and its treatments can cause various long-term and late effects among survivors. Prevalence reported for Korean cancer survivors include 43.6% for pain, 66.1% to 71.1% for fatigue, 58.9% for sleep disturbance, 39.5% to 47.2% for anxiety, 24.9% to 36.7% for depression, and 67.8% for distress.4-6 According to national data analysis, 25.9% of newly diagnosed cancer patients lost their job within 1 year of diagnosis, and 47% within 5 years.7 Such physical, psychological, and social sequelae ultimately deteriorate QOL. Many studies have demonstrated that the QOL of posttreatment cancer survivors was significantly lower than that of the general population.8-12 Approximately 20% of disease-free Korean cancer survivors were found to suffer problematic QOL levels.8The numerous Korean studies that have examined the impact of cancer and its treatment on survivor QOL have identified factors associated with it. Identification of such factors is crucial for identifying potential targets for intervention.13 Examined factors, however, have been quite broad and have included sociodemographic, disease-related, and treatment-related symptoms as well as psychosocial and lifestyle factors. In addition, findings have not been consistent.14 Because QOL studies among Korean cancer survivors have accumulated over the past 20 years, there is a need to evaluate all the evidence to determine which factors to prioritize in a cancer survivorship program.Meta-analysis is a powerful statistical technique that can help explain variability and produce more precise estimates of the associations among the concepts involved. To the best of our knowledge, there is no previous meta-analysis on factors associated with QOL in posttreatment cancer survivors in Korea. Although there are several meta-analyses of QOL among cancer survivors,15-17 the results are not specific to Korea, but QOL can be influenced by culture and socioenvironmental factors.18,19 Accordingly, we aimed in this study to conduct a meta-analysis on factors associated with QOL among Korean cancer survivors living in Korea. We trust that a comprehensive understanding derived from this study will enable healthcare providers to develop more effective survivor care programs that will improve the QOL of Korean cancer survivors.This systematic review and meta-analysis report is based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guideline.20Background Identification of factors associated with quality of life (QOL) among cancer survivors is crucial for identifying potential targets for intervention.We aimed to provide evidence of factors associated with the QOL among posttreatment cancer survivors in Korea.We performed a systematic literature search from January 2000 to September 2022 using PubMed, EMBASE, CINAHL, PsycINFO, and Korean databases (RISS, SCIENCEON). We evaluated study quality using the Joanna Briggs Institute Quality Appraisal Checklists for Analytical Cross-sectional Studies and performed statistical analysis using the R 3.0 software (R Foundation for Statistical Computing, Vienna, Austria) package. We analyzed the pooled effect sizes of potential QOL correlates by the random-effects model.This meta-analysis included 31 studies with 8934 participants. The pooled estimates were significantly large for economic status (r = -0.53); significantly medium for fatigue (r = -0.39), anxiety (r = -0.29), depression (r = -0.42), self-efficacy (r = 0.37), and social support (r = 0.30); and significantly small for education level (r = -0.18), job status (r = -0.09), cancer stage (r = -0.20), and time since diagnosis (r = -0.26).Low education level, having no job, low economic status, advanced cancer stage, short disease period, fatigue, anxiety, and depression were significantly associated with worse QOL, whereas self-efficacy and social support were significantly associated with better QOL.The findings have potential implications for identifying "at-risk survivors" of deteriorated QOL and for suggesting powerful strategies (eg, enhancing self-efficacy or social support) for improving QOL.Cancer, a leading cause of death worldwide, accounted for nearly 10 million deaths in 2020.1 Cancer is also a foremost public health concern and a leading cause of death in South Korea (hereinafter referred to as Korea).2 More than 250 000 patients were newly diagnosed with cancer in 2019, and the prevalence of cancer continues to rise.3 Because of advances in early detection and treatment, however, the cancer survival rate has also improved. Korea experienced a remarkable increase in its 5-year relative cancer survival rate from 42.9% in 1993-1995 to 70.7% in 2015-2019.3 Since 2018, the number of cancer survivors exceeded 2 million, indicating that 1 in 25 people (4.2% of the entire population) has had a cancer diagnosis.3 As the number of cancer survivors continues to grow, so does their quality of life (QOL).Cancer and its treatments can cause various long-term and late effects among survivors. Prevalence reported for Korean cancer survivors include 43.6% for pain, 66.1% to 71.1% for fatigue, 58.9% for sleep disturbance, 39.5% to 47.2% for anxiety, 24.9% to 36.7% for depression, and 67.8% for distress.4-6 According to national data analysis, 25. 