Zhang, YuehanThandrayen, JoanneSoga, KayWeber, MarianneKoczwara, BogdaLaidsaar‑Powell, RebekahLim, Chloe Yi ShingJoshy, GraceBanks, Emily2025-12-162025-12-16PubMed:40389978WOS:001490854900002ORCID:/0000-0002-4617-1302/work/188300221ORCID:/0000-0002-0718-6368/work/188300792ORCID:/0009-0004-6247-3580/work/188301675https://hdl.handle.net/1885/733795234Background: Although most people with cancer now survive long-term, evidence on long-term person-centred outcomes in survivors is limited, particularly relative to people without cancer. We quantified changes in physical and psychological outcomes among adults aged ≥ 45 years from pre- to post-cancer-diagnosis, for multiple cancer types and compared to changes in people without cancer. Methods: Questionnaire data from the Australian population-based 45 and Up Study were linked to cancer registrations, hospitalisations and deaths; those without cancer at baseline (2006–2009) and participating in a follow-up survey (by 2015) were included (n = 142,682). Generalised linear models quantified changes in physical functioning (MOS-PF score, range = 0–100) and psychological distress (Kessler-10 score, range = 10–50) between surveys in people diagnosed and not diagnosed with cancer between surveys, adjusting for confounding factors. Results: Overall, 9313 individuals had incident cancer (12.2/1000 person-years; median follow-up = 5.2 years). Among those without cancer, 30.0% had moderate or severe physical functioning limitations at baseline, increasing to 40.6% at follow-up; corresponding figures were 35.2% and 52.3%, respectively, in participants with incident cancer. Around 80% of those with and without incident cancer had low psychological distress at baseline and follow-up. Compared to those without cancer, cancer survivors had greater average physical functioning declines (mean-score: 77.5 versus 82.9 at follow-up; mean-change: − 8.31 versus − 4.71; adjusted-difference − 2.55 (95%CI = − 2.97–2.13)) and slightly greater increases in psychological distress (mean-score: 13.6 versus 13.5 at follow-up; mean-change: 0.24 versus − 0.04; adjusted-difference 0.21 (95%CI = 0.12–0.31)). Physical outcomes varied by cancer type with greater deterioration with multiple myeloma, lung cancer and leukaemia and lesser declines with breast, colorectal and prostate cancers. Greater deterioration in physical and psychological outcomes were observed in cancer survivors with more advanced disease at diagnosis and recent cancer treatment at follow-up; psychological outcomes in those not receiving recent treatment did not differ from cancer-free participants. Conclusions: On average, cancer survivors experienced greater declines in physical wellbeing than people without cancer and minimal differences in psychological distress. Those not receiving recent cancer treatment and those with many common cancer types had physical and psychological outcomes comparable to people without cancer. Additional targeted support may particularly benefit those receiving treatment, with specific cancer types, and advanced disease.This research was completed using data collected through the 45 and Up Study (www.saxinstitute.org.au). The 45 and Up Study is managed by the Sax Institute in collaboration with major partner Cancer Council NSW and partners the Heart Foundation and the NSW Ministry of Health. We thank the SEEF Project investigators for access to data from this research, and the many thousands of people participating in the 45 and Up Study. We acknowledge the Sax Institute's Secure Unified Research Environment (SURE) for provision of secure data access. The NSW Cancer Registry data is provided by the Cancer Institute NSW. The NSW Admitted Patient Data Collection is provided by the NSW Ministry of Health. The NSW Registry of Births, Deaths and Marriages is provided by the NSW Ministry of Health. We thank the Centre for Health Record Linkage (CHeReL, www.cherel.org.au) for the provision of linked data. We thank Ms Angelina Inthavong and Dr Melonie Martin for providing research support.15en©2025 The Author(s).CancerChange in outcomesCohortPhysical functioningPsychological distressSurvivorship2025-05-1910.1186/s12916-025-04111-0105005535905