Breast Cancer Research and Treatment

, Volume 127, Issue 2, pp 541–547 | Cite as

Improvement in self-reported physical health predicts longer survival among women with a history of breast cancer

  • Ruth E. PattersonEmail author
  • Nazmus Saquib
  • Loki Natarajan
  • Cheryl L. Rock
  • Barbara A. Parker
  • Cynthia A. Thomson
  • John P. Pierce


Physical health-related quality of life scores have been, inconsistently, associated with breast cancer prognosis. This analysis examined whether change in physical health scores were related to outcomes in women with a history of breast cancer. 2343 breast cancer survivors in a randomized diet trial provided self-reported assessment of physical health-related quality of life at baseline and year 1. Based on change in physical health score, participants were grouped into subpopulations of decreased physical health, no/minimal changes, and increased physical health. Cox regression analysis assessed whether change in physical health (from baseline to year 1) predicted disease-free and overall survival; hazard ratio (HR) was the measure of association. There were 294 additional breast cancer events and 162 deaths among women followed for 7.3 years. Improvements in physical health were associated with younger age, lower BMI, being employed, not receiving tamoxifen, lower physical activity, and lower baseline physical and mental health. There was no association of change in physical health with additional breast cancer events or mortality among women diagnosed ≤2 years before study enrollment. However, among women who entered the study >2 years post-diagnosis, the HR for increased compared to decreased physical health was 0.38 (95% CI, 0.16–0.85) for all-cause mortality. These results appear to support testing an intervention to improve physical health in breast cancer patients among patients after the acute stage of treatment.


Breast cancer Physical health Survival Mortality 



The Women’s Healthy Eating and Living (WHEL) Study was initiated with the support of the Walton Family Foundation and continued with funding from NCI grant CA 69375. Some of the data were collected from General Clinical Research Centers, NIH Grants M01-RR00070, M01-RR00079, and M01-RR00827. WHEL Study Coordinating Center University of California, San Diego, Cancer Prevention and Control Program, Moores UCSD Cancer Center, San Diego, CA (John P. Pierce, PhD; Susan Faerber, BA; Barbara A. Parker, MD; Loki Natarajan, PhD, Cheryl L. Rock, PhD; Vicky A. Newman, MS; Shirley W. Flatt, MS; Sheila Kealey, MPH; Ruth E. Patterson, PhD, Linda Wasserman, MD; Wayne A. Bardwell, PhD; Lisa Madlensky, PhD.; Wael Al-Delaimy MD. WHEL Study Clinical Sites Center for Health Research-Portland, Portland, OR (Njeri Karanja, PhD, Mark U. Rarick, MD); Kaiser Permanente Northern California, Oakland, CA (Bette J. Caan, DrPH, Lou Fehrenbacher, MD); Stanford Prevention Research Center, Stanford University, CA (Marcia L. Stefanick, PhD, Robert Carlson, MD); University of Arizona, Tucson and Phoenix, AZ (Cynthia Thomson, PhD, James Warneke, MD); University of California, Davis, Davis, CA (Ellen B. Gold, PhD, Sidney Scudder, MD); University of California, San Diego, Moores UCSD Cancer Center, San Diego, CA (Kathryn A. Hollenbach, PhD, Vicky Jones, MD); University of Texas M.D. Anderson Cancer Center, Houston, TX (Lovell A. Jones, PhD, Richard Hajek, PhD, Richard Theriault, DO).