9% of newly diagnosed cancer patients lost their job within 1 year of diagnosis, and 47% within 5 years.7 Such physical, psychological, and social sequelae ultimately deteriorate QOL. Many studies have demonstrated that the QOL of posttreatment cancer survivors was significantly lower than that of the general population.8-12 Approximately 20% of disease-free Korean cancer survivors were found to suffer problematic QOL levels.8The numerous Korean studies that have examined the impact of cancer and its treatment on survivor QOL have identified factors associated with it. Identification of such factors is crucial for identifying potential targets for intervention.13 Examined factors, however, have been quite broad and have included sociodemographic, disease-related, and treatment-related symptoms as well as psychosocial and lifestyle factors. In addition, findings have not been consistent.14 Because QOL studies among Korean cancer survivors have accumulated over the past 20 years, there is a need to evaluate all the evidence to determine which factors to prioritize in a cancer survivorship program.Meta-analysis is a powerful statistical technique that can help explain variability and produce more precise estimates of the associations among the concepts involved. To the best of our knowledge, there is no previous meta-analysis on factors associated with QOL in posttreatment cancer survivors in Korea. Although there are several meta-analyses of QOL among cancer survivors,15-17 the results are not specific to Korea, but QOL can be influenced by culture and socioenvironmental factors.18,19 Accordingly, we aimed in this study to conduct a meta-analysis on factors associated with QOL among Korean cancer survivors living in Korea. We trust that a comprehensive understanding derived from this study will enable healthcare providers to develop more effective survivor care programs that will improve the QOL of Korean cancer survivors.This systematic review and meta-analysis report is based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guideline.20Background Identification of factors associated with quality of life (QOL) among cancer survivors is crucial for identifying potential targets for intervention.We aimed to provide evidence of factors associated with the QOL among posttreatment cancer survivors in Korea.We performed a systematic literature search from January 2000 to September 2022 using PubMed, EMBASE, CINAHL, PsycINFO, and Korean databases (RISS, SCIENCEON). We evaluated study quality using the Joanna Briggs Institute Quality Appraisal Checklists for Analytical Cross-sectional Studies and performed statistical analysis using the R 3.0 software (R Foundation for Statistical Computing, Vienna, Austria) package. We analyzed the pooled effect sizes of potential QOL correlates by the random-effects model.This meta-analysis included 31 studies with 8934 participants. The pooled estimates were significantly large for economic status (r = -0.53); significantly medium for fatigue (r = -0.39), anxiety (r = -0.29), depression (r = -0.42), self-efficacy (r = 0.37), and social support (r = 0.30); and significantly small for education level (r = -0.18), job status (r = -0.09), cancer stage (r = -0.20), and time since diagnosis (r = -0.26).Low education level, having no job, low economic status, advanced cancer stage, short disease period, fatigue, anxiety, and depression were significantly associated with worse QOL, whereas self-efficacy and social support were significantly associated with better QOL. The findings have potential implications for identifying "at-risk survivors" of deteriorated QOL and for suggesting powerful strategies (eg, enhancing self-efficacy or social support) for improving QOL.Cancer, a leading cause of death worldwide, accounted for nearly 10 million deaths in 2020.1 Cancer is also a foremost public health concern and a leading cause of death in South Korea (hereinafter referred to as Korea).2 More than 250 000 patients were newly diagnosed with cancer in 2019, and the prevalence of cancer continues to rise.3 Because of advances in early detection and treatment, however, the cancer survival rate has also improved. Korea experienced a remarkable increase in its 5-year relative cancer survival rate from 42.9% in 1993-1995 to 70.7% in 2015-2019.3 Since 2018, the number of cancer survivors exceeded 2 million, indicating that 1 in 25 people (4.2% of the entire population) has had a cancer diagnosis.3 As the number of cancer survivors continues to grow, so does their quality of life (QOL).Cancer and its treatments can cause various long-term and late effects among survivors. Prevalence reported for Korean cancer survivors include 43.6% for pain, 66.1% to 71.1% for fatigue, 58.9% for sleep disturbance, 39.5% to 47.2% for anxiety, 24.9% to 36.7% for depression, and 67.8% for distress.4-6 According to national data analysis, 25.9% of newly diagnosed cancer patients lost their job within 1 year of diagnosis, and 47% within 5 years.7 Such physical, psychological, and social sequelae ultimately deteriorate QOL. Many studies have demonstrated that the QOL of posttreatment cancer survivors was