Breast Cancer Research and Treatment

, Volume 123, Issue 2, pp 507–524

Quality of life among women recently diagnosed with invasive breast cancer: the Pathways Study

  • Marilyn L. Kwan
  • Isaac Joshua Ergas
  • Carol P. Somkin
  • Charles P. QuesenberryJr.
  • Alfred I. Neugut
  • Dawn L. Hershman
  • Jeanne Mandelblatt
  • Michael P. Pelayo
  • Allegra W. Timperi
  • Sunita Q. Miles
  • Lawrence H. Kushi


Few studies have assessed quality of life (QOL) of women diagnosed with breast cancer within the first few weeks of their initial diagnosis. We describe QOL among 950 women recently diagnosed with invasive breast cancer. Starting in January 2006, we invited women aged ≥21 years who were diagnosed with first primary invasive breast cancer within Kaiser Permanente Northern California (KPNC) to enroll in the Pathways Study, a prospective study of breast cancer survivorship. QOL was measured using the Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B), along with sociodemographic and social support information. Clinical characteristics were obtained from the KPNC cancer registry and electronic medical record. We used multivariable linear regression models to identify factors associated with QOL scores calculated from the FACT-B. The mean age ± SD of the sample was 59.6 years (±11.9 years), and the mean time ±SD from diagnosis until interview was 8.0 weeks (±3.2 weeks). Younger age at diagnosis was associated with lower scores in all QOL domains (P < 0.01), and later stage at diagnosis was associated with lower scores in all domains (P < 0.05) except for social well-being. Higher levels of social support were associated with higher QOL except for physical well-being (P < 0.05). These associations were stronger within 2 months of breast cancer diagnosis. Quality of life as influenced by a diagnosis of breast cancer is an important factor in cancer survivorship. Age, stage at diagnosis, and social support are key factors in this important variable.


