# Protocol Development for the Korean Survey for Cancer Survivorship and Preliminary Analysis of Employment Change’s Impact on Quality of Life and Psychological Health

## TL;DR

This study developed a nationwide survey protocol to assess cancer survivors' quality of life and found that employment changes significantly impact their psychological health and well-being.

## Contribution

The study introduces a feasible nationwide protocol for assessing cancer survivorship and identifies employment changes as a novel independent factor affecting survivors' mental health.

## Key findings

- Employment changes are strongly linked to worse psychological health and quality of life in cancer survivors.
- Survivors diagnosed within 1–3 years show higher rates of depression and anxiety compared to those diagnosed more than 5 years ago.
- Online survey participation was significantly higher than in-person responses in the study.

## Abstract

The Korean Survey for Cancer Survivorship (KSCS) is a nationwide multi-center study that aimed to systematically investigate cancer survivors’ problems after cancer treatment. This study reports the protocol of KSCS and the process of its development. The study aimed to evaluate the feasibility of the KSCS protocol and explore the preliminary associations between employment change and cancer survivors’ well-being. KSCS targets about 5000 cancer survivors diagnosed with breast, colorectal, liver, lung, stomach, prostate, and gynecological cancers who had completed active treatment within 1 to 10 years. Preliminary analysis showed that employment change is strongly associated with worse psychological health and extreme quality of life (QoL) problems. The study demonstrated that the KSCS protocol is feasible for nationwide application and that employment-related factors play a significant and independent role in shaping cancer survivors’ mental health and overall QoL. The KSCS provides valuable evidence for comprehensive cancer survivorship care and policy development.

Background/Objectives: The Korean Survey for Cancer Survivorship (KSCS) aims to comprehensively assess cancer survivors’ health behaviors, quality of life (QoL), and socioeconomic challenges. This study evaluated the feasibility of the KSCS protocol and identified key factors influencing psychological health and QoL among cancer survivors. Methods: The nationwide survey targeted survivors diagnosed with breast, colorectal, liver, lung, stomach, prostate, and gynecological cancers who had completed active treatment within 1 to 10 years. The respondents were given the option to participate in the survey either online or in-person. The questionnaire has 229 questions, including internationally validated tools such as the EQ-5D-3L, PHQ-9, and GAD-7. Results: A total of 983 cancer survivors completed the survey (92.7% online, 8.3% in-person) and were categorized by post-diagnosis duration. Survivors diagnosed within 1–3 years reported higher rates of moderate-severe depression (11.4% vs. 8.3%), moderate-severe anxiety (5.9% vs. 5.1%), and poorest QoL (63.0% vs. 50.9%) compared to those diagnosed more than 5 years ago. Employment changes, such as loss of job, change of workplace, or work leave, were significantly associated with worse health outcomes, including higher rates of moderate-severe depression (OR = 4.39; 95% CI 2.43–7.96), moderate-severe anxiety (OR = 3.63; 95% CI 1.68–0.88), and having extreme QoL problems (OR = 6.37; 95% CI 2.03–20.00). Conclusions: The KSCS protocol is feasible for nationwide implementation and provides comprehensive data on health, psychological, and socioeconomic challenges among cancer survivors. Preliminary findings highlight employment’s critical role in cancer survivors’ well-being and the need for survivorship care that integrates socioeconomic and clinical factors.