Abstract
Purpose
To describe quality of life (QoL) in a cohort of surviving women 4 years after breast cancer treatment and to analyze its role as a predictor of mortality within 2 years.
Methods
This is a prospective cohort study of 544 women who have undergone surgical treatment, from 2001 to 2002 and who answered a questionnaire about QoL in 2006. After, we conducted a survival study to evaluate the association between QoL and mortality within 2 years with the same population. We conducted factor analysis between the variables of the scales of function and symptoms. Survival analysis was conducted by Kaplan–Meier, and differences in survival curves were assessed with the log-rank test, assuming significant statistical level of 5 %. The Cox proportional hazards regression model was used to explore the relationship between QoL variables (functional scales) and prognostic value for survival.
Results
The mean age of the women was 59.1 years (SD 11.66). The mean of overall QoL score was 75.16 (SD 20.93). Using factor analysis, we identified three conditions that made up the construct of QoL in this group of patients: social, psycho-emotional, and physical. Social condition was the most important factor. After assessment of QoL, the mean survival was 23 months (SD 3.90). Women who reported worse future perspective had higher chance of death compared with women better prospect of future (HR = 3.46; 95 % CI 1.36–8.79; p value = 0.009).
Conclusion
Future perspectives were predictors of mortality, which reinforce the relevance of social support and psychological aspects for these women.
Similar content being viewed by others
References
Ferlay, J., Shin, H. R., Bray, F., Forman, D., Mathers, C., Parkin, D. M. (2010). GLOBOCAN 2008 v1.2, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 10. Accessed May 25, 2012, from http://globocan.iarc.fr.
Siegel, R., DeSantis, C., Virgo, K., Stein, K., Mariotto, A., Smith, T., et al. (2012). Cancer treatment and survivorship statistics. CA: A Cancer Journal for Clinicians, 62(4), 220–241.
Moss, S. M., Nyström, L., Jonsson, H., Paci, E., Lynge, E., Njor, S., et al. (2012). The impact of mammographic screening on breast cancer mortality in Europe: A review of trend studies. Journal of Medicine Screening, 19(Suppl1), 26–32.
DiSantis, C., Siegel, R., Bandi, P., & Jemal, A. (2011). Breast cancer statistics. CA: A Cancer Journal for Clinicians, 61(6), 409–418.
National Institute Cancer. U.S. National Institutes of Health. (2013). Accessed April 4, 2013, from www.cancer.gov.br.
Chopra, I., & Kamal, K. M. (2012). A systematic review of quality of life instruments in long-term breast cancer survivors. Health and Quality of Life Outcomes, 10, 14.
Bloom, J. R., Stewart, S. L., Chang, S., & Banks, P. J. (2004). Then and now: Quality of life of young breast cancer survivors. Psycho-Oncology, 13, 147–160.
Meeske, K., Smith, A. W., Alfano, C. M., McGregor, B. A., McTiernan, A., Baumgartner, K. B., et al. (2007). Fatigue in breast cancer survivors two to five years post diagnosis: A HEAL Study report. Quality of Life Research. doi:10.1007/s11136-007-9215-3.
Ahn, S. H., Park, B. H., Noh, D. Y., Nam, S. J., Lee, E. S., Lee, M. K., et al. (2007). Health-related quality of life in disease-free survivors of breast cancer with the general population. Annals of Oncology, 18(1), 173–182.
Ganz, P. A., Desmond, K. A., Leedham, B., Rowland, J. H., Meyerowitz, B. E., & Belin, T. R. (2002). Quality of life in long-term, disease-free survivors of breast cancer: A follow-up study. Journal of the National Cancer Institute, 94(1), 39–49.
Bloom, J. R., Petersen, D. M., & Kang, S. H. (2007). Multi-dimensional quality of life among long-term (5+ years) adult cancer survivors. Psycho-Oncology, 16, 691–706.
Bloom, J. R., Stewart, S. L., Oakley-Girvan, I., Banks, P. J., & Shema, S. (2012). Quality of life of younger breast cancer survivors: Persistence of problems and sense of well-being. Psycho-Oncology, 21, 655–665.
Härtl, K., Janni, W., Kästner, R., Sommer, H., Strobl, B., Rack, B., et al. (2003). Impact of medical and demographic factors on long-term quality of life and body image of breast cancer patients. Annals of Oncology, 14(7), 1064–1071.