Conflict of interest



  1. 1.
    ACS (2006) Breast cancer facts and figures. American Cancer Society, Atlanta, GAGoogle Scholar
  2. 2.
    Gotay CC, Kawamoto CT, Bottomley A, Efficace F (2008) The prognostic significance of patient-reported outcomes in cancer clinical trials. J Clin Oncol 26:1355–1363PubMedCrossRefGoogle Scholar
  3. 3.
    Myint PK, Luben RN, Surtees PG, Wainwright NW, Welch AA, Bingham SA et al (2006) Relation between self-reported physical functional health and chronic disease mortality in men and women in the European Prospective Investigation into Cancer (EPIC-Norfolk): a prospective population study. Ann Epidemiol 16:492–500PubMedCrossRefGoogle Scholar
  4. 4.
    Kroenke CH, Kubzansky LD, Adler N, Kawachi I (2008) Prospective change in health-related quality of life and subsequent mortality among middle-aged and older women. Am J Public Health 98:2085–2091PubMedCrossRefGoogle Scholar
  5. 5.
    Efficace F, Therasse P, Piccart MJ, Coens C, van Steen K, Welnicka-Jaskiewicz M et al (2004) Health-related quality of life parameters as prognostic factors in a nonmetastatic breast cancer population: an international multicenter study. J Clin Oncol 22:3381–3388PubMedCrossRefGoogle Scholar
  6. 6.
    Goodwin JS, Zhang DD, Ostir GV (2004) Effect of depression on diagnosis, treatment, and survival of older women with breast cancer. J Am Geriatr Soc 52:106–111PubMedCrossRefGoogle Scholar
  7. 7.
    Kenne Sarenmalm E, Oden A, Joakim O, Gaston-Johansson F, Holmberg SB (2009) Changes in health-related quality of life may predict recurrent breast cancer. Eur J Oncol Nurs 13(5):323–329PubMedCrossRefGoogle Scholar
  8. 8.
    Coates AS, Hurny C, Peterson HF, Bernhard J, Castiglione-Gertsch M, Gelber RD et al (2000) Quality-of-life scores predict outcome in metastatic but not early breast cancer. International Breast Cancer Study Group. J Clin Oncol 18:3768–3774PubMedGoogle Scholar
  9. 9.
    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 94:39–49PubMedGoogle Scholar
  10. 10.
    Saquib N, Pierce JP, Saquib J, Flatt SW, Natarajan L, Bardwell WA et al (2010) Poor physical health predicts time to additional breast cancer events and mortality in breast cancer survivors. Psychooncology. doi: 10.1002/pon.1742
  11. 11.
    Pierce JP, Faerber S, Wright FA, Rock CL, Newman V, Flatt SW et al (2002) 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) Study. Control Clin Trials 23:728–756PubMedCrossRefGoogle Scholar
  12. 12.
    Pierce JP, Natarajan L, Caan BJ, Parker BA, Greenberg ER, Flatt SW et al (2007) Influence of a diet very high in vegetables, fruit, and fiber and low in fat on prognosis following treatment for breast cancer: the Women’s Healthy Eating and Living (WHEL) randomized trial. JAMA 298:289–298PubMedCrossRefGoogle Scholar
  13. 13.
    Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483PubMedCrossRefGoogle Scholar
  14. 14.
    Bjorner JB, Wallenstein GV, Martin MC, Lin P, Blaisdell-Gross B, Tak Piech C et al (2007) Interpreting score differences in the SF-36 Vitality scale: using clinical conditions and functional outcomes to define the minimally important difference. Curr Med Res Opin 23:731–739PubMedCrossRefGoogle Scholar
  15. 15.
    WHI (1998) WHI Personal Habits Questionnaire (cited November 25, 2009).
  16. 16.
    Johnson-Kozlow M, Rock CL, Gilpin EA, Hollenbach KA, Pierce JP (2007) Validation of the WHI brief physical activity questionnaire among women diagnosed with breast cancer. Am J Health Behav 31:193–202PubMedGoogle Scholar
  17. 17.
    Otero-Rodriguez A, Leon-Munoz LM, Balboa-Castillo T, Banegas JR, Rodriguez-Artalejo F, Guallar-Castillon P (2010) Change in health-related quality of life as a predictor of mortality in the older adults. Qual Life Res 19:15–23PubMedCrossRefGoogle Scholar
  18. 18.
    Browall M, Ahlberg K, Karlsson P, Danielson E, Persson LO, Gaston-Johansson F (2008) Health-related quality of life during adjuvant treatment for breast cancer among postmenopausal women. Eur J Oncol Nurs 12:180–189PubMedCrossRefGoogle Scholar
  19. 19.
    Bardwell WA, Major JM, Rock CL, Newman VA, Thomson CA, Chilton JA et al (2004) Health-related quality of life in women previously treated for early-stage breast cancer. Psychooncology 13:595–604PubMedCrossRefGoogle Scholar
  20. 20.
    Zebrack BJ, Yi J, Petersen L, Ganz PA (2008) The impact of cancer and quality of life for long-term survivors. Psychooncology 17:891–900PubMedCrossRefGoogle Scholar
  21. 21.
    Morey MC, Snyder DC, Sloane R, Cohen HJ, Peterson B, Hartman TJ et al (2009) Effects of home-based diet and exercise on functional outcomes among older, overweight long-term cancer survivors: RENEW: a randomized controlled trial. JAMA 301:1883–1891PubMedCrossRefGoogle Scholar
  22. 22.
    Kendall AR, Mahue-Giangreco M, Carpenter CL, Ganz PA, Bernstein L (2005) Influence of exercise activity on quality of life in long-term breast cancer survivors. Qual Life Res 14:361–371PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2010

Authors and Affiliations

  • Ruth E. Patterson
    • 1
    Email author
  • Nazmus Saquib
    • 1
  • Loki Natarajan
    • 1
  • Cheryl L. Rock
    • 1
  • Barbara A. Parker
    • 1
  • Cynthia A. Thomson
    • 2
  • John P. Pierce
    • 1
  1. 1.Cancer Prevention and Control Program, Moores UCSD Cancer CenterUniversity of CaliforniaSan DiegoUSA
  2. 2.Arizona Cancer Center, Department of Nutritional SciencesUniversity of ArizonaTucsonUSA

Personalised recommendations