Breast Cancer Research and Treatment

, Volume 99, Issue 3, pp 341–350 | Cite as

Health-related quality of life in breast cancer: A cross-cultural survey of German, Japanese, and South Korean patients

  • Eun-Jung Shim
  • Anja Mehnert
  • Atsuko Koyama
  • Seong-Jin Cho
  • Hiroki Inui
  • Nam-Sun Paik
  • Uwe Koch
Epidemiology

Abstract

Purpose

The aim of this study was to evaluate health-related quality of life (HRQOL) in breast cancer patients across countries, and to cross-culturally examine the impact of psychosocial factors on HRQOL.

Patients and methods

A total of 413 women with breast cancer from Germany (n=195), Japan (n=112), and Korea (n=106) completed a survey assessing HRQOL and HRQOL-related factors. HRQOL was measured using the Short-Form Health Survey (SF-8). Measures of psychological distress (Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised), coping (Dealing with Illness Inventory-German Revised), and social support (Illness-Specific Social Support Scale-German Revised) were included.

Results

The effect of the factor country on physical QOL was seen to be significant, but small (P=0.049, ES=0.018). The scales of General Health (P=0.023), Vitality (P=0.004), and Role Emotional (P=0.003) differed across countries, with the South Korean patients having lower scores compared to the German and Japanese patients. The nature of the impact of psychosocial factors on HRQOL did not differ greatly across countries except with regard to avoidance, however, the degree to which these factors influence HRQOL did differ greatly. Overall, depression, depressive coping, and problematic support showed a strong detrimental effect on the HRQOL of breast cancer patients.

Conclusions

Results from this study suggest that strategies which target an improvement of HRQOL in cancer patients should also consider the patients’ cultural and healthcare system contexts. Interventions are needed to improve detrimental psychosocial factors.