significantly lower than that of the general population.8-12 Approximately 20% of disease-free Korean cancer survivors were found to suffer problematic QOL levels.8The numerous Korean studies that have examined the impact of cancer and its treatment on survivor QOL have identified factors associated with it. Identification of such factors is crucial for identifying potential targets for intervention.13 Examined factors, however, have been quite broad and have included sociodemographic, disease-related, and treatment-related symptoms as well as psychosocial and lifestyle factors. In addition, findings have not been consistent.14 Because QOL studies among Korean cancer survivors have accumulated over the past 20 years, there is a need to evaluate all the evidence to determine which factors to prioritize in a cancer survivorship program.Meta-analysis is a powerful statistical technique that can help explain variability and produce more precise estimates of the associations among the concepts involved. To the best of our knowledge, there is no previous meta-analysis on factors associated with QOL in posttreatment cancer survivors in Korea. Although there are several meta-analyses of QOL among cancer survivors,15-17 the results are not specific to Korea, but QOL can be influenced by culture and socioenvironmental factors.18,19 Accordingly, we aimed in this study to conduct a meta-analysis on factors associated with QOL among Korean cancer survivors living in Korea. We trust that a comprehensive understanding derived from this study will enable healthcare providers to develop more effective survivor care programs that will improve the QOL of Korean cancer survivors.This systematic review and meta-analysis report is based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guideline. 20Background Identification of factors associated with quality of life (QOL) among cancer survivors is crucial for identifying potential targets for intervention.We aimed to provide evidence of factors associated with the QOL among posttreatment cancer survivors in Korea.We performed a systematic literature search from January 2000 to September 2022 using PubMed, EMBASE, CINAHL, PsycINFO, and Korean databases (RISS, SCIENCEON). We evaluated study quality using the Joanna Briggs Institute Quality Appraisal Checklists for Analytical Cross-sectional Studies and performed statistical analysis using the R 3.0 software (R Foundation for Statistical Computing, Vienna, Austria) package. We analyzed the pooled effect sizes of potential QOL correlates by the random-effects model.This meta-analysis included 31 studies with 8934 participants. The pooled estimates were significantly large for economic status (r = -0.53); significantly medium for fatigue (r = -0.39), anxiety (r = -0.29), depression (r = -0.42), self-efficacy (r = 0.37), and social support (r = 0.30); and significantly small for education level (r = -0.18), job status (r = -0.09), cancer stage (r = -0.20), and time since diagnosis (r = -0.26).Low education level, having no job, low economic status, advanced cancer stage, short disease period, fatigue, anxiety, and depression were significantly associated with worse QOL, whereas self-efficacy and social support were significantly associated with better QOL.The findings have potential implications for identifying "at-risk survivors" of deteriorated QOL and for suggesting powerful strategies (eg, enhancing self-efficacy or social support) for improving QOL.Cancer, a leading cause of death worldwide, accounted for nearly 10 million deaths in 2020.1 Cancer is also a foremost public health concern and a leading cause of death in South Korea (hereinafter referred to as Korea).2 More than 250 000 patients were newly diagnosed with cancer in 2019, and the prevalence of cancer continues to rise.3 Because of advances in early detection and treatment, however, the cancer survival rate has also improved. Korea experienced a remarkable increase in its 5-year relative cancer survival rate from 42.9% in 1993-1995 to 70.7% in 2015-2019.3 Since 2018, the number of cancer survivors exceeded 2 million, indicating that 1 in 25 people (4.2% of the entire population) has had a cancer diagnosis.3 As the number of cancer survivors continues to grow, so does their quality of life (QOL).Cancer and its treatments can cause various long-term and late effects among survivors. Prevalence reported for Korean cancer survivors include 43.6% for pain, 66.1% to 71.1% for fatigue, 58.9% for sleep disturbance, 39.5% to 47.2% for anxiety, 24.9% to 36.7% for depression, and 67.8% for distress.4-6 According to national data analysis, 25.9% of newly diagnosed cancer patients lost their job within 1 year of diagnosis, and 47% within 5 years.7 Such physical, psychological, and social sequelae ultimately deteriorate QOL. Many studies have demonstrated that the QOL of posttreatment cancer survivors was significantly lower than that of the general population.8-12 Approximately 20% of disease-free Korean cancer survivors were found to suffer problematic QOL levels.8The numerous Korean studies that have examined the impact of cancer and its treatment on survivor QOL have identified factors associated with it. Identification of such factors is crucial for identifying potential targets for intervention. 