Breast Cancer Research and Treatment

, Volume 99, Issue 3, pp 341–350

Health-related quality of life in breast cancer: A cross-cultural survey of German, Japanese, and South Korean patients

  • Eun-Jung Shim
  • Anja Mehnert
  • Atsuko Koyama
  • Seong-Jin Cho
  • Hiroki Inui
  • Nam-Sun Paik
  • Uwe Koch

DOI: 10.1007/s10549-006-9216-x

Cite this article as:
Shim, E., Mehnert, A., Koyama, A. et al. Breast Cancer Res Treat (2006) 99: 341. doi:10.1007/s10549-006-9216-x



The aim of this study was to evaluate health-related quality of life (HRQOL) in breast cancer patients across countries, and to cross-culturally examine the impact of psychosocial factors on HRQOL.

Patients and methods

A total of 413 women with breast cancer from Germany (n=195), Japan (n=112), and Korea (n=106) completed a survey assessing HRQOL and HRQOL-related factors. HRQOL was measured using the Short-Form Health Survey (SF-8). Measures of psychological distress (Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised), coping (Dealing with Illness Inventory-German Revised), and social support (Illness-Specific Social Support Scale-German Revised) were included.


The effect of the factor country on physical QOL was seen to be significant, but small (P=0.049, ES=0.018). The scales of General Health (P=0.023), Vitality (P=0.004), and Role Emotional (P=0.003) differed across countries, with the South Korean patients having lower scores compared to the German and Japanese patients. The nature of the impact of psychosocial factors on HRQOL did not differ greatly across countries except with regard to avoidance, however, the degree to which these factors influence HRQOL did differ greatly. Overall, depression, depressive coping, and problematic support showed a strong detrimental effect on the HRQOL of breast cancer patients.


Results from this study suggest that strategies which target an improvement of HRQOL in cancer patients should also consider the patients’ cultural and healthcare system contexts. Interventions are needed to improve detrimental psychosocial factors.


Health-related quality of lifeBreast cancerCultureCopingSocial supportPsychological distress

Copyright information

© Springer Science+Business Media B.V. 2006

Authors and Affiliations

  • Eun-Jung Shim
    • 1
  • Anja Mehnert
    • 2
  • Atsuko Koyama
    • 3
  • Seong-Jin Cho
    • 4
  • Hiroki Inui
    • 5
  • Nam-Sun Paik
    • 6
  • Uwe Koch
    • 7
  1. 1.Institute of Medical PsychologyUniversity Medical Center Hemburg-EppendorfHamburgGermany
  2. 2.Institute of Medical PsychologyUniversity Medical Center Hemburg-EppendorfHamburgGermany
  3. 3.Department of Psychosomotic Medicine, Sakai HospitalKinki University School of MedicineOsakaJapan
  4. 4.Department of NeuropsychiatryKorea Cancer Center HospitalSeoutSouth Korea
  5. 5.Department of SurgeryKinki university Hospital, Kinki University School of MedicineOsakaJapan
  6. 6.Department of SurgeryKorea Cancer Center HospitalSeoutSouth Korea
  7. 7.Institute of Medical PsychologyUniversity Medical Center Hemburg-EppendorfHamburgGermany