Keywords

Health-related quality of life Breast cancer Culture Coping Social support Psychological distress 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Parkin DM, Bray F, Ferlay J, Pisani P (2005) Global cancer statistics 2002. CA Cancer J Clin 55:74–108PubMedGoogle Scholar
  2. 2.
    Arndt V, Merx H, Stegmaier C, Ziegler H, Brenner H (2005) Persistence of restrictions in quality of life from the first to the third year after diagnosis in women with breast cancer. J Clin Oncol 23:4945–4953PubMedCrossRefGoogle Scholar
  3. 3.
    Avis NE, Crawford S, Manusel J (2005) Quality of life among younger women with breast cancer. J Clin Oncol 23:3322–3330PubMedCrossRefGoogle Scholar
  4. 4.
    Ganz PA, Kwan L, Stanton AL, et al (2004) Quality of life at the end of primary treatment of breast cancer: first results from the moving beyond cancer randomized trials. J Natl Cancer Inst 96:376–387PubMedGoogle Scholar
  5. 5.
    Goodwin PJ, Black JT, Bordeleau LJ, Ganz PA (2003) Health-related quality-of-life measurement in randomized clinical trials in breast cancer-taking stock. J Natl Cancer Inst 95:263–281PubMedCrossRefGoogle Scholar
  6. 6.
    Northouse LL, Mood D, Kershaw T, et al (2002) Quality of life of women with recurrent breast cancer and their family members. J Clin Oncol 20:4050–4064PubMedCrossRefGoogle Scholar
  7. 7.
    Ashing-Giwa KT, Padilla G, Tejero J, et al (2004) Understanding the breast cancer experience of women: a qualitative study of African American, Asian American, Latina and Caucasian cancer survivors. Psychooncology 13:408–428PubMedCrossRefGoogle Scholar
  8. 8.
    Gotay CC, Holup JL, Pagano I (2002) Ethnic differences in quality of life among early breast and prostate cancer survivors. Psychooncology 11:103–113PubMedCrossRefGoogle Scholar
  9. 9.
    Mandelblatt J, Armetta C, Yabroff R, Liang W (2004) Descriptive review of the literature on breast cancer outcomes: 1990 through 2000. J Natl Cancer Monogra 33:8–44CrossRefGoogle Scholar
  10. 10.
    Meyerowtiz B, Richardson J, Hudson S, Leedham B (1998) Ethnicity and cancer outcomes: behavioral and psychosocial considerations. Psychol Bull 123:47–70CrossRefGoogle Scholar
  11. 11.
    Andritsch E, Goldzweig G, Samonigg H, et al (2004) Changes in psychological distress of women in long-term remission from breast cancer in two different geographical settings: a randomized study. Support Care Cancer 12:10–18PubMedCrossRefGoogle Scholar
  12. 12.
    Forjaz MJ, Guarnaccia CA (2001) A comparison of Portuguese and American patients with hematological malignacies: a cross-cultural survey of health-related quality of life. Psychooncology 10:251–258PubMedCrossRefGoogle Scholar
  13. 13.
    Ashing-Giwa KT (2005) The contextual model of HRQoL: a paradigm for expanding the HRQoL framework. Qual Life Res 14:297–307PubMedCrossRefGoogle Scholar
  14. 14.
    Johnson KRS (1998) Ethnocultural influences in cancer. J Clin Psych Med Set 5:357–364CrossRefGoogle Scholar
  15. 15.
    Culver JL, Arena PL, Antoni MH, Carver CS (2002) Coping and distress among women under treatment for early stage breast cancer: comparing African Americans, Hispanics and non-Hispanic Whites. Psychooncology 11:495–504PubMedCrossRefGoogle Scholar
  16. 16.
    Ware JE, Kosinski M, Dewey JE, Gandek B (1999) How to score and interpret single-item health status measures: a manual for users of the SF-8 TM Health Survey. QualityMetric Inc., Lincoln, RIGoogle Scholar
  17. 17.
    Zigmond AS, Snaith RP (1983) The hospital and depression scale. Acta Psychiatr Scand 67: 361–370PubMedCrossRefGoogle Scholar
  18. 18.
    Ibbotson T, Maguire P, Selby P, Priestman T, Wallace L (1994) Screening for anxiety and depression in cancer patients: the effects of disease and treatment. Eur J Cancer 30A:37–40PubMedCrossRefGoogle Scholar
  19. 19.
    Moorey S, Greer S, Watson M, et al (1991) The factor structure and factor stability of the Hospital Anxiety and Depression Scale in patients with cancer. Br J Psychiatry 158: 255–259PubMedGoogle Scholar
  20. 20.
    Osbourne RH, Elsworth GR, Sprangers MA, Oort FJ, Hopper JL (2004) The value of the Hospital Anxiety and Depression Scale (HADS) for comparing women with early onset breast cancer with population-based reference women. Qual Life Res 13:191–206CrossRefGoogle Scholar
  21. 21.
    Weiss DS, Marmar CR (1997) The impact of event scale – revised. In: Wilson JP, Keane TM (eds) Assessing psychological trauma and PTSD. Guilford Press, New York, pp 399–411Google Scholar
  22. 22.
    Horowitz M, Wilner N, Alvarez W (1979) Impact of event scale: a measure of subjective stress. Psychosom Med 41:209–218PubMedGoogle Scholar
  23. 23.
    Zaun S (2002) Psychometrische ÜberprÜfung und Weiterentwicklung des dealing with illness inventory – revised an einer Stichprobe aus einer onkologischen Rehabilitationsklinik. Dissertation, Universitätsklinikum Hamburg-Eppendorf, HamburgGoogle Scholar
  24. 24.
    Revenson TA, Schiaffino KM, Majerovitz SD, Gibofsky A (1991) Social support as a double-edged sword: the relation of positive and problematic support to depression among rheumatoid arthritis patients. Soc Sci Med 33:807–813PubMedCrossRefGoogle Scholar
  25. 25.
    Ramm GC, Hasenbring M (2003) Die deutsche Adaptation der Illness-Specific Social Support Scale und ihre teststatistische ÜberprÜfung beim Einsatz an Patienten vor und nach -Knochenmarktranplantation. Z Med Psychol 12:29–38Google Scholar
  26. 26.
