Quality of Life and Patient Reported Outcomes in Breast Cancer

Abstract

Background: Breast cancer is the most common cancer worldwide and one of the most common causes of cancer deaths. Over the past decades, improvements in early detection and prevention combined with advancements in treatments have led to vastly improved survival rates with an estimated average 5-year survival of over 90%. In the context of the long survival and specific side effects of each treatment, the health-related quality of life of breast cancer survivors has become a focus point in research. This chapter aims to comprehensively summarize the available evidence on this topic.

Methods: To guarantee a certain degree of quality of the respective articles only systematic reviews from January 2011 onwards in English reporting on the quality of life in breast cancer patients were included. The 10-year time frame was chosen as this coincides with the advent of all commonly used adjuvant therapies. Only papers unrelated to quality of life in breast cancer patients were excluded. No exclusion was made based on geographic region, interventions, patient or cancer characteristics. Outcomes of interest were factors influencing the quality of life in breast cancer patients and interventions impacting the quality of life.

Results: The literature research yielded 65 results, out of which 17 were excluded according to the above criteria, and the remaining 48 were included.

6 studies research what factors influencing the quality of life in breast cancer patients. The identified factors can be summarised into 4 main categories: patient and lesion characteristics, treatment, social and psychological factors, and physical factors. For each category, factors with a positive or negative effect on quality of life were identified.

42 studies analysed the impact of a specific intervention or therapy on the quality of life with overall mixed results. There is however a notable mismatch with research focusing on interventions targeting factors that area not clearly proven to influence quality of life while neglecting factors with a strong positive or negative correlation.

Conclusion: Several factors influencing quality of life in breast cancer patients could be identified. Regarding interventions targeting these factors, the current literature is mixed. In the factors related to treatment, there is a focus on factors with contradictory evidence regarding their influence on quality of life, such as surgery and endocrine therapy, while neglecting interventions targeting factors that have a known association to quality of life. In other categories such as psychological and physical factors, there is a good literature body evaluating interventions suggesting promising results for psychological interventions such as cognitive behavioural therapies or the implementation of exercise regimes. Based on these findings, both areas for future research and increased focus in clinical practice could be identified.