Breast Cancer Research and Treatment

, Volume 92, Issue 1, pp 25–33 | Cite as

The impact of a second breast cancer diagnosis on health related quality of life

  • Andrea A. Thornton
  • Lisa Madlensky
  • Shirley W. Flatt
  • Robert M. Kaplan
  • John  P. Pierce
  • for the Women’s Healthy Eating and Living (WHEL) Study Group


A growing of research documents the negative impact of recurrent breast cancer on quality of life (QOL), however few prospective investigations are available that compare QOL outcomes across different types of second cancer events (e.g., local/regional recurrence (LR) versus distant/metastatic recurrence (DR) versus a new primary breast cancer (NP)). In addition, although participant attrition is a major issue in this group of cancer patients, the potential impact of attrition or response bias on QOL outcomes is not typically examined. To address these issues, we prospectively examined QOL data obtained from a sample of women (n=140) participating in the Women’s Healthy Eating and Living (WHEL) Study who experienced a second cancer event (LR, DR or NP). Women in our study reported significant worsening in most areas of QOL, except for emotional wellbeing, from pre- to post-second cancer event. Although the patterns of change to QOL differed slightly within each category (LR versus DR versus NP), participants were more similar than different in their QOL ratings. However, the perceived health status of women with DR was significantly lower than women with LR or NP. We also identify important sources of response bias that should be considered when interpreting findings. Specifically, women diagnosed with DR (a) were more likely to decline to complete the post-recurrence QOL questionnaire (27% refusal rate versus 14% LR and 13% NP), and (b) had higher death rates (28% death rate versus 4% LR and 6% NP) after agreeing to but before completing the post-second diagnosis QOL questionnaire.