13 Examined factors, however, have been quite broad and have included sociodemographic, disease-related, and treatment-related symptoms as well as psychosocial and lifestyle factors. In addition, findings have not been consistent.14 Because QOL studies among Korean cancer survivors have accumulated over the past 20 years, there is a need to evaluate all the evidence to determine which factors to prioritize in a cancer survivorship program.Meta-analysis is a powerful statistical technique that can help explain variability and produce more precise estimates of the associations among the concepts involved. To the best of our knowledge, there is no previous meta-analysis on factors associated with QOL in posttreatment cancer survivors in Korea. Although there are several meta-analyses of QOL among cancer survivors,15-17 the results are not specific to Korea, but QOL can be influenced by culture and socioenvironmental factors.18,19 Accordingly, we aimed in this study to conduct a meta-analysis on factors associated with QOL among Korean cancer survivors living in Korea. We trust that a comprehensive understanding derived from this study will enable healthcare providers to develop more effective survivor care programs that will improve the QOL of Korean cancer survivors.This systematic review and meta-analysis report is based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guideline.20Background Identification of factors associated with quality of life (QOL) among cancer survivors is crucial for identifying potential targets for intervention.We aimed to provide evidence of factors associated with the QOL among posttreatment cancer survivors in Korea.We performed a systematic literature search from January 2000 to September 2022 using PubMed, EMBASE, CINAHL, PsycINFO, and Korean databases (RISS, SCIENCEON). We evaluated study quality using the Joanna Briggs Institute Quality Appraisal Checklists for Analytical Cross-sectional Studies and performed statistical analysis using the R 3.0 software (R Foundation for Statistical Computing, Vienna, Austria) package. We analyzed the pooled effect sizes of potential QOL correlates by the random-effects model.This meta-analysis included 31 studies with 8934 participants. The pooled estimates were significantly large for economic status (r = -0.53); significantly medium for fatigue (r = -0.39), anxiety (r = -0.29), depression (r = -0.42), self-efficacy (r = 0.37), and social support (r = 0.30); and significantly small for education level (r = -0.18), job status (r = -0.09), cancer stage (r = -0.20), and time since diagnosis (r = -0.26).Low education level, having no job, low economic status, advanced cancer stage, short disease period, fatigue, anxiety, and depression were significantly associated with worse QOL, whereas self-efficacy and social support were significantly associated with better QOL.The findings have potential implications for identifying "at-risk survivors" of deteriorated QOL and for suggesting powerful strategies (eg, enhancing self-efficacy or social support) for improving QOL.Cancer, a leading cause of death worldwide, accounted for nearly 10 million deaths in 2020.1 Cancer is also a foremost public health concern and a leading cause of death in South Korea (hereinafter referred to as Korea).2 More than 250 000 patients were newly diagnosed with cancer in 2019, and the prevalence of cancer continues to rise.3 Because of advances in early detection and treatment, however, the cancer survival rate has also improved. Korea experienced a remarkable increase in its 5-year relative cancer survival rate from 42.9% in 1993-1995 to 70.7% in 2015-2019.3 Since 2018, the number of cancer survivors exceeded 2 million, indicating that 1 in 25 people (4.2% of the entire population) has had a cancer diagnosis.3 As the number of cancer survivors continues to grow, so does their quality of life (QOL).Cancer and its treatments can cause various long-term and late effects among survivors. Prevalence reported for Korean cancer survivors include 43.6% for pain, 66.1% to 71.1% for fatigue, 58.9% for sleep disturbance, 39.5% to 47.2% for anxiety, 24.9% to 36.7% for depression, and 67.8% for distress.4-6 According to national data analysis, 25.9% of newly diagnosed cancer patients lost their job within 1 year of diagnosis, and 47% within 5 years.7 Such physical, psychological, and social sequelae ultimately deteriorate QOL. Many studies have demonstrated that the QOL of posttreatment cancer survivors was significantly lower than that of the general population.8-12 Approximately 20% of disease-free Korean cancer survivors were found to suffer problematic QOL levels.8The numerous Korean studies that have examined the impact of cancer and its treatment on survivor QOL have identified factors associated with it. Identification of such factors is crucial for identifying potential targets for intervention.13 Examined factors, however, have been quite broad and have included sociodemographic, disease-related, and treatment-related symptoms as well as psychosocial and lifestyle factors. In addition, findings