Health‐related quality of life in long‐term breast cancer survivors

BACKGROUND:

The Survivor's Health and Reaction (SHARE) study examined health‐related quality of life (HRQL) in breast cancer patients who had participated in Cancer and Leukemia Group B Trial 8541 from 1985 to 1991.

METHODS:

In total, 245 survivors (78% of eligible patients) who were 9.4 to 16.5 years postdiagnosis (mean, 12.5 years postdiagnosis) completed HRQL surveys relating to 5 domains. Analyses examined HRQL domains according to 3 different chemotherapy dose levels that were administered in the original treatment trial: low‐dose cyclophosphamide, doxorubicin, and fluorouracil (CAF) at 300 mg/m², 30 mg/m², and 300×2 mg/m², respectively, over 4 cycles; standard‐dose CAF at 400 mg/m², 40 mg/m², and 400×2 mg/m², respectively, over 6 cycles; and high‐dose CAF at 600 mg/m², 60 mg/m² and 600×2 mg/m², respectively, over 4 cycles.

RESULTS:

In univariate analyses, a statistically significant difference was observed on the Medical Outcomes Study 36‐item short form Physical Role Functioning subscale by treatment group, with lower mean scores in the standard treatment arm (mean, 65.05) compared with mean scores in the low‐dose arm (mean, 74.66) and the high‐dose arm (mean, 84.94; P.0001). However, multivariate analysis revealed that treatment arm no longer was statistically significant, whereas the following factors were associated with decreased physical role functioning: age ≥60 years (odds ratio [OR], 3.55; P = .006), increased comorbidity interference total score (OR, 1.64; P = .005), lower vitality (OR, 1.05; P = .0002), and increased menopausal symptoms (OR, 1.04 P = .02).

CONCLUSIONS:

At 9.4‐16.5 years after their original diagnosis, differences in physical role functioning among breast cancer survivors who had received 3 different dose levels of chemotherapy were explained by clinical and demographic variables, such as age, fatigue, menopausal symptoms, and comorbidities. Prospective studies are needed to further assess the role of these factors in explaining HRQL and physical role functioning among long‐term survivors. Cancer 2009. © 2009 American Cancer Society.     

Prospective assessment of quality of life in long‐term ovarian cancer survivors

The objective of our study was to compare prospectively the QoL in long‐term ovarian cancer survivors with short‐term survivors and to explore discriminating variables between short‐term and long‐term survival. Thirty‐three patients were included, 22 died within 5 years post diagnosis and 11 survived beyond 10 years. QoL data were collected pre‐treatment (baseline), 1‐year post diagnoses and for long‐term survivors 10 years post‐treatment using the EORTC QLQ‐C30. At baseline, there was no difference in terms of FIGO stage, residual tumor and adjuvant chemotherapy. Significantly, more short‐term survivors (96%) had intra operative ascites as compared to long‐term survivors (55%) (p=0.01). Before treatment, short‐term survivors had clinically significantly lower QoL scores on the physical functioning (mean 75.45) and role functioning scale (mean 68.94) compared to long‐term survivors (mean 68.94 and 84.85, respectively). They also reported higher levels of symptoms. One year post‐diagnosis, QoL scores were comparable in most domains. Long‐term survivors had a significantly better global QoL but more insomnia. Emotional functioning and global QoL/health status improved significantly from baseline to 1‐year post‐diagnosis and remained relatively stable at the 10‐year follow‐up. The presence of intra operative ascites and a supporting social network were identified as significant variables that discriminated between short‐term and long‐term survival. Compared to a reference sample, long‐term survivors showed similar QoL scores but more dyspnoea. Although ovarian cancer patients do not belong to the most prevalent survivor populations, we found that long‐term survivors have QoL scores similar to females without a history of cancer.     

