Skip to main content

Advertisement

SpringerLink
Log in

Depression and quality of life before and after breast cancer diagnosis in older women from the Women’s Health Initiative

  • Published:
Journal of Cancer Survivorship Aims and scope Submit manuscript

Abstract

Purpose

Distress and reduced quality of life (QOL) are common among people with cancer. No study has compared these variables after breast cancer diagnosis to pre-cancer diagnosis levels.

Methods

Data on women with breast cancer 50 years of age or older (n = 6949) were analyzed from the Women’s Health Initiative (1993–2013). Health-related QOL (physical function, mental health) was measured using Rand-36. Depressive symptoms were measured with the six-item Center for Epidemiologic Studies Depression scale. Assessments occurred before and after the cancer diagnosis. Hierarchical linear modeling compared pre-cancer QOL and depressive symptoms to levels post-diagnosis and tested whether pre-cancer physical activity, stressful life events, sleep disturbance, and pain predicted post-diagnosis outcomes.

Results

Compared with pre-cancer levels, depressive symptoms increased (20.0 % increase at 0–6 months, 12.9 % increase at 6–12 months), while physical function (−3.882 points at 0–6 months, −3.545 at 6–12 months) and mental health decreased (−2.899 points at 0–6 months, −1.672 at 6–12 months) in the first year after diagnosis (all p < .01). Depressive symptoms returned to pre-cancer levels after 10 years, but QOL remained significantly lower. At more than 10 years post-diagnosis, physical function was 2.379 points lower than pre-cancer levels (p < 0.01) while mental health was 1.922 points lower (p < 0.01). All pre-cancer predictors were associated with all outcomes. Pain predicted uniquely greater decreases in physical function post-diagnosis.

Conclusions

Depressive symptoms increased and QOL decreased following breast cancer diagnosis compared with pre-cancer levels, particularly in the first year.

Implications for Cancer Survivors

QOL may remain lower for years after breast cancer diagnosis, although decreases are small.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Andersen BL, Kiecolt-Glaser JK, Glaser R. A biobehavioral model of cancer stress and disease course. Am Psychol. 1994;49(5):389–404.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  2. Shapiro SL et al. Quality of life and breast cancer: relationship to psychosocial variables. J Clin Psychol. 2001;57(4):501–19.

    Article  CAS  PubMed  Google Scholar 

  3. Mitchell AJ et al. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol. 2011;12(2):160–74.

    Article  PubMed  Google Scholar 

  4. van't Spijker AD, Trijsburg RW, Duivenvoorden HJ. Psychological sequelae of cancer diagnosis: a meta-analytical review of 58 studies after 1980. Psychosom Med. 1997;59:280–93.

    Article  Google Scholar 

  5. Trask PC. Assessment of depression in cancer patients. J Natl Cancer Inst Monogr. 2004;32:80–92.

    Article  PubMed  Google Scholar 

  6. So WK et al. The symptom cluster of fatigue, pain, anxiety, and depression and the effect on the quality of life of women receiving treatment for breast cancer: a multicenter study. Oncol Nurs Forum. 2009;36(4):E205–14.

    Article  PubMed  Google Scholar 

  7. Fann JR et al. Major depression after breast cancer: a review of epidemiology and treatment. Gen Hosp Psychiatry. 2008;30(2):112–26.

    Article  PubMed  Google Scholar 

  8. Howren MB, Lamkin DM, Suls J. Associations of depression with C-reactive protein, IL-1, and IL-6: a meta-analysis. Psychosom Med. 2009;71:171–86.

    Article  CAS  PubMed  Google Scholar 

  9. Dowlati Y et al. A meta-analysis of cytokines in major depression. Biol Psychiatry. 2010;67(5):446–57.

    Article  CAS  PubMed  Google Scholar 

  10. Pinquart M, Duberstein PR. Depression and cancer mortality: a meta-analysis. Psychol Med. 2010;115:1–14.

  11. Satin JR, Linden W, Phillips MJ. Depression as a predictor of disease progression and mortality in cancer patients: a meta-analysis. Cancer. 2009;115(22):5349–61.

    Article  PubMed  Google Scholar 

  12. Carlson LE et al. Associations among salivary cortisol, melatonin, catecholamines, sleep quality and stress in women with breast cancer and healthy controls. J Behav Med. 2007;30(1):45–58.

    Article  PubMed  Google Scholar 

  13. Iwamitsu Y et al. Anxiety, emotional suppression, and psychological distress before and after breast cancer diagnosis. Psychosomatics. 2005;46(1):19–24.

    Article  PubMed  Google Scholar 

  14. Musselman DL, Evans DL, Nemeroff CB. The relationship of depression to cardiovascular disease: epidemiology, biology, and treatment. Arch Gen Psychiatry. 1998;55(7):580–92.

    Article  CAS  PubMed  Google Scholar 

  15. Chida Y et al. Do stress-related psychosocial factors contribute to cancer incidence and survival? Nat Clin Pract Oncol. 2008;5(8):466–75.

    Article  PubMed  Google Scholar 

  16. Coyne JC, Ranchor AV, Palmer SC. Meta-analysis of stress-related factors in cancer. Nat Rev Clin Oncol. 2010;7(5):1–2.

  17. Trentham-Dietz A et al. Health-related quality of life before and after a breast cancer diagnosis. Breast Cancer Res Treat. 2008;109(2):379–87.

    Article  PubMed  Google Scholar 

  18. Paskett ED et al. Breast cancer survivors’ health-related quality of life: racial differences and comparisons with noncancer controls. Cancer. 2008;113(11):3222–30.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Mols F et al. Quality of life among long-term breast cancer survivors: a systematic review. Eur J Cancer. 2005;41(17):2613–9.

