Quality of Life Research

, Volume 14, Issue 6, pp 1467–1479 | Cite as

Population-based study of the relationship of treatment and sociodemographics on quality of life for early stage breast cancer

  • Nancy K. Janz
  • Mahasin Mujahid
  • Paula M. Lantz
  • Angela Fagerlin
  • Barbara Salem
  • Monica Morrow
  • Dennis Deapen
  • Steven J. Katz


Objective: To examine the relationship between cancer stage, surgical treatment and chemotherapy on quality of life (QOL