Association between physical activity and quality of life among Western Australian breast cancer survivors

Previous research has shown that physical activity (PA) may be beneficial to quality of life (QoL) in breast cancer survivors. Few studies however, have focused on the time period soon after the completion of adjuvant therapy or examined exercise issues separately for rural/urban or healthy weight/obese breast cancer survivors. Our study addressed these issues. Breast cancer survivors (N = 558) from the Western Australia Cancer Registry completed a survey that included the Godin Leisure Time Exercise Questionnaire (GLTEQ) and the Functional Assessment of Cancer Therapy-Breast (FACT-B) scale. Results showed that only 31% of breast cancer survivors were meeting the recommended PA guidelines post-treatment. Analysis of variance revealed that survivors meeting these guidelines reported higher scores on the FACT-B (mean difference 8.6; 95% CI = 5.0-12.1; p<0.001), the FACT-General (mean difference 6.3; 95% CI = 3.5-9.0; p<0.001), the trial outcome index (TOI; p<0.001), and several of the FACT-B subscales. Furthermore, healthy weight participants also reported higher scores than obese participants on the FACT-B (p = 0.058) and the breast cancer subscale (p = 0.033). There were no differences based on geographic location. We conclude that physically active and healthy weight breast cancer survivors report better QoL than their inactive and obese counterparts soon after completing adjuvant therapy.     

Cancer surveillance behaviors and psychosocial factors among long‐term survivors of breast cancer

BACKGROUND:

Little is known about cancer surveillance (mammography, clinical breast examination, and pelvic examination) behaviors in long‐term (9‐16 years) breast cancer survivors. This report describes the relation of these behaviors to demographic and clinical characteristics, psychological symptoms, body satisfaction, and social support.

METHODS:

Survivors who had participated in Cancer and Leukemia Group B treatment Trial 8541 completed a survey that included questions on breast cancer surveillance and pelvic examination, psychological well being, body satisfaction, and social support.

RESULTS:

The participation rate was 78% and included 245 breast cancer survivors. Survivors (n = 107; 44%) reported completing breast cancer surveillance (mammography and clinical breast examination) and completing pelvic examination (n = 162; 68%) within recommended guidelines. There were no significant associations between breast cancer surveillance and breast cancer anxiety, depression, stressful life events, body satisfaction, social support, or demographic characteristics. Survivors within recommended guidelines for pelvic examinations were younger (P = .05), married (P = .003), had health insurance (P = .004), and had lower depression scores (P = .005) than survivors who underused or overused pelvic examination. In addition, survivors within recommended pelvic examination guidelines had significantly lower levels of breast cancer anxiety (P = .03) compared with survivors who underused pelvic examination.

CONCLUSIONS:

Many long‐term breast cancer survivors were not within recommended cancer surveillance guidelines. Private health insurance was associated with following recommendations for pelvic examinations, although such a relation did not exist for breast cancer surveillance. The results of this study have implications for the development of educational programs to improve cancer surveillance among the growing population of long‐term breast cancer survivors. Cancer 2009. © 2009 American Cancer Society.     

Associations between leisure‐time physical activity and health‐related quality of life among adolescent and adult survivors of childhood cancers

Objective: Survivors of childhood cancer are at an increased risk for reduced quality of life (QOL), yet few studies have explored factors associated with improving health‐related QOL (HRQOL) in this population. We thus explored the relationship between physical activity (PA) and HRQOL among survivors of childhood cancer. Methods: A total of 215 survivors of childhood lymphoma, leukemia, and central nervous system cancers completed mailed surveys that elicited information regarding leisure‐time PA (LTPA) measured in metabolic equivalents, HRQOL, and diagnostic and demographic factors. Correlations and adjusted regression models were used to explore the relationship between LTPA and HRQOL. Results: In the total sample, modest, yet significant linear associations were observed between LTPA and overall HRQOL (β=0.17, p<0.01), as well as each of the respective subscales (β=0.11?0.23 and p's<0.05 to <0.001). Among adolescent survivors of childhood cancer, LTPA was significantly associated with overall HRQOL (β=0.27), cancer worry (β=0.36), cognitive function (β=0.32), body appearance (β=0.29), and social function (β=0.27) (all p's<0.05). Among adult survivors of childhood cancer, LTPA was only significantly associated with physical function (β=0.28, p<0.001). Conclusions: Significant associations exist between LTPA and HRQOL; however, the association was stronger and observed in more domains for adolescent survivors of childhood cancer. More research is needed to determine the antecedents and consequences of PA in this population. Copyright © 2010 John Wiley & Sons, Ltd.     