Lu, W., Cui, Y., Chen, X., Zheng, Y., Gu, K., Cai, H., et al. (2009). Changes in quality of life among breast cancer patients three years post-diagnosis. Breast Cancer Research and Treatment, 114(2), 357–369.
Thong, M. S. Y., Mols, F., Coebergh, J.-W. W., Roukema, J. A., & Van de Poll-Franse, L. V. (2009). The impact of disease progression on perceived health status and quality of life of long-term cancer survivors. Journal of Cancer Survivorship, 3(3), 164–173.
Efficace, F., Biganzoli, L., Piccart, M., Coens, C., Van Steen, K., Cufer, T., et al. (2004). Baseline health-related quality-of-life data as prognostic factors in a phase III multicentre study of women with metastatic breast cancer. European Journal of Cancer, 40(7), 1021–1030.
Kramer, J. A., Curran, D., Piccart, M., Haes, J. C. J. M., Bruning, P., Klijn, J., et al. (2000). Identification and interpretation of clinical and quality of life prognostic factors for survival and response to treatment in first-line chemotherapy in advanced breast cancer. European Journal of Cancer, 36(12), 1498–1506.
Luoma, M. L., Hakamies-Blomqvist, L., Sjöströn, J., Pluzanska, A., Ottoson, S., Mouridsen, H., et al. (2003). Prognostic value of quality of life scores for time to progression (TTP) and overall survival time (OS) in advanced breast cancer. European Journal of Cancer, 39(10), 1370–1376.
Reynolds, P., Boyd, P. T., Blacklow, R. S., Jackson, J. S., Greenberg, R. S., Austin, D. F., et al. (1994). The relationship between social ties and survival among black and white breast cancer patients. Cancer Epidemiology, Biomarkers & Prevention, 3, 253–259.
Chou, A. F., Stewart, S. L., Wild, R. C., & Bloom, J. R. (2012). Social support and survival in young women with breast carcinoma. Psycho-Oncology, 21(2), 125–133.
Saquib, N., Pierce, J. P., Saquib, J., Flatt, S. W., Natarajan, L., Bardwell, W. A., et al. (2011). Poor physical health predicts time to additional breast cancer events and mortality in breast cancer survivors. Psycho-Oncology, 20(3), 252–259.
Mendonça, G. A. S., Silva, A. M., & Caula, W. M. (2004). Características tumorais e sobrevida de cinco anos em pacientes com câncer de mama admitidas no Instituto Nacional de Câncer, Rio de Janeiro. Brasil. Cadernos de Saúde Pública, 20(5), 1232–1239.
Moraes, A. B., Zanini, R. R., Turchiello, M. S., Riboldi, J., & Medeiros, L. R. (2006). Estudo da sobrevida de pacientes com câncer de mama atendidas no hospital da Universidade Federal de Santa Maria, Rio Grande do Sul, Brasil. Cadernos Saúde Pública, 22(10), 2219–2228.
Schneider, I. J. C., & D’Orsi, E. (2009). Sobrevida em cinco anos e fatores prognósticos em mulheres com câncer de mama em Santa Catarina. Brasil. Cadernos Saúde Pública, 25(6), 1285–1296.
Guerra, M. R., Mendonça, G. A. S., Bustamante-Teixeira, M. T., Cintra, J. R. D., Carvalho, L. M., & Magalhães, L. M. P. V. (2009). Sobrevida de cinco anos e fatores prognósticos em coorte de pacientes com câncer de mama assistidas em Juiz de Fora, Minas Gerais, Brasil. Cadernos Saúde Pública, 25(11), 2455–2466.
Conde, D. M., Pinto-Neto, A. M., Cabello, C., Santos-Sá, D., Costa-Paiva, L., & Martinez, Z. E. (2005). Quality of life in brazilian breast cancer survivors age 45–65 years: Associated factors. The Breast Journal, 11(6), 425–432.
Soares, P. B. M., Carneiro, J. A., Rocha, L. A., Gonçalves, R. C. R., Martelli, D. R. B., Silveira, M. F., et al. (2013). The quality of life of disease-free Brazilian breast cancer survivors. Revista da Escola de Enfermagem da USP, 47(1), 69–75.
Kluthcovsky, A. C. G. C., Urbanetz, A. A., Carvalho, D. S., Maluf, E. M. C. P., Sylvestre, G. C. S., & Hatschbach, S. B. B. (2012). Fatigue after treatment in breast cancer survivors: Prevalence, determinants and impact on health-related quality of life. Support Care Cancer, 20, 1901–1909.
