Eur J Public Health. 2017 Feb;27:115-119

Quality of life and living with cancer: findings from the European social survey (2014) special module on the social determinants of health.

Ringdal K1 , Ringdal GI2.

Department of Sociology and Political Science1, and Department of Psychology2, NTNU, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.

Running title: European Journal of Public Health

To whom correspondence should be addressed: Prof. Kristen Ringdal, Department of Sociology and Political Science, NTNU, NO-7491 Trondheim, Norway, E-mail;



Background: This study is a comparison of quality of life (QOL) of current and previous cancer victims with people who never had experienced cancer in samples from the general population from the 19 countries in the European Social Survey (ESS) 2014. Methods: The study was based on the ESS 2014 with representative samples from 19 countries. QOL was measured by combining two questions on happiness and life satisfaction into a QOL scale. Multilevel modelling was used to examine whether the relationship between cancer status and QOL varies between countries in general and by welfare state regimes in particular. Results: People with cancer at the time of the interview, showed lower general QOL than both people who previously have had cancer and people who never have experienced cancer. The unadjusted and the adjusted odds ratios (ORs) for poor QOL were respectively, OR= 2.38, (2.07, 2.74) and OR= 1.98, (1.71, 2.30). The difference between the ‘Never’ and the ‘Previously’ groups was minor but statistical significant. The welfare state classification was a strong predictor of country differences in QOL, but there was no significant statistical interaction effect between cancer status and the welfare state classification. The study also replicated well-documented findings on differences in QOL by education and social support. Conclusion: The QOL of people with a cancer disease is significantly impaired. People who previously have had cancer, scored only slightly lower on the QOL scale than people who never had experienced cancer. We found evidence indicating that these differences may vary between the countries, but this variation cannot be explained by the welfare state classification. 

KEYWORDS: Quality of life; current and previous cancer victims; and those who never had experienced cancer; European social survey (2014) special module; social determinant of health 

PMID: 28355642

DOI doi:10.1093/eurpub/ckw226



The European Social Survey (ESS) ( is an academically driven cross-national survey conducted across Europe since its establishment in 2001. The ESS has set new and improved methodological and coordination standards in cross-national survey research in other areas to including questionnaire design, translation, response measurement, fieldwork design, and cross-sectional harmonization1.

Every two years, 1,000 – 2,000 face-to-face interviews are completed in newly selected, cross-sectional samples from the general populations of more than 20 countries. The ESS has so far completed and published data for seven rounds, which have covered around 30 countries and resulted in around 1,000 to 2,000 interviews in each country per round. Data from the round eight is scheduled to be published in October 2017. The ESS data is available free of charge for non-commercial use and can be downloaded from this website after a short registration (

The ESS questionnaire includes a core module of about 100 questions and two rotating modules, each with 30 questions. The core module is repeated in each round with questions on attitudes, beliefs, behavior patterns and background information on the respondents.

The module Social Inequality in Health, was fielded in 2014. Specific items included a range of health measurements (BMI, self-reported diagnoses including a question on the experience of a cancer disease, and mental well-being); social determinants (childhood conditions, housing quality and working environment); behaviors (smoking, alcohol use, fruit and vegetable consumption and physical activity); and use of primary, secondary and alternative care ( The ESS module enhances our abilities to conduct cross-sectional sociological and social science research into health and health inequalities. The new ESS module means that for the first time, such a pan-European data set is available to take this sociological approach to health inequalities2.



  1. Fitzgerald, R., Jowell, R. Measurement equivalence in comparative surveys: the European Social Survey – from design to implementation and beyond. In Harkness J.A. et al. (Eds.) Cross-Cultural Survey Methods. Londone: Wiley, 2010.
  1. Eikemo, T. A., et al. (2017). “The First Pan-European Sociological Health Inequalities Survey of the General Population: The European Social Survey Rotating Module on the Social Determinants of Health.” European Sociological Review 33(1): 137-153.