have not been consistent.14 Because QOL studies among Korean cancer survivors have accumulated over the past 20 years, there is a need to evaluate all the evidence to determine which factors to prioritize in a cancer survivorship program.Meta-analysis is a powerful statistical technique that can help explain variability and produce more precise estimates of the associations among the concepts involved. To the best of our knowledge, there is no previous meta-analysis on factors associated with QOL in posttreatment cancer survivors in Korea. Although there are several meta-analyses of QOL among cancer survivors,15-17 the results are not specific to Korea, but QOL can be influenced by culture and socioenvironmental factors.18,19 Accordingly, we aimed in this study to conduct a meta-analysis on factors associated with QOL among Korean cancer survivors living in Korea. We trust that a comprehensive understanding derived from this study will enable healthcare providers to develop more effective survivor care programs that will improve the QOL of Korean cancer survivors.This systematic review and meta-analysis report is based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guideline.20Background Identification of factors associated with quality of life (QOL) among cancer survivors is crucial for identifying potential targets for intervention.We aimed to provide evidence of factors associated with the QOL among posttreatment cancer survivors in Korea.We performed a systematic literature search from January 2000 to September 2022 using PubMed, EMBASE, CINAHL, PsycINFO, and Korean databases (RISS, SCIENCEON). We evaluated study quality using the Joanna Briggs Institute Quality Appraisal Checklists for Analytical Cross-sectional Studies and performed statistical analysis using the R 3.0 software (R Foundation for Statistical Computing, Vienna, Austria) package. We analyzed the pooled effect sizes of potential QOL correlates by the random-effects model.This meta-analysis included 31 studies with 8934 participants. The pooled estimates were significantly large for economic status (r = -0.53); significantly medium for fatigue (r = -0.39), anxiety (r = -0.29), depression (r = -0.42), self-efficacy (r = 0.37), and social support (r = 0.30); and significantly small for education level (r = -0.18), job status (r = -0.09), cancer stage (r = -0.20), and time since diagnosis (r = -0.26).Low education level, having no job, low economic status, advanced cancer stage, short disease period, fatigue, anxiety, and depression were significantly associated with worse QOL, whereas self-efficacy and social support were significantly associated with better QOL.The findings have potential implications for identifying "at-risk survivors" of deteriorated QOL and for suggesting powerful strategies (eg, enhancing self-efficacy or social support) for improving QOL.Cancer, a leading cause of death worldwide, accounted for nearly 10 million deaths in 2020.1 Cancer is also a foremost public health concern and a leading cause of death in South Korea (hereinafter referred to as Korea).2 More than 250 000 patients were newly diagnosed with cancer in 2019, and the prevalence of cancer continues to rise.3 Because of advances in early detection and treatment, however, the cancer survival rate has also improved. Korea experienced a remarkable increase in its 5-year relative cancer survival rate from 42.9% in 1993-1995 to 70.7% in 2015-2019.3 Since 2018, the number of cancer survivors exceeded 2 million, indicating that 1 in 25 people (4.2% of the entire population) has had a cancer diagnosis.3 As the number of cancer survivors continues to grow, so does their quality of life (QOL).Cancer and its treatments can cause various long-term and late effects among survivors. Prevalence reported for Korean cancer survivors include 43.6% for pain, 66.1% to 71.1% for fatigue, 58.9% for sleep disturbance, 39.5% to 47.2% for anxiety, 24.9% to 36.7% for depression, and 67.8% for distress.4-6 According to national data analysis, 25.9% of newly diagnosed cancer patients lost their job within 1 year of diagnosis, and 47% within 5 years.7 Such physical, psychological, and social sequelae ultimately deteriorate QOL. Many studies have demonstrated that the QOL of posttreatment cancer survivors was significantly lower than that of the general population.8-12 Approximately 20% of disease-free Korean cancer survivors were found to suffer problematic QOL levels.8The numerous Korean studies that have examined the impact of cancer and its treatment on survivor QOL have identified factors associated with it. Identification of such factors is crucial for identifying potential targets for intervention.13 Examined factors, however, have been quite broad and have included sociodemographic, disease-related, and treatment-related symptoms as well as psychosocial and lifestyle factors. In addition, findings have not been consistent.14 Because QOL studies among Korean cancer survivors have accumulated over the past 20 years, there is a need to evaluate all the evidence to determine which factors to prioritize in a cancer survivorship program.Meta-analysis is a powerful statistical technique that can