Bergmann, A. (2005). Incidência e fatores de risco do linfedema após tratamento cirúrgico para câncer de mama: Estudo de uma coorte hospitalar. Dissertation, National School of Public Health—Oswaldo Cruz Foundation, Rio de Janeiro (RJ), Brazil.
Bergmann, A., Koifman, R. J., Ribeiro, M. J. P., & Mattos, I. E. (2007). Upper limb lymphedema following breast cancer surgery: Prevalence and associated factors. Lymphology, 40(Suppl.), 96–106.
Bevilacqua, J. L. B., Kattan, M. W., Changhong, Y., Koifman, S., Mattos, I. E., Koifman, R. J., et al. (2012). Nomograms for predicting the risk of arm lymphedema after axillary dissection in breast cancer. Annals of Surgical Oncology, 19(8), 2580–2589.
Moura Junior, L. G. (2007). Qualidade de vida e câncer de mama: uma comparação entre mulheres com e sem linfedema. Dissertation, National School of Public Health—Oswaldo Cruz Foundation, Rio de Janeiro (RJ), Brazil.
Fayers, P. M., Aaronson, N. K., Bjordal, K., Groenvold, M., Curran, D., Bottomley, A., et al. (2001). The EORTC QLQ-C30 Scoring Manual (3rd ed.). Brussels: European Organization for Research and Treatment of Cancer.
Fayer, P., & Bottomley, A. (2002). Quality of life research within the EORTC—The EORTC QLQ-C30. European Journal of Cancer, 38, S125–S133.
Koller, M., & Lorenz, W. (1998). Quality of life research in patients with rectal cancer: Traditional approaches versus a problem-solving oriented perspective. Langenbeck’s Archives of Surgery, 383(6), 427–436.
Lee, M. K., Son, B. H., Hwang, S. Y., Han, W., Yang, J.-H., Lee, S., et al. (2007). Factors affecting health-related quality of life in women with recurrent breast cancer in Korea. Quality of Life Research, 16(4), 559–569.
Kornblith, A. B., Herndon, J. E, 2nd, Weiss, R. B., Zhang, C., Zuckerman, E. L., Rosenberg, S., et al. (2003). Long-term adjustment of survivors of early-stage breast carcinoma, 20 years after adjuvant chemotherapy. Cancer, 98(4), 679–689.
Ferrell, B., & Dow, K. H. (1997). Quality of life among long-term cancer survivors. Oncology, 11(4), 565–576.
Ferrell, B., Grant, M., Funk, B., Otis-Green, S., & Garcia, N. (1997). Quality of life in breast cancer survivors as identified by focus groups. Psycho-Oncology, 6(1), 13–23.
Ganz, P. A., Guadagnoli, E., Landrum, M. B., Lash, T. L., Rakowski, W., & Silliman, R. A. (2003). Breast cancer in older women: Quality of life and psychosocial adjustment in the 15 months after diagnosis. Journal of Clinical Oncology, 21(21), 4027–4033.
Grupta, D., Granick, J., Grutsch, J. F., & Lis, C. G. (2007). The prognostic association of health-related quality of life scores with survival in breast cancer. Supportive Care in Cancer, 15(4), 387–393.
Shimozuma, K., Sonoo, H., Ichihara, K., & Tanaka, K. (2000). The prognostic value of quality-of-life scores: Preliminary results of an analysis of patients with breast cancer. Surgery Today, 30(3), 255–261.
Groenvold, M., Petersen, M. A., Idler, E., Bjorner, J. B., Fayers, P. M., Mouridsen, H. T. (2007). Psychological distress and fatigue predicted recurrence and survival in primary breast cancer patients. Breast Cancer Research and Treatment. doi:10.1007/s10549-006-9447-x.
Svensson, H., Hatschek, T., Johansson, H., Einbeigi, Z., Brandberg, Y. (2012). Health-related quality of life as prognostic factor for response, progression-free survival, and survival in women with metastatic breast cancer. Medical Oncology. doi:10.1007/s12032-011-9844-9.
Watson, M., Homewood, J., Haviland, J., & Bliss, J. M. (2005). Influence of psychological response on breast cancer survival: 10-year follow-up of a population-based cohort. European Journal of Cancer, 41, 1710–1714.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
De Aguiar, S.S., Bergmann, A. & Mattos, I.E. Quality of life as a predictor of overall survival after breast cancer treatment. Qual Life Res 23, 627–637 (2014). https://doi.org/10.1007/s11136-013-0476-8
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11136-013-0476-8