Breast Cancer Research and Treatment

, Volume 38, Issue 2, pp 183–199

Breast cancer survivors: Psychosocial concerns and quality of life

  • Patricia A. Ganz
  • Anne Coscarelli
  • Carol Fred
  • Barbara Kahn
  • Margaret L. Polinsky
  • Laura Petersen
Report

Abstract

Purpose

To describe the psychosocial concerns and quality of life of breast cancer survivors evaluated 2 and 3 years after primary treatment.

Methods

A sample of 139 breast cancer survivors who had been interviewed during the first year after primary treatment participated in a mailed survey at 2 years (N = 69) and 3 years (N = 70) after initial surgery. A random sample of these survivors were also interviewed in person. The mailed questionnaire included standardized instruments to assess quality of life (QL), rehabilitation needs, and psychological distress. Additional survey questions were developed to examine post-surgical recovery, employment and insurance problems. social support, and existential concerns. The in-person interviews expanded on these questions and systematically compared these patients' rehabilitation needs to those which existed at the time of an interview 1 year after surgery.

Results

The 2 and 3 year participants in this follow-up study did not differ from each other on their prior assessments with standardized QL instruments during the first year after surgery, nor did they differ from the full study sample of 227 women. The scores on the Profile of Mood States and the Functional Living Index-Cancer were the same for the 2 and 3 year survivor groups and did not differ from the previous assessments at 1 year after initial treatment. The scores on the Cancer Rehabilitation Evaluation System showed a significant decline in Global Quality of Life, Sexual Functioning and Marital Functioning between the 1 year and 3 year evaluations. For the 2 year sample only Sexual Functioning showed a deterioration between the 1 and 2 year evaluations. Using the RAND 36-Item Health Survey 1.0, the breast cancer survivors were compared with patients from the Medical Outcomes Study. The breast cancer survivors demonstrated higher levels of functioning in many dimensions (role functioning, social functioning, pain, and general health) than the patients with chronic medical conditions. In spite of relatively good physical and emotional functioning on this generic measure of health status and quality of life, these breast cancer survivors reported a number of important and severe rehabilitation problems that persisted beyond one year after primary treatment. Especially frequent were problems associated with physical and recreational activities, body image, sexual interest, sexual function, and problems with dating for those who were single.

Conclusions

Breast cancer survivors appear to attain maximum recovery from the physical and psychological trauma of cancer treatment by one year after surgery. A number of aspects of QL and rehabilitation problems worsen after that time. Nevertheless, breast cancer survivors rate their QL more favorably than outpatients with other common medical conditions, and they identify many positive aspects from the cancer experience.