help explain variability and produce more precise estimates of the associations among the concepts involved. To the best of our knowledge, there is no previous meta-analysis on factors associated with QOL in posttreatment cancer survivors in Korea. Although there are several meta-analyses of QOL among cancer survivors,15-17 the results are not specific to Korea, but QOL can be influenced by culture and socioenvironmental factors.18,19 Accordingly, we aimed in this study to conduct a meta-analysis on factors associated with QOL among Korean cancer survivors living in Korea. We trust that a comprehensive understanding derived from this study will enable healthcare providers to develop more effective survivor care programs that will improve the QOL of Korean cancer survivors.This systematic review and meta-analysis report is based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guideline.20Background Identification of factors associated with quality of life (QOL) among cancer survivors is crucial for identifying potential targets for intervention.We aimed to provide evidence of factors associated with the QOL among posttreatment cancer survivors in Korea.We performed a systematic literature search from January 2000 to September 2022 using PubMed, EMBASE, CINAHL, PsycINFO, and Korean databases (RISS, SCIENCEON). We evaluated study quality using the Joanna Briggs Institute Quality Appraisal Checklists for Analytical Cross-sectional Studies and performed statistical analysis using the R 3.0 software (R Foundation for Statistical Computing, Vienna, Austria) package. We analyzed the pooled effect sizes of potential QOL correlates by the random-effects model.This meta-analysis included 31 studies with 8934 participants. The pooled estimates were significantly large for economic status (r = -0.53); significantly medium for fatigue (r = -0.39), anxiety (r = -0.29), depression (r = -0.42), self-efficacy (r = 0.37), and social support (r = 0.30); and significantly small for education level (r = -0.18), job status (r = -0.09), cancer stage (r = -0.20), and time since diagnosis (r = -0.26).Low education level, having no job, low economic status, advanced cancer stage, short disease period, fatigue, anxiety, and depression were significantly associated with worse QOL, whereas self-efficacy and social support were significantly associated with better QOL.The findings have potential implications for identifying "at-risk survivors" of deteriorated QOL and for suggesting powerful strategies (eg, enhancing self-efficacy or social support) for improving QOL.Cancer, a leading cause of death worldwide, accounted for nearly 10 million deaths in 2020.1 Cancer is also a foremost public health concern and a leading cause of death in South Korea (hereinafter referred to as Korea).2 More than 250 000 patients were newly diagnosed with cancer in 2019, and the prevalence of cancer continues to rise.3 Because of advances in early detection and treatment, however, the cancer survival rate has also improved. Korea experienced a remarkable increase in its 5-year relative cancer survival rate from 42.9% in 1993-1995 to 70.7% in 2015-2019.3 Since 2018, the number of cancer survivors exceeded 2 million, indicating that 1 in 25 people (4.2% of the entire population) has had a cancer diagnosis.3 As the number of cancer survivors continues to grow, so does their quality of life (QOL).Cancer and its treatments can cause various long-term and late effects among survivors. Prevalence reported for Korean cancer survivors include 43.6% for pain, 66.1% to 71.1% for fatigue, 58.9% for sleep disturbance, 39.5% to 47.2% for anxiety, 24.9% to 36.7% for depression, and 67.8% for distress.4-6 According to national data analysis, 25. 9% of newly diagnosed cancer patients lost their job within 1 year of diagnosis, and 47% within 5 years.7 Such physical, psychological, and social sequelae ultimately deteriorate QOL. Many studies have demonstrated that the QOL of posttreatment cancer survivors was significantly lower than that of the general population.8-12 Approximately 20% of disease-free Korean cancer survivors were found to suffer problematic QOL levels.8The numerous Korean studies that have examined the impact of cancer and its treatment on survivor QOL have identified factors associated with it. Identification of such factors is crucial for identifying potential targets for intervention.13 Examined factors, however, have been quite broad and have included sociodemographic, disease-related, and treatment-related symptoms as well as psychosocial and lifestyle factors. In addition, findings have not been consistent.14 Because QOL studies among Korean cancer survivors have accumulated over the past 20 years, there is a need to evaluate all the evidence to determine which factors to prioritize in a cancer survivorship program.Meta-analysis is a powerful statistical technique that can help explain variability and produce more precise estimates of the associations among the concepts involved. To the best of our knowledge, there is no previous meta-analysis on factors associated with QOL in posttreatment cancer survivors in Korea. Although there are several meta-analyses of QOL among