    Article  PubMed  Google Scholar 

  20. Fafouti M et al. Depression, anxiety and general psychopathology in breast cancer patients: a cross-sectional control study. In Vivo. 2010;24(5):803–10.

    CAS  PubMed  Google Scholar 

  21. The Women’s Health Initiative Study Group. Design of the Women’s Health Initiative clinical trial and observational study. The Women’s Health Initiative Study Group. Control Clin Trials. 1998;19(1):61–109.

  22. Tuunainen A et al. Short version of the CES-D (Burnam screen) for depression in reference to the structured psychiatric interview. Psychiatry Res. 2001;103(2–3):261–70.

    Article  CAS  PubMed  Google Scholar 

  23. Hays RD, Sherbourne CD, Mazel R. User’s manual for the Medical Outcomes Study (MOS) core measures of health-related quality of life. Rand Corporation: Santa Monica, California, USA. 1995.

  24. Schmitz KH et al. Controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev. 2005;14(7):1588–95.

    Article  PubMed  Google Scholar 

  25. Wu SM, Andersen BL. Stress generation over the course of breast cancer survivorship. J Behav Med. 2010;33(3):250–7.

    Article  PubMed Central  PubMed  Google Scholar 

  26. Palesh OG et al. A longitudinal study of depression, pain, and stress as predictors of sleep disturbance among women with metastatic breast cancer. Biol Psychol. 2007;75(1):37–44.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Spiegel D, Sands S, Koopman C. Pain and depression in patients with cancer. Cancer. 1994;74(9):2570–8.

    Article  CAS  PubMed  Google Scholar 

  28. Seguin R et al. Sedentary behavior and physical function decline in older women: findings from the Women’s Health Initiative. J Aging Res. 2012;2012:271589.

    Article  PubMed Central  PubMed  Google Scholar 

  29. Nguyen HQ et al. Recreational physical activity in postmenopausal women is stable over 8 years of follow-up. J Phys Act Health. 2013;10(5):656–68.

    PubMed  Google Scholar 

  30. Levine DW et al. Reliability and validity of the Women’s Health Initiative Insomnia Rating Scale. Psychol Assess. 2003;15(2):137–48.

    Article  PubMed  Google Scholar 

  31. Shambaugh EM, et al. SEER extent of disease—1988 codes and coding instructions, 1988.

  32. Mitchell AJ et al. Depression and anxiety in long-term cancer survivors compared with spouses and healthy controls: a systematic review and meta-analysis. Lancet Oncol. 2013;14(8):721–32.

    Article  PubMed  Google Scholar 

  33. Burgess C et al. Depression and anxiety in women with early breast cancer: five year observational cohort study. Br Med J. 2005;330(7493):702.

    Article  Google Scholar 

  34. Brant JM et al. Symptom trajectories in posttreatment cancer survivors. Cancer Nurs. 2011;34(1):67–77.

    Article  PubMed  Google Scholar 

  35. Bowen DJ et al. Possible socioeconomic and ethnic disparities in quality of life in a cohort of breast cancer survivors. Breast Cancer Res Treat. 2007;106(1):85–95.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Ganz PA et al. Quality of life in long-term, disease-free survivors of breast cancer: a follow-up study. J Natl Cancer Inst. 2002;94(1):39–49.

    Article  PubMed  Google Scholar 

  37. Dorval M et al. Long-term quality of life after breast cancer: comparison of 8-year survivors with population controls. J Clin Oncol. 1998;16(2):487–94.

    CAS  PubMed  Google Scholar 

  38. Helgeson VS, Snyder P, Seltman H. Psychological and physical adjustment to breast cancer over 4 years: identifying distinct trajectories of change. Health Psychol. 2004;23(1):3–15.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The WHI program is funded by the National Heart, Lung, and Blood Institute, National Institutes of Health, US Department of Health and Human Services, through contracts HHSN268201100046C, HHSN268201100001C, HHSN268201100002C, HHSN268201100003C, HHSN268201100004C, and HHSN271201100004C. Dr. Jones is funded by a fellowship from the National Institute on Aging (T32 AG027677).

Conflict of interest

The authors do not have any conflicts of interest to report.

Author information

Authors and Affiliations

  1. Group Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA

    Salene M. W. Jones

  2. University of California, San Diego, La Jolla, CA, 92093, USA

    Andrea Z. LaCroix

  3. University of Massachusetts Medical School, Worcester, MA, 01655, USA

    Wenjun Li & Judith K. Ockene

  4. University of Haifa, Haifa, Israel

    Oleg Zaslavsky

  5. Albert Einstein College of Medicine, Bronx, NY, 10461, USA

    Sylvia Wassertheil-Smoller

  6. Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA

    Julie Weitlauf

  7. Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA

    Julie Weitlauf

  8. Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA

    Gretchen A. Brenes & Suzanne C. Danhauer

  9. University of California, Davis, Davis, CA, 95616, USA

    Rami Nassir

  10. Center for Research on Food and Development, Hermosillo, México

    Graciela Caire-Juvera

Authors
  1. Salene M. W. Jones
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrea Z. LaCroix
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wenjun Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Oleg Zaslavsky
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sylvia Wassertheil-Smoller
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Julie Weitlauf
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gretchen A. Brenes
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Rami Nassir
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Judith K. Ockene
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Graciela Caire-Juvera
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Suzanne C. Danhauer
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Salene M. W. Jones.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM Table 1

(DOC 52 kb)

ESM 1

(DOC 39 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jones, S.M.W., LaCroix, A.Z., Li, W. et al. Depression and quality of life before and after breast cancer diagnosis in older women from the Women’s Health Initiative. J Cancer Surviv 9, 620–629 (2015). https://doi.org/10.1007/s11764-015-0438-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11764-015-0438-y

Keywords

Search

Navigation