Diet quality is directly associated with quality of life in breast cancer survivors

Summary Purpose To determine whether there is a direct relationship between diet quality and quality of life in breast cancer survivors. Methods Subjects (n = 714) were members of the Health, Eating, Activity, and Lifestyle study, a study of breast cancer prognosis conducted in three areas of the western United States. Approximately 2 years after entry to this study, diet data were collecting using food frequency questionnaires. These data were used to classify diet quality using the Diet Quality Index. Approximately 10 months later, data on quality of life were gathered using the Medical Outcomes Study 36-Item short form health survey. Results After controlling for age, education, race/ethnicity, body mass index, stage of disease, and time from diagnosis to quality of life measurement, women with excellent diet quality had significantly better scores than women with poor diet quality for overall mental health functioning and for 3 of 4 mental health subscale scores and 2 of 4 physical health subscale scores. Conclusion Post-diagnosis diet quality is directly associated with subsequent mental and physical functioning in breast cancer survivors. This association is stronger for mental functioning than for physical functioning. The association remains strong after control for potential confounding variables.     

Comparison of lasting life changes after cancer and BMT: perspectives of long‐term survivors and spouses

Objective: This qualitative follow up of long‐term (>5 years) cancer survivor and spouse participants from a large, previous study of quality of life after blood and marrow transplantation (BMT) was designed to gain a deeper understanding of lasting life changes they experienced. Methods: Thirty spouse–survivor pairs, an average of 13 years post‐BMT, were individually interviewed to identify lasting life changes. Participants were asked about their most significant long‐lasting change since cancer/BMT, most significant positive change and negative change, and whether the experience had affected them and their spouse differently. Results: Spouses and survivors spontaneously identified both positive and negative changes. Spouses reported a higher proportion of negative changes (24%) than did survivors (15%), and survivors a higher proportion of positive changes (85%) than spouses (76%). For both groups, the most frequent positive change was in ‘perspective/outlook on life’ and negative change was ‘lingering health effects,’ although survivors mentioned the latter twice as often as did spouses. Spouses were more likely to talk about changes in the first‐person plural (we, us) that were largely emotional or in relation to the survivor, whereas survivors spoke of changes in the first‐person singular (I, me) that occurred to them directly and were largely physical. Conclusions: Although both spouses and survivors described similar negative and positive long‐lasting changes that continued an average of 13 years post‐BMT, they reported differences in the ways they were impacted by the experience, which was reflected in the language they used. Implications for future studies, family education, and couples‐based interventions are discussed. Copyright © 2010 John Wiley & Sons, Ltd.     

Participation in water‐exercising long‐term after breast cancer surgery: Experiences of significant factors for continuing exercising as a part of cancer rehabilitation

Although physical exercising has great benefits, little is known regarding factors of significance for cancer survivors to continue exercising within their rehabilitation. The objective was to describe factors experienced to be of significance for cancer survivors to continue with water‐exercising long‐term after breast cancer surgery. Women (n = 29) who had undergone breast cancer surgery (mastectomy 79%, axillary surgery 86%, and radiotherapy 86%) for median (md) 13 (25th–75th percentile 3–21.5) was followed up regarding their rehabilitation, arm function Disabilities of Arm Shoulder and Hand (md 14, IQR 7–32), EQ‐5D score (md 0.8, IQR 0.73–1.0) and quality of life EQ health barometer (md 80, IQR 64–95). We performed qualitative focus‐group interviews regarding the women's views (n = 24). The women had participated in water‐exercising 1–46 semesters, md 8 (25th–75th percentile 3–21.5) semesters. Nearly all, 97%, participated in the water‐exercising group every week, and 21 (72%) had participated in the water‐exercising group at least half of the time since their breast cancer surgery, without complications. The women experienced that factors of significance to continue with water‐exercising were the convenience of easily modified weightless exercising in the water, social interaction, and access to a private dressing room. These factors would be important to consider to encourage continuing in exercising.