Key words

breast cancer quality of life rehabilitation sexual functioning 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Boring CC, Squires TS, Tong T, Montgomery S: Cancer Statistics, 1994. CA-Cancer Journal for Clinicians 44: 7–26, 1994Google Scholar
  2. 2.
    Ganz PA for the ASCO Committee on Patient Advocacy: The physician as the patient's advocate. J Clin Oncol 11: 1011–1013, 1993Google Scholar
  3. 3.
    Leventhal BG, Shearer PD: Recognizing and managing the late effects of cancer treatment. Oncology 3(5): 73–84, 1989Google Scholar
  4. 4.
    Morris T, Greer HS, White P: Psychological and social adjustment to mastectomy: A two year follow-up study. Cancer 40: 2381–2387, 1977PubMedGoogle Scholar
  5. 5.
    Taylor SE, Lichtman RR, Wood JV, Bluming AZ, Dosik GM, Leibowitz RL: Illness-related and treatment-related factors in psychological adjustment to breast cancer. Cancer 55: 2506–2513, 1985PubMedGoogle Scholar
  6. 6.
    Jamison K, Wellisch DK, Pasnau RO: Psychosocial aspects of mastectomy: I. The woman's perspective. Am J Psychiatry 135: 432–436, 1978PubMedGoogle Scholar
  7. 7.
    Knobf MT: Physical and psychologic distress associated with adjuvant chemotherapy in women with breast cancer. J Clin Oncol 4: 678–684, 1986PubMedGoogle Scholar
  8. 8.
    Ganz PA, Schag CC, Cheng H: Assessing the quality of life—A study in newly-diagnosed breast cancer patients. J Clin Epidemiol 43: 75–86, 1990PubMedGoogle Scholar
  9. 9.
    Ganz PA, Schag CAC, Lee JJ, Polinsky ML, Tan S-J: Breast conservation versus mastectomy: Is there a difference in psychological adjustment or quality of life in the year after surgery? Cancer 68: 1729–1738, 1992Google Scholar
  10. 10.
    Schag CAC, Ganz PA, Polinsky ML, Fred C, Hirji K, Petersen L: Characteristics of women at risk for psychosocial distress in the year after breast cancer. J Clin Oncol 11: 783–793, 1993PubMedGoogle Scholar
  11. 11.
    Ganz PA, Hirji K, Sim M-S, Schag CAC, Fred C, Polinsky ML: Predicting psychosocial risk in patients with breast cancer. Medical Care 31(5): 419–431, 1993PubMedGoogle Scholar
  12. 12.
    Ganz PA, Rofessart J, Polinsky ML, Schag CC, Heinrich RL: A comprehensive approach to the assessment of cancer patients' rehabilitation needs: The cancer inventory of problem situations and a companion interview. J Psychosocial Oncol 4: 27–42, 1986Google Scholar
  13. 13.
    Collins MS: Distinguishing among the attributions of causality, responsibility, and blame, including the effects of each on adjustment to a victimizing event. Doctoral Dissertation, University of California, Los Angeles, 1990Google Scholar
  14. 14.
    Taylor SE, Wayment H, Collins MS: Positive illusions and affect regulation. In: Wegner DM, Oennebaker JW (eds) Handbook of Mental Control, Prentice Hall, Englewood Cliffs, NJ, 1993, pp 325–343Google Scholar
  15. 15.
    Aaronson NK: Quality of life: What is it? How should it be measured? Oncology 2: 69–74, 1988PubMedGoogle Scholar
  16. 16.
    Schipper H, Levitt M: Measuring quatity of life: Risks and benefits. Cancer Treatment Reports 69: 1115–1123, 1985PubMedGoogle Scholar
  17. 17.
    Ware JE Jr.: Conceptualizing disease impact and treatment outcomes. Cancer 53 (Supplement): 2316–2323, 1984PubMedGoogle Scholar
  18. 18.
    Gough IR, Furnival CM, Schilder L, Grove W: Assessment of the quality of life of patients with advanced cancer. Eur J Cancer Clin Oncol 19: 1161–1165, 1983PubMedGoogle Scholar
  19. 19.
    Schipper H, Clinch J, McMurray A, Levitt M: Measuring the quality of life of cancer patients: The functional living index-cancer: Development and validation. J Clin Oncol 2: 472–483, 1984Google Scholar
  20. 20.
    Schag CC, Heinrich RL, Aadland R, Ganz PA: Assessing problems of cancer patients: Psychometric properties of the cancer inventory of problem situations. Health Psychology 9: 83–102, 1990PubMedGoogle Scholar
  21. 21.
    Hays RD, Sherbourne CD, Mazel RM: The RAND 36-item health survey 1.0. Health Economics 2: 217–227, 1993PubMedGoogle Scholar
  22. 22.
    Ware JE, Sherbourne CD: The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Medical Care 30: 473–483, 1992PubMedGoogle Scholar
  23. 23.
    Stewart AL, Ware JE (eds): Measuring function and well-being. The Medical Outcomes Study Approach. Duke University Press, Durham, 1992Google Scholar
  24. 24.
    McNair PM, Lorr M, Droppelman L: EITS manual for the profile of mood states. Educational and Industrial Testing Service, San Diego, CA, 1971/1981Google Scholar
  25. 25.
    Cassileth BR, Lusk EJ, Brown LL, Cross P: Psychosocial status of cancer patients and next of kin: Normative data from the profile of mood states. J Psychosoc Oncol 3: 99–105, 1985Google Scholar
  26. 26.
    Cella DF, Tross S, Orav EJ, Holland JC, Silberfarb PM, Ralfa S: Mood states of patients after the diagnosis of cancer. J Psychosoc Oncol 7: 45–54, 1989Google Scholar
  27. 27.
    Wolberg WH, Romsaas EP, Tanner MA, Malec JF: Psychosexual adaptation to breast cancer surgery. Cancer 63: 1645–1655, 1989PubMedGoogle Scholar
  28. 28.
    Polinsky ML: Functional status of long-term breast cancer survivors: Demonstrating chronicity. Health and Social Work 19: 165–173, 1994Google Scholar
  29. 29.
    Schover LR: The impact of breast cancer on sexuality, body image, and intimate relationships. CA-A Journal for Clinicians 41(2): 112–120, 1991Google Scholar
  30. 30.
    Kaplan HS: A neglected issue: The sexual side effects of current treatment for breast cancer. J Sex and Marital Therapy 18: 3–19, 1992Google Scholar
  31. 31.
    Fisher B, Constantino J, Redmond Cet al.: A randomized clinical trial evaluating tamoxifen in the treatment of patients with node-negative breast cancer who have estrogen-receptor-positive tumors. N Engl J Med 320: 479–484, 1989PubMedGoogle Scholar

Copyright information

© Kluwer Academic Publishers 1996

Authors and Affiliations

  • Patricia A. Ganz
    • 1
  • Anne Coscarelli
    • 1
  • Carol Fred
    • 1
  • Barbara Kahn
    • 1
  • Margaret L. Polinsky
    • 1
  • Laura Petersen
    • 1
  1. 1.Division of Cancer Prevention and Control Research, Jonsson Comprehensive Cancer CenterUniversity of California at Los AngelesLos AngelesUSA

Personalised recommendations