The value of quality of life and health status measurements in the evaluation of the well-being of breast cancer survivors

Background

Quality of life (QoL) in breast cancer survivors has become increasingly important. However, QoL is often assessed using a questionnaire meant to assess health status (HS). In this study the differences in outcomes between a HS and QoL questionnaire are shown and the correlation between both questionnaires is assessed.

Methods

From the 140 breast cancer survivors that participated in the study, 68 received breast conserving therapy (BCT) and 72 were treated with mastectomy (MTC). HS was measured using the RAND-36 and QoL was assessed with the WHOQOL-100. Scores were compared with healthy reference populations.

Results

The scores on QoL in both treatment groups were comparable to those of healthy women. HS scores showed lower physical functioning and general health perceptions for the MTC women. Pearson correlations between both questionnaires ranged between 0.19 and 0.75. Thus, the results of both questionnaires were not interchangeable.

Conclusion

A HS questionnaire reflects functional impairments and reveals different areas of concern compared with a QoL questionnaire. The latter reflects the (dis)satisfaction of a patient and this seems not to mirror the functional limitations. Assessment of both objective functioning and subjective appraisal of functioning will result in treatment suggestions that meet the patients needs.     

A qualitative investigation of breast cancer survivors’ experiences with breastfeeding

Introduction  This is an exploratory, qualitative investigation of breast cancer survivors’ experiences with breastfeeding. Previous studies have focused on the physiology of lactation after surgery and treatment, but have not explored factors influencing breastfeeding decisions and behavior. Methods  We used purposeful sampling to identify 11 breast cancer survivors who had a child after their diagnosis and treatment. Participants were recruited from among those in the Women’s Healthy Eating and Living (WHEL) study and a Young Survival Coalition (YSC) affiliate. We conducted semi-structured, open-ended telephone interviews lasting 45–75 min. We used social cognitive theory (SCT) to structure questions regarding influences on breastfeeding behavior. We transcribed interviews and used cross-case, inductive analysis to identify themes. Results  Ten of 11 participants initiated breastfeeding. The following main themes emerged: 1) Cautiously hopeful, 2) Exhausting to rely on one breast, 3) Motivated despite challenges, 4) Support and lack of support, and 5) Encouraging to others. Discussion/Conclusions  Study participants were highly motivated to breastfeed but faced considerable challenges. Participants described problems that are not unique to women with breast cancer, but experienced these to a much greater degree because they relied mostly or entirely on one lactating breast. This study revealed a need for improved access to information and support and greater sensitivity to the obstacles faced by breast cancer survivors. Implications for cancer survivors  Results of this qualitative analysis indicate that interventions to support the efforts of breast cancer survivors who are interested in breastfeeding are warranted. Additional research would aid in the development of such interventions.     

Use of cancer support groups among Latina breast cancer survivors

Introduction Although Latina women diagnosed with breast cancer may be at greater risk of psychosocial morbidity compared to white women, few utilize support services such as support groups. Reasons for this under-use among Latinas are unknown. Methods A cross-sectional telephone survey examined the association of predisposing, enabling, and need factors with use of cancer support groups among 330 Latina breast cancer survivors recruited from a population-based tumor registry in counties with Spanish language support groups. Results Thirty-two percent had ever used a support group. Among the 225 (68%) women who had never used one, major reasons for not using a support group included receiving enough support from other sources (20%), not needing one (18%), and being unaware of groups in their local area (17%). Women receiving quite a bit or a lot of encouragement from family members to attend a cancer support group were seven times more likely to have ever attended one than women receiving little or no encouragement (OR = 7.04, 95% CI 3.72, 13.30). Spiritual well-being was inversely associated with ever having attended a support group (OR = 0.93, 95% CI 0.89, 0.98). Discussion Results suggest that families play an important role in promoting use of support groups among Latina breast cancer survivors, and that spirituality may offer an alternative source of support. Implications for Cancer Survivors More effort should be directed toward providing culturally and linguistically appropriate support services to breast cancer survivors, and increasing awareness of these services among oncologists, patients and family members.     