breast cancer new primary psychosocial adjustment quality of life recurrence response bias 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    American Cancer Society: Cancer Facts and Figures – 2004. Atlanta, Author, 2004Google Scholar
  2. 2.
    Gotay, CC 1984The experience of cancer during early and advanced stages: the views of patients and their matesSoc Sci Med18605613CrossRefPubMedGoogle Scholar
  3. 3.
    Spencer, SM, Lehman, JM, Wynings, C, Arena, P, Carver, CS, Antoni, MH, Derhagopian, RP, Ironson, G, Love, N 1999Concerns about breast cancer and relations to psychosocial well-being in a multiethnic sample of early-stage patientsHealth Psychol18159168PubMedGoogle Scholar
  4. 4.
    Santiago, RJ, Wu, L, Harris, E, Fox, K, Schultz, D, Glick, J, Solin, LJ 2004Fifteen-year results of breast-conserving surgery and definitive irradiation for Stage I and II breast carcinoma: the University of Pennsylvania experienceInt J Radiat Oncol Biol Phys123332340Google Scholar
  5. 5.
    Saphner, T, Tormey, DC, Gray, R 1996Annual hazard rates of recurrence for breast cancer after primary therapyJ Clin Oncol1427382746PubMedGoogle Scholar
  6. 6.
    Voogd, AC, Nielsen, M, Peterse, JL, Blichert-Toft, M, Bartelink, H, Overgaard, M, Tienhoven, G, Andersen, KW, Sylvester, RJ, Dongen, JA 2001Danish Breast Cancer Cooperative Group. Breast Cancer Cooperative Group of the European Organisation for Research and Treatment of Cancer: differences in risk factors for local and distant recurrence after breast conserving therapy or masectomy for Stage I and II breast cancer: pooled results of two large European randomized trialsJ Clin Oncol1916881697PubMedGoogle Scholar
  7. 7.
    Camilleri-Brennan, J, Steele, RJC 2001The impact of recurrent rectal cancer on quality of lifeEur J Cancer27349353Google Scholar
  8. 8.
    Frost, MH, Suman, VJ, Rummans, TA, Dose, AM, Taylor, M, Novotny, P, Johnson, R, Evans, RE 2000Physical, psychological and social well-being of women with breast cancer: the influence of disease phasePsycho-Oncology9221231CrossRefPubMedGoogle Scholar
  9. 9.
    Winer, EP, Lindley, C, Hardee, M, Sawyer, WT, Brunatti, C, Borstelmann, NA, Peters, W 1999Quality of life in patients surviving at least 12 months following high dose chemotherapy with autologous bone marrow supportPsycho-Oncology8167176CrossRefPubMedGoogle Scholar
  10. 10.
    Bull, AA, Meyerowitz, BE, Hart, S, Mosconi, P, Apolone, G, Liberati, A 1999Quality of life in women with recurrent breast cancerBreast Cancer Res Treat544757CrossRefPubMedGoogle Scholar
  11. 11.
    Hurny, C, Bernhard, J, Coates, AS, Castiglione-Gertsch, M, Peterson, HF, Gelber, RD, Forbes, JF, Rudenstam, CM, Simoncini, E, Crivellari, D, Goldhirsch, A, Senn, HJ 1996for the International Breast Cancer Study Group: Impact of adjuvant therapy on quality of life in women with node-positive breast cancerLancet34712791284PubMedGoogle Scholar
  12. 12.
    Oh, S, Heflin, L, Meyerowitz, BE, Desmond, KA, Rowland, JH, Ganz, PA 2004Quality of life of breast cancer survivors after a recurrence: a follow-up studyBreast Cancer Res Treat874557CrossRefPubMedGoogle Scholar
  13. 13.
    Ganz, PA, Desmond, KA, Leedham, B, Rowland, JH, Meyerowitz, BE, Belin, TR 2002Quality of life in long-term, disease-free survivors of breast cancer: a follow-up studyJ Natl Cancer Inst943949PubMedGoogle Scholar
  14. 14.
    Pierce, JP, Faerber, S, Wright, FA, Rock, CL, Newman, V, Flatt, SW, Kealey, S, Jones, VE, Caan, BJ, Gold, EB, Haan, M, Hollenbach, KA, Jones, L, Marshall, JR, Ritenbaugh, C, Stefanick, ML, Thomson, C, Wasserman, L, Natarajan, L, Thomas, RG, Gilpin, EA 2002Women’s Healthy Eating and Living (WHEL) study group: a randomized trial of the effect of a plant-based dietary pattern on additional breast cancer events and survival: the Women’s Healthy Eating and Living (WHEL) StudyControl Clin Trials23728756PubMedGoogle Scholar
  15. 15.
    American Joint Committee on Cancer: Manual for Staging of Cancer, 4th ed. J.B. Lippincott Company, Philadelphia, PA, 1992Google Scholar
  16. 16.
    Hays, R, Sherbourne, C, Mazel, R 1993The Rand 36-Item Health Survey 1.0Health Economics2217227PubMedGoogle Scholar
  17. 17.
    Ware, JE, Snow, KK, Kosinski, M, Gandek, B 2000SF-36 Health Survey: Manual and Interpretation GuideLincoln, RIQualityMetric IncorporatedGoogle Scholar
  18. 18.
    McHorney, CA, Kosinksi, M, Ware, JE 1994Comparisons of the costs and quality of norms for the SF-36 Health Survey collected by mail versus telephone interview: results from a national surveyMed Care32551567PubMedGoogle Scholar
  19. 19.
    Bernhard, J, Cella, DF, Coates, AS, Fallowfield, L, Ganz, PA, Moinpour, CM, Mosconi, P, Osoba, D, Simes, J, Hurny, C 1998Missing quality of life data in cancer clinical trials: serious problems and challengesStat Med17517532CrossRefPubMedGoogle Scholar
  20. 20.
    Sales, AE, Plomondon, ME, Magid, DJ, Spertus, JA, Rumsfeld, JS 2004Assessing response bias from missing quality of life data: the Heckman methodHealth Qual Life Outcome249CrossRefGoogle Scholar
  21. 21.
    Curran, D, Molenberghs, G, Fayers, PM, Machin, D 1998Incomplete quality of life data in randomized trials: missing formsStat Med17697709CrossRefPubMedGoogle Scholar
  22. 22.
    Simes, RJ, Greatorex, V, Gebski, VJ 1998Practical approaches to minimize problems with missing quality of life dataStat Med17725737CrossRefPubMedGoogle Scholar
  23. 23.
    Moinpour, CM, Sawyers Triplett, J, McKnight, B 2000Challenges posed by non-random missing quality of life data in an advanced-stage colorectal cancer clinical trialPsycho-oncology9340354CrossRefPubMedGoogle Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  • Andrea A. Thornton
    • 1
  • Lisa Madlensky
    • 2
  • Shirley W. Flatt
    • 2
  • Robert M. Kaplan
    • 3
  • John  P. Pierce
    • 2
  • for the Women’s Healthy Eating and Living (WHEL) Study Group
  1. 1.Department of Supportive Care, Pain, and Palliative MedicineCity of Hope National Medical CenterDuarteUSA
  2. 2.Cancer Prevention and Control Program, Cancer CenterUniversity of CaliforniaSan DiegoUSA
  3. 3.Department of Health Services, UCLA School of Public HealthUniversity of CaliforniaUSA

Personalised recommendations