Quality of life FACT-B Social support Breast cancer Survival Age Stage 


  1. 1.
    American Cancer Society (2008) Cancer facts and figures 2008. American Cancer Society Inc., AtlantaGoogle Scholar
  2. 2.
    American Cancer Society (2007–2008) Breast cancer facts and figures 2007–2008. American Cancer Society Inc., AtlantaGoogle Scholar
  3. 3.
    De Angelis R, Tavilla A, Verdecchia A et al (2009) Breast cancer survivors in the United States: geographic variability and time trends, 2005–2015. Cancer 115:1954–1966CrossRefPubMedGoogle Scholar
  4. 4.
    Ell K, Nishimoto R, Morvay T, Mantell J, Hamovitch M (1989) A longitudinal analysis of psychological adaptation among survivors of cancer. Cancer 63(2):406–413CrossRefPubMedGoogle Scholar
  5. 5.
    Northouse L (1989) A longitudinal study of the adjustment of patients and husbands to breast cancer. Oncol Nurs Forum 16(4):511–516PubMedGoogle Scholar
  6. 6.
    Levy SM, Haynes LT, Herberman RB, Lee J, McFeeley S, Kirkwood J (1992) Mastectomy versus breast conservation surgery: mental health effects at long-term follow-up. Health Psychol 11(6):349–354CrossRefPubMedGoogle Scholar
  7. 7.
    Vinokur AD, Threatt BA, Vinokur-Kaplan D, Satariano WA (1990) The process of recovery from breast cancer for younger and older patients. Changes during the first year. Cancer 65(5):1242–1254CrossRefPubMedGoogle Scholar
  8. 8.
    Mor V, Malin M, Allen S (1994) Age differences in the psychosocial problems encountered by breast cancer patients. J Natl Cancer Inst Monogr 16:191–197PubMedGoogle Scholar
  9. 9.
    Wenzel LB, Fairclough DL, Brady MJ et al (1999) Age-related differences in the quality of life of breast carcinoma patients after treatment. Cancer 86(9):1768–1774CrossRefPubMedGoogle Scholar
  10. 10.
    Arora NK, Gustafson DH, Hawkins RP et al (2001) Impact of surgery and chemotherapy on the quality of life of younger women with breast carcinoma: a prospective study. Cancer 92(5):1288–1298CrossRefPubMedGoogle Scholar
  11. 11.
    Ganz PA, Guadagnoli E, Landrum MB, Lash TL, Rakowski W, Silliman RA (2003) Breast cancer in older women: quality of life and psychosocial adjustment in the 15 months after diagnosis. J Clin Oncol 21(21):4027–4033CrossRefPubMedGoogle Scholar
  12. 12.
    Avis NE, Crawford S, Manuel j (2005) Quality of life among younger women with breast cancer. J Clin Oncol 23(15):3322–3330CrossRefPubMedGoogle Scholar
  13. 13.
    Bowen DJ, Alfano CM, McGregor BA et al (2007) Possible socioeconomic and ethnic disparities in quality of life in a cohort of breast cancer survivors. Breast Cancer Res Treat 106(1):85–95CrossRefPubMedGoogle Scholar
  14. 14.
    Janz NK, Mujahid MS, Hawley ST et al (2009) Racial/ethnic differences in quality of life after diagnosis of breast cancer. J Cancer Surviv 3(4):212–222CrossRefPubMedGoogle Scholar
  15. 15.
    Bloom JR, Stewart SL, Chang S, Banks PJ (2004) Then and now: quality of life of young breast cancer survivors. Psychooncology 13(3):147–160CrossRefPubMedGoogle Scholar
  16. 16.
    Ganz PA, Desmond KA, Leedham B, Rowland JH, Meyerowitz BE, Belin TR (2002) Quality of life in long-term, disease-free survivors of breast cancer: a follow-up study. J Natl Cancer Inst 94(1):39–49PubMedGoogle Scholar
  17. 17.
    Holzner B, Kemmler G, Kopp M et al (2001) Quality of life in breast cancer patients: not enough attention for long-term survivors? Psychosomatics 42(2):117–123CrossRefPubMedGoogle Scholar
  18. 18.
    Pandey M, Thomas BC, Ramdas K, Ratheesan K (2006) Early effect of surgery on quality of life in women with operable breast cancer. Jpn J Clin Oncol 36(7):468–472CrossRefPubMedGoogle Scholar
  19. 19.
    Goodwin JS, Hunt WC, Key CR, Samet JM (1987) The effect of marital status on stage, treatment, and survival of cancer patients. JAMA 258(21):3125–3130CrossRefPubMedGoogle Scholar
  20. 20.
    Spiegel D (1997) Psychosocial aspects of breast cancer treatment. Semin Oncol 24(1 Suppl 1):S1-36–S1-47Google Scholar
  21. 21.
    Sprehn GC, Chambers JE, Saykin AJ, Konski A, Johnstone PA (2009) Decreased cancer survival in individuals separated at time of diagnosis: critical period for cancer pathophysiology? Cancer 115(21):5108–5116CrossRefPubMedGoogle Scholar