cancer survivors,15-17 the results are not specific to Korea, but QOL can be influenced by culture and socioenvironmental factors.18,19 Accordingly, we aimed in this study to conduct a meta-analysis on factors associated with QOL among Korean cancer survivors living in Korea. We trust that a comprehensive understanding derived from this study will enable healthcare providers to develop more effective survivor care programs that will improve the QOL of Korean cancer survivors.This systematic review and meta-analysis report is based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guideline.20Background Identification of factors associated with quality of life (QOL) among cancer survivors is crucial for identifying potential targets for intervention.We aimed to provide evidence of factors associated with the QOL among posttreatment cancer survivors in Korea.We performed a systematic literature search from January 2000 to September 2022 using PubMed, EMBASE, CINAHL, PsycINFO, and Korean databases (RISS, SCIENCEON). We evaluated study quality using the Joanna Briggs Institute Quality Appraisal Checklists for Analytical Cross-sectional Studies and performed statistical analysis using the R 3.0 software (R Foundation for Statistical Computing, Vienna, Austria) package. We analyzed the pooled effect sizes of potential QOL correlates by the random-effects model.This meta-analysis included 31 studies with 8934 participants. The pooled estimates were significantly large for economic status (r = -0.53); significantly medium for fatigue (r = -0.39), anxiety (r = -0.29), depression (r = -0.42), self-efficacy (r = 0.37), and social support (r = 0.30); and significantly small for education level (r = -0.18), job status (r = -0.09), cancer stage (r = -0.20), and time since diagnosis (r = -0.26).Low education level, having no job, low economic status, advanced cancer stage, short disease period, fatigue, anxiety, and depression were significantly associated with worse QOL, whereas self-efficacy and social support were significantly associated with better QOL. The findings have potential implications for identifying "at-risk survivors" of deteriorated QOL and for suggesting powerful strategies (eg, enhancing self-efficacy or social support) for improving QOL.Cancer, a leading cause of death worldwide, accounted for nearly 10 million deaths in 2020.1 Cancer is also a foremost public health concern and a leading cause of death in South Korea (hereinafter referred to as Korea).2 More than 250 000 patients were newly diagnosed with cancer in 2019, and the prevalence of cancer continues to rise.3 Because of advances in early detection and treatment, however, the cancer survival rate has also improved. Korea experienced a remarkable increase in its 5-year relative cancer survival rate from 42.9% in 1993-1995 to 70.7% in 2015-2019.3 Since 2018, the number of cancer survivors exceeded 2 million, indicating that 1 in 25 people (4.2% of the entire population) has had a cancer diagnosis.3 As the number of cancer survivors continues to grow, so does their quality of life (QOL).Cancer and its treatments can cause various long-term and late effects among survivors. Prevalence reported for Korean cancer survivors include 43.6% for pain, 66.1% to 71.1% for fatigue, 58.9% for sleep disturbance, 39.5% to 47.2% for anxiety, 24.9% to 36.7% for depression, and 67.8% for distress.4-6 According to national data analysis, 25.9% of newly diagnosed cancer patients lost their job within 1 year of diagnosis, and 47% within 5 years.7 Such physical, psychological, and social sequelae ultimately deteriorate QOL. Many studies have demonstrated that the QOL of posttreatment cancer survivors was significantly lower than that of the general population.8-12 Approximately 20% of disease-free Korean cancer survivors were found to suffer problematic QOL levels.8The numerous Korean studies that have examined the impact of cancer and its treatment on survivor QOL have identified factors associated with it. Identification of such factors is crucial for identifying potential targets for intervention.13 Examined factors, however, have been quite broad and have included sociodemographic, disease-related, and treatment-related symptoms as well as psychosocial and lifestyle factors. In addition, findings have not been consistent.14 Because QOL studies among Korean cancer survivors have accumulated over the past 20 years, there is a need to evaluate all the evidence to determine which factors to prioritize in a cancer survivorship program.Meta-analysis is a powerful statistical technique that can help explain variability and produce more precise estimates of the associations among the concepts involved. To the best of our knowledge, there is no previous meta-analysis on factors associated with QOL in posttreatment cancer survivors in Korea. Although there are several meta-analyses of QOL among cancer survivors,15-17 the results are not specific to Korea, but QOL can be influenced by culture and socioenvironmental factors.18,19 Accordingly, we aimed in this study to conduct a meta-analysis on factors associated with QOL among Korean cancer survivors living in Korea. We trust that a comprehensive understanding derived from this study will enable healthcare providers to develop more effective survivor care programs that will improve the QOL of Korean cancer survivors.This systematic review and meta-analysis report is based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guideline. 