Objectively measured breast symmetry has no influence on quality of life in breast cancer patients

Aims

This study investigates how quality of life (QoL) of breast cancer patients is related to breast symmetry.

Methods

We objectively measured breast symmetry using the breast analyzing tool (BAT) in 101 patients after breast conserving surgery for breast cancer at different time points during follow up. We correlated the results with the quality of life measured at the same time using the breast image scale (BIS), the EORTC QLQ-BR23 scale and a not validated sexual score scale. Age, tumour size, tumour/breast relation and the use of oncoplastic surgery were also correlated with symmetry and quality of life scales. Using multivariate analyses, independent parameters for an improved quality of life were identified.

Results

Mean age was 56 (±11.6), and 75.2% of patients had T1 or T2 tumours. Patient age (p = 0.03) and tumour size (p = 0.01) significantly influenced objectively measured breast symmetry. The cosmetic result was important for 53% of patients while 48% found it not important. Independent from this, neither overall quality of life nor breast self esteem was influenced by breast symmetry in our patients.

Conclusions

After breast cancer surgery, breast symmetry is not a major factor for patients’ quality of life and breast self esteem. Cosmetic result seems to be less important than oncologic outcome in patients with breast cancer.     

A mixed-methods exploration of the quality of life of Chinese breast cancer survivors

ABSTRACT

Quality of life (QOL) in cancer survivorship is a multidimensional and subjective concept, which represents the personal sense of the physical, psychological, social, and spiritual consequences of cancer diagnosis and its treatment. This mixed method study aimed to explore the QOL of Chinese breast cancer survivors. Participants were recruited from a cancer self-help organization in the central area of China. QOL was assessed using the QOL–Cancer Survivor Scale and subsequently elicited by in-depth interviews. Results showed that participants had good overall QOL but with unfavorable aspects in psychological and social well-being. Interview data revealed that participants seldom attended spiritual activities. Instead, they actively reconnected with their “self” to create a positive meaning from their cancer experience. Understanding how Chinese breast cancer survivors perceive QOL is important for health professionals to address survivorship in this population.     

Health-related quality of life in long-term breast cancer survivors: nationwide survey in Denmark

Aim To investigate health-related quality of life (HRQOL) in a nationally representative sample of long-term breast cancer survivors (BCS) in Denmark. Participants and methods An age-stratified random sample of 2,000 female BCS ≥ 5 years after primary surgery without recurrence was drawn from the Danish Breast Cancer Cooperative Group register, which is representative regarding long-term BCS in Denmark, and compared with 3,104 women of the nationally representative Danish Health and Morbidity Survey 2000. The Short Form-36 questionnaire assessed HRQOL and its association with BCS’ sociodemography, type of surgery, systemic therapy, radiotherapy, time since operation, receptor status, and low/high risk protocol. Results The response rate was 79%. BCS tended to rate HRQOL better than the general female population. BCS reported significantly less “bodily pain” (P < 0.0001), better “general health” (P < 0.0001), but worse “mental health” (P < 0.0001). Age interacted significantly with four other subscales (P < 0.05): Younger BCS reported worse HRQOL than equally aged women of the general population, while older BCS reported better HRQOL. Poor HRQOL was significantly associated with being single (all subscales: P < 0.05), short education (all subscales: P < 0.05, except “social function”), and high body mass index (“physical function”, “role physical”: P < 0.05). Breast cancer (low/high risk, receptor status) and treatment did not affect HRQOL. Conclusion HRQOL was similar between BCS and women of the general population. Potential long-term effects of breast cancer (low/high risk, receptor status) and treatment did not seem to impact HRQOL. However, predictors for worse HRQOL in BCS were being single, and having a short education.     