  22. 22.
    Goodwin PJ, Leszcz M, Ennis M et al (2001) The effect of group psychosocial support on survival in metastatic breast cancer. N Engl J Med 345(24):1719–1726CrossRefPubMedGoogle Scholar
  23. 23.
    Falagas ME, Zarkadoulia EA, Ioannidou EN, Peppas G, Christodoulou C, Rafailidis PI (2007) The effect of psychosocial factors on breast cancer outcome: a systematic review. Breast Cancer Res 9(4):R44CrossRefPubMedGoogle Scholar
  24. 24.
    Goodwin PJ, Ennis M, Bordeleau LJ et al (2004) Health-related quality of life and psychosocial status in breast cancer prognosis: analysis of multiple variables. J Clin Oncol 22(20):4184–4192CrossRefPubMedGoogle Scholar
  25. 25.
    Phillips KA, Osborne RH, Giles GG et al (2008) Psychosocial factors and survival of young women with breast cancer: a population-based prospective cohort study. J Clin Oncol 26(28):4666–4671CrossRefPubMedGoogle Scholar
  26. 26.
    Kwan ML, Ambrosone CB, Lee MM et al (2008) The Pathways Study: a prospective study of breast cancer survivor ship within Kaiser Permanente Northern California. Cancer Causes Control 19(10):1065–1076CrossRefPubMedGoogle Scholar
  27. 27.
    Brady MJ, Cella DF, Mo F et al (1997) Reliability and validity of the Functional Assessment of Cancer Therapy-Breast quality-of-life instrument. J Clin Oncol 15(3):974–986PubMedGoogle Scholar
  28. 28.
    Cella DF, Tulsky DS, Gray G et al (1993) The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol 11(3):570–579PubMedGoogle Scholar
  29. 29.
    Sherbourne CD, Stewart AL (1991) The MOS social support survey. Soc Sci Med 32(6):705–714CrossRefPubMedGoogle Scholar
  30. 30.
    Oehrli MD, Quesenberry CP, Leyden W (2006) Annual report on trends, incidence, and outcomes. Kaiser Permanente, Northern California Cancer RegistryGoogle Scholar
  31. 31.
  32. 32.
  33. 33.
    Selvin S (1995) Practical biostatistical methods. Duxbury Press, BelmontGoogle Scholar
  34. 34.
    Baker F, Denniston M, Smith T, West MM (2005) Adult cancer survivors: how are they faring? Cancer 104(11 Suppl):2565–2576CrossRefPubMedGoogle Scholar
  35. 35.
    Costanzo ES, Lutgendorf SK, Mattes ML et al (2007) Adjusting to life after treatment: distress and quality of life following treatment for breast cancer. Br J Cancer 97(12):1625–1631CrossRefPubMedGoogle Scholar
  36. 36.
    Ashing-Giwa KT, Padilla GV, Bohorquez DE, Tejero JS, Garcia M (2006) Understanding the breast cancer experience of Latina women. J Psychosoc Oncol 24(3):19–52CrossRefPubMedGoogle Scholar
  37. 37.
    Janz NK, Mujahid MS, Hawley ST, Griggs JJ, Hamilton AS, Katz SJ (2008) Racial/ethnic differences in adequacy of information and support for women with breast cancer. Cancer 113(5):1058–1067CrossRefPubMedGoogle Scholar
  38. 38.
    Kim Y, Kashy DA, Wellisch DK, Spillers RL, Kaw CK, Smith TG (2008) Quality of life of couples dealing with cancer: dyadic and individual adjustment among breast and prostate cancer survivors and their spousal caregivers. Ann Behav Med 35(2):230–238CrossRefPubMedGoogle Scholar
  39. 39.
    Yoon J, Malin JL, Tao ML et al (2008) Symptoms after breast cancer treatment: are they influenced by patient characteristics? Breast Cancer Res Treat 108(2):153–165CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2010

Authors and Affiliations

  • Marilyn L. Kwan
    • 1
  • Isaac Joshua Ergas
    • 1
  • Carol P. Somkin
    • 1
  • Charles P. QuesenberryJr.
    • 1
  • Alfred I. Neugut
    • 2
    • 3
  • Dawn L. Hershman
    • 2
    • 3
  • Jeanne Mandelblatt
    • 4
  • Michael P. Pelayo
    • 1
    • 5
  • Allegra W. Timperi
    • 1
  • Sunita Q. Miles
    • 1
  • Lawrence H. Kushi
    • 1
  1. 1.Division of ResearchKaiser PermanenteOaklandUSA
  2. 2.Department of EpidemiologyMailman School of Public Health, Columbia UniversityNew YorkUSA
  3. 3.Department of Medicine and Herbert Irving Comprehensive Cancer Center, College of Physicians and SurgeonsColumbia UniversityNew YorkUSA
  4. 4.Department of Oncology and MedicineGeorgetown University Medical Center, Lombardi Comprehensive Cancer CenterWashingtonUSA
  5. 5.Helen Diller Family Comprehensive Cancer CenterUniversity of CaliforniaSan FranciscoUSA

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