20Background Identification of factors associated with quality of life (QOL) among cancer survivors is crucial for identifying potential targets for intervention.We aimed to provide evidence of factors associated with the QOL among posttreatment cancer survivors in Korea.We performed a systematic literature search from January 2000 to September 2022 using PubMed, EMBASE, CINAHL, PsycINFO, and Korean databases (RISS, SCIENCEON). We evaluated study quality using the Joanna Briggs Institute Quality Appraisal Checklists for Analytical Cross-sectional Studies and performed statistical analysis using the R 3.0 software (R Foundation for Statistical Computing, Vienna, Austria) package. We analyzed the pooled effect sizes of potential QOL correlates by the random-effects model.This meta-analysis included 31 studies with 8934 participants. The pooled estimates were significantly large for economic status (r = -0.53); significantly medium for fatigue (r = -0.39), anxiety (r = -0.29), depression (r = -0.42), self-efficacy (r = 0.37), and social support (r = 0.30); and significantly small for education level (r = -0.18), job status (r = -0.09), cancer stage (r = -0.20), and time since diagnosis (r = -0.26).Low education level, having no job, low economic status, advanced cancer stage, short disease period, fatigue, anxiety, and depression were significantly associated with worse QOL, whereas self-efficacy and social support were significantly associated with better QOL.The findings have potential implications for identifying "at-risk survivors" of deteriorated QOL and for suggesting powerful strategies (eg, enhancing self-efficacy or social support) for improving QOL.Cancer, a leading cause of death worldwide, accounted for nearly 10 million deaths in 2020.1 Cancer is also a foremost public health concern and a leading cause of death in South Korea (hereinafter referred to as Korea).2 More than 250 000 patients were newly diagnosed with cancer in 2019, and the prevalence of cancer continues to rise.3 Because of advances in early detection and treatment, however, the cancer survival rate has also improved. Korea experienced a remarkable increase in its 5-year relative cancer survival rate from 42.9% in 1993-1995 to 70.7% in 2015-2019.3 Since 2018, the number of cancer survivors exceeded 2 million, indicating that 1 in 25 people (4.2% of the entire population) has had a cancer diagnosis.3 As the number of cancer survivors continues to grow, so does their quality of life (QOL).Cancer and its treatments can cause various long-term and late effects among survivors. Prevalence reported for Korean cancer survivors include 43.6% for pain, 66.1% to 71.1% for fatigue, 58.9% for sleep disturbance, 39.5% to 47.2% for anxiety, 24.9% to 36.7% for depression, and 67.8% for distress.4-6 According to national data analysis, 25.9% of newly diagnosed cancer patients lost their job within 1 year of diagnosis, and 47% within 5 years.7 Such physical, psychological, and social sequelae ultimately deteriorate QOL. Many studies have demonstrated that the QOL of posttreatment cancer survivors was significantly lower than that of the general population.8-12 Approximately 20% of disease-free Korean cancer survivors were found to suffer problematic QOL levels.8The numerous Korean studies that have examined the impact of cancer and its treatment on survivor QOL have identified factors associated with it. Identification of such factors is crucial for identifying potential targets for intervention. 13 Examined factors, however, have been quite broad and have included sociodemographic, disease-related, and treatment-related symptoms as well as psychosocial and lifestyle factors. In addition, findings have not been consistent.14 Because QOL studies among Korean cancer survivors have accumulated over the past 20 years, there is a need to evaluate all the evidence to determine which factors to prioritize in a cancer survivorship program.Meta-analysis is a powerful statistical technique that can help explain variability and produce more precise estimates of the associations among the concepts involved. To the best of our knowledge, there is no previous meta-analysis on factors associated with QOL in posttreatment cancer survivors in Korea. Although there are several meta-analyses of QOL among cancer survivors,15-17 the results are not specific to Korea, but QOL can be influenced by culture and socioenvironmental factors.18,19 Accordingly, we aimed in this study to conduct a meta-analysis on factors associated with QOL among Korean cancer survivors living in Korea. We trust that a comprehensive understanding derived from this study will enable healthcare providers to develop more effective survivor care programs that will improve the QOL of Korean cancer survivors.This systematic review and meta-analysis report is based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guideline.20