Breast Cancer Research and Treatment

, Volume 173, Issue 3, pp 709–717 | Cite as

Impact of pre-diagnosis depressive symptoms and health-related quality of life on treatment choice for ductal carcinoma in situ and stage I breast cancer in older women

  • Daniela L. Buscariollo
  • Angel M. Cronin
  • Nancy A. Borstelmann
  • Rinaa S. PungliaEmail author



To examine whether pre-diagnosis patient-reported health-related quality of life (HRQOL) and depressive symptoms are associated with local treatment for older women with ductal carcinoma in situ (DCIS) and stage I breast cancer (BC).


Using the SEER-MHOS dataset, we identified women ≥ 65 years old with DCIS or stage I BC diagnosed 1998–2011 who completed surveys ≤ 24 months before diagnosis. Depressive symptoms were measured by major depressive disorder (MDD) risk and HRQOL was measured by Physical and Mental Component Summary scores (PCS and MCS, respectively) of the SF-36/VR-12. Associations with treatment choice (breast-conserving surgery [BCS] and radiation therapy [RT], BCS alone, mastectomy) were assessed with multivariable multinomial logistic regression, controlling for patient characteristics.


We identified 425 women with DCIS and 982 with stage I BC. Overall, 20.4% endorsed depressive symptoms placing them at risk for MDD pre-diagnosis; mean MCS and PCS scores were 52.3 (SD = 10.1) and 40.5 (SD = 11.5), respectively. Among women with DCIS, those at risk for MDD were more likely to receive BCS (adjusted odds ratio [AOR] 2.04, 95% CI 1.04–4.00, p = 0.04) or mastectomy (AOR 1.88, 95% CI 0.91–3.86, p = 0.09) compared to BCS + RT. For DCIS, MCS score was not associated with treatment; higher PCS score was associated with decreased likelihood of receiving mastectomy versus BCS + RT (AOR 0.71 per 10-point increase, 95% CI 0.54–0.95, p = 0.02). For BC, none of the measures were significantly associated with treatment.


Older women at risk for MDD before DCIS diagnosis were less likely to receive RT after BCS, compared to BCS alone or mastectomy.


Quality of life Depression DCIS Breast cancer Local therapy 



No external funding was received for this work. The views expressed in this article are those of the authors.

Compliance with ethical standards

Conflict of interest

None of the authors have any conflict of interest related to the subject matter presented.

Ethical approval

This survey study was approved by the Dana-Farber/Harvard Cancer Center (DFCI/HCC) IRB (Protocol #12–420). This article does not contain any studies with animals.

Supplementary material

10549_2018_5006_MOESM1_ESM.doc (176 kb)
Supplementary material 1 (DOC 175 KB)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Daniela L. Buscariollo
    • 1
  • Angel M. Cronin
    • 2
  • Nancy A. Borstelmann
    • 3
  • Rinaa S. Punglia
    • 1
    Email author
  1. 1.Department of Radiation OncologyBrigham and Women’s Hospital and Dana-Farber Cancer Institute, Harvard Medical SchoolBostonUSA
  2. 2.Center for Outcomes and Policy ResearchDana-Farber Cancer Institute, Harvard Medical SchoolBostonUSA
  3. 3.Department of Psychosocial Oncology and Palliative CareDana-Farber Cancer InstituteBostonUSA

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