    Lehto US, Ojanen M, Kellokumpu-Lehtinen P (2005) Predictors of quality of life in newly diagnosed melanoma and breast cancer patients. Ann Oncol 16:805–816PubMedCrossRefGoogle Scholar
  27. 27.
    Amir M, Ramati A (2002) Post-traumatic symptoms, emotional distress and quality of life in long-term survivors of breast cancer: a preliminary research. J Anxiety Dis 16:191–206CrossRefGoogle Scholar
  28. 28.
    Cordova MJ, Andrykowski MA, Kenady DE, McGrath PC, Sloan DA, Redd WH (1995) Frequency and correlates of posttraumatic-stress-disorder-like symptoms after treatment for breast cancer. J Consult Clin Psychol 63:981–986PubMedCrossRefGoogle Scholar
  29. 29.
    Jacobsen PB, Widows MR, Hann DM, Andrykowsky MA, Kronish LE, Fields KK (1998) Posttraumatic stress disorder symptoms after bone marrow transplantation for breast cancer. Psychosom Med 60:366–371PubMedGoogle Scholar
  30. 30.
    Stark D, Kiely A, Smith A, Velikova G, House A, Selby P (2002) Anxiety disorders in cancer patients: their nature, associations, and relation to quality of life. J Clin Oncol 20:3137–3148PubMedCrossRefGoogle Scholar
  31. 31.
    Skarstein J, Aass N, Fossa SD, Skovlund E, Dahl AA (2000) Anxiety and depression in cancer patients: relation between the Hospital Anxiety and Depression Scale and the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire. J Psychosom Res 49:27–34PubMedCrossRefGoogle Scholar
  32. 32.
    Grassi L, Indelli M, Marzola M, et al (1996) Depressive symptoms and quality of life in home-care-assisted cancer patients. J Pain Symptom Manage 12:301–07CrossRefGoogle Scholar
  33. 33.
    Waza K, Graham AV, Zyzanski SJ, Inoue K (1999) Comparison of symptoms in Japanese and American depressed primary care patients. Fam Pract 16:528–533PubMedCrossRefGoogle Scholar
  34. 34.
    Elliot A, Chirkov VI, Kim Y, Sheldon KM (2001) A cross-cultural analysis of avoidance (relative to approach) personal goals. Psychol Sci 12:505–510PubMedCrossRefGoogle Scholar
  35. 35.
    Faller H, Heinrich B, Drings P, Hermann L (1999) Coping, distress, and survival among patients with lung cancer. Arch Gen Psychiatry 56:756–761PubMedCrossRefGoogle Scholar
  36. 36.
    Koopman C, Hermanson K, Diamond S, Angell K, Spiegel D (1998) Social support, life stress, pain and emotional adjustment to advanced breast cancer. Psychooncology 7:101–111PubMedCrossRefGoogle Scholar
  37. 37.
    Manne S, Glassman M (2000) Perceived control, coping efficacy, and avoidance coping as mediators between spouses’ unsupportive behaviors and cancer patients’ psychological distress. Health Psychol 19:155–164PubMedCrossRefGoogle Scholar
  38. 38.
    Makabe R, Hull MM (2000) Components of social support among Japanese women with breast cancer. Oncol Nurs Forum 27:1381–1390PubMedGoogle Scholar
  39. 39.
    Wellisch D, Kagawa-Singer M, Reid SL, Lin YJ, Nishikawa-Lee S, Wellisch M (1999) An exploratory study of social support: a cross-cultural comparison of Chinese-, Japanese-, and Anglo-American breast cancer patients. Psychooncology 8:207–219PubMedCrossRefGoogle Scholar
  40. 40.
    Diener E, Oishi S, Lucas RE (2003) Personality, culture, and subjective well-being: emotional and cognitive evaluations of life. Ann Rev Psychol 54:403–425CrossRefGoogle Scholar
  41. 41.
    Organisation for Economic Co-operation and Development (OECD) (2005) OECD health data 2005. Available from URL: http://www.oecd.org/dataoecd/16/6/34970073.pdf [accessed July 28, 2005]Google Scholar
  42. 42.
    Emanuel EJ, Fairclough DL, Slutsman J, Emanuel LL (2000) Understanding economic and other burdens of terminal illness: the experience of patients and their caregivers. Ann Intern Med 132:451–459PubMedGoogle Scholar
  43. 43.
    Yun YH, Rhee YS, Kang IO, et al (2005) Economic burdens and quality of family caregivers of cancer patients. Oncology 68:107–114PubMedCrossRefGoogle Scholar
  44. 44.
    Ward E, Jemal A, Cokkinides V, et al (2004) Cancer disparities by race/ethnicity and socioeconomic status. CA Cancer J Clin 54:78–93PubMedCrossRefGoogle Scholar
  45. 45.
    Kagawa-Singer M, Wellisch D, Durvasula R (1997) Impact of breast cancer patient’s on Asian American and Anglo American women. Cult Med Psychiatry 21:449–480PubMedCrossRefGoogle Scholar
  46. 46.
    Goel MS, Burns RB, Phillips RS, Davis RB, Ngo-Metzger Q, McCarthy EP (2005) Trends in breast conserving surgery among Asian Americans and Pacific Islanders, 1992–2000. J Gen Intern Med 20:604–611PubMedCrossRefGoogle Scholar
  47. 47.
    Janz NK, Mujahid M, Lantz PM, et al (2005) Population-based study of the relationship of treatment and sociodemographics on quality of life for early stage breast cancer. Qual Life Res 14:1467–1479PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2006

Authors and Affiliations

  • Eun-Jung Shim
    • 1
  • Anja Mehnert
    • 2
  • Atsuko Koyama
    • 3
  • Seong-Jin Cho
    • 4
  • Hiroki Inui
    • 5
  • Nam-Sun Paik
    • 6
  • Uwe Koch
    • 7
  1. 1.Institute of Medical PsychologyUniversity Medical Center Hemburg-EppendorfHamburgGermany
  2. 2.Institute of Medical PsychologyUniversity Medical Center Hemburg-EppendorfHamburgGermany
  3. 3.Department of Psychosomotic Medicine, Sakai HospitalKinki University School of MedicineOsakaJapan
  4. 4.Department of NeuropsychiatryKorea Cancer Center HospitalSeoutSouth Korea
  5. 5.Department of SurgeryKinki university Hospital, Kinki University School of MedicineOsakaJapan
  6. 6.Department of SurgeryKorea Cancer Center HospitalSeoutSouth Korea
  7. 7.Institute of Medical PsychologyUniversity Medical Center Hemburg-EppendorfHamburgGermany

Personalised recommendations