Dimensions of physical activity and their relationship to physical and emotional symptoms in breast cancer survivors

Background  Many breast cancer survivors experience long term sequelae, including fatigue, decreased physical functioning, pain, and psychological distress. Physical activity can ameliorate these problems, but there is little research on how activity should be performed to be most beneficial. This study explores how dimensions of physical activity (total energy expenditure, frequency, and duration) are associated with symptoms among breast cancer survivors. Methods  We conducted a secondary analysis of data on physical activity behavior and symptoms in a cross-sectional study (n = 148) of breast cancer survivors who were off treatment and had been diagnosed within the past 5 years. Results  Multivariate analyses showed that total energy expenditure was associated with better general health (p = 0.006) and fewer depressive symptoms (p = 0.014), while frequency of activity was linearly related to physical functioning (p = 0.047), pain (0.057), general health (p < 0.001), and depressive symptoms (p < 0.001). Duration was related to physical functioning, pain, and general health, but the worst outcomes were reported by the participants with the shortest and longest duration of activity (quadratic trend p values = 0.002, 0.003, 0.008, respectively). Discussion/Conclusions  Greater total energy expenditure, higher physical activity frequency, and moderate duration were associated with better outcomes for most symptoms, although there was no relationship between any of the dimensions of physical activity and fatigue. Implications for cancer survivors  The association of better outcomes with higher energy expenditure, higher frequency of activity, and moderate duration indicates that increasing activity through multiple short bouts may be the most beneficial for breast cancer survivors. However, randomized studies are needed to confirm this finding.     

Health-related quality of life before and after a breast cancer diagnosis

While many reports describe health-related quality of life (QOL) among breast cancer survivors, few compare QOL before and after diagnosis and whether changes in QOL substantially differ from changes experienced by all women during aging. QOL was examined in a cohort of female residents of Beaver Dam, Wisconsin, aged 43-86 years at the time of a 1988-1990 baseline examination (N = 2,762; 83% of eligible). Participants were re-contacted four times through 2002 to ascertain QOL using the 36-item Short Form Health Survey (SF-36). QOL data for 114 incident breast cancer cases identified by data linkage with the statewide cancer registry were compared with data for 2,527 women without breast cancer. Women with breast cancer averaged 4.5 (95% CI: 1.6, 7.3) points lower than control women on the SF-36 Physical Component Summary (PCS) scale, regardless of time since diagnosis (up to 13 years). Women with breast cancer also reported lower scores on the SF-36 Mental Component Summary (MCS) scale within two years after diagnosis, but not at more distant times. In longitudinal analyses, 26 women who completed the SF-36 before and after breast cancer diagnosis experienced larger declines than age-matched controls in seven of the eight SF-36 health domains (all but role-emotional) and reported relative declines of -7.0 (95% CI: -11.5, -2.6) and -2.9 (95% CI: -6.3, 0.6) on the PCS and MCS scales, respectively. These results suggest that breast cancer survivors experience relative declines in health-related QOL across a broad spectrum of domains, even many years after diagnosis.     

乳腺癌患者化疗后的心理痛苦与其生活质量之间的关系分析

目的 探讨乳腺癌患者化疗后不同程度的心理痛苦与其生活质量之间的关系。方法以本院2015年3月至2016年3月62例完成6个周期标准化疗的乳腺癌术后患者为研究对象,在化疗后分别完成心理痛苦温度计（DT）及乳腺癌生活质量量表（FACT-B）的测查,根据DT是否≥4分分为高分组和低分组,比较两组间生活质量的差异,同时分析心理痛苦与生活质量的相关性。结果 62例患者中有2例未完成问卷调查剔除。60例低分组和高分组患者生活质量的评分分别为（124.3±11.2）分和（89.5±15.6）分,组间的差异有统计学意义（t=10.06,P＜0.05）。60例患者的心理痛苦评分与生活质量评分呈显著负相关（r=-0.949,P＜0.05）。结论 乳腺癌患者化疗后存在不同程度心理痛苦,且心理痛苦的评分与其生活质量密切相关。     

Long-term quality of life among localised prostate cancer survivors: QALIPRO population-based study

BackgroundTo evaluate quality of life (QoL) 10 years after treatments for localised prostate cancer (LPCa) patients in comparison with aged-matched healthy controls.MethodsLPCa patients diagnosed in 2001 were obtained from 11 French cancer registries. Controls were recruited among the general population and were matched to patients on age and geographic area. EORTC Quality of Life Questionnaire – Core 30 items, Expanded Prostate Cancer Index Composite, Hospital Anxiety and Depression Scale and Multidimensional Fatigue Inventory self-reported questionnaires were used to measure QoL, anxiety and fatigue. Patients were classified in three groups according to previous treatments: radical prostatectomy (RP), radiotherapy (RT) and radical prostatectomy and radiotherapy (RP+RT). The differences in QoL between patients and controls and according to treatment groups were evaluated.ResultsThere were 287 patients and 287 controls. There was no socio-demographic difference between patients and controls. Treatments were: RP (143), RT (78), PR+RT (33), baseline hormone therapy (49) and hormone therapy at the time of the study (34). Patients had similar levels of global QoL, anxiety, depression and fatigue as controls. They reported more urinary troubles (urinary function and incontinence) (p < 0.0001) and more sexual dysfunctions (p < 0.0001) than controls, whatever the treatment group. Worse bowel dysfunction was reported in patients treated by RT and RP+RT (p < 0.002). According to the treatments, RP groups had the worst urinary function and incontinence (p < 0.01), and reported more bowel bother when the treatment was combined with RT.ConclusionsEven though patients reported similar global QoL as control 10 years after treatment, patients reported numerous urinary and sexual dysfunctions. Patients treated with RP+RT reported cumulative sequelae of both treatments.     

Worse quality of life in young and recently diagnosed breast cancer survivors compared with female survivors of other cancers: A cross‐sectional study

Literature focusing on health‐related quality of life (HRQoL) by cancer site among women only is scarce. This study examines HRQoL of breast cancer (BC) survivors compared with female survivors of other cancers, and to understand which subgroups of BC survivors were particularly at risk of reduced HRQoL. We placed emphasis on young (<50 years) and recently diagnosed (≤5 years) survivors, where the deficits in HRQoL were most pronounced. The cross‐sectional study consisted of 2,224 BC survivors, 8,504 non‐cancer controls and 2,205 other cancer survivors in the Karma study. We examined HRQoL differences using linear regression analyses in the whole cohort and in a subset of young and recently diagnosed BC survivors (n = 242) and female survivors of other cancers (n = 140) with comparable ages at diagnosis (43.6 vs 43.6, p = 0.917) and time since diagnosis (2.3 vs 2.8 years, p < 0.001). HRQoL was assessed using the EORTC QLQ‐C30 questionnaire. While only cognitive functioning was significantly compromised in BC survivors compared with survivors of other cancers when women of all ages were included, young BC survivors reported significantly lower HRQoL on multiple functional scales (global quality of life, emotional, role, social and cognitive functioning) and experienced more fatigue and insomnia. BC survivors with any prior medical history of mental disorders reported poorer HRQoL than those without such a history. We also observed a close–knit relationship between tumor and treatment characteristics. BC survivors perform poorly in HRQoL in comparison with female survivors of other cancers. Our results emphasize the importance of age‐ and gender‐appropriate comparison groups.     

Resistance training improves fatigue and quality of life in previously sedentary breast cancer survivors: a randomised controlled trial

The primary aim of this study was to evaluate the benefits of resistance training (RT) on quality of life (QOL) and fatigue in breast cancer survivors as an adjunct to usual care. We recruited 39 women who had survived breast cancer [mean age (y) 51.9 ± 8.8; time since diagnosis (m) 11.6 ± 13.2]. Primary outcomes were fatigue as assessed by the Functional Assessment of Chronic Illness Therapy – Fatigue (FACIT) scale and QOL as assessed by the Functional Assessment of Cancer Therapy – General (FACT‐G) scale. ANCOVA was used to assess the change in the primary outcomes while controlling for baseline values, with effect sizes (ES) displayed as partial Eta squared. The experimental group received supervised RT 3 days per week in a university clinic for 16 weeks. Perceptions of fatigue improved significantly in the RT group compared to controls [mean (SD) 6.7 (7.5) points vs. 1.5 (3.7) points], (P = 0.006, ES = 0.20) as did QOL [6.9 (8.5) points vs. 1.6 (4.4) points], (P = 0.015, ES = 0.16). We demonstrated both statistically and clinically important improvements in fatigue and QOL in response to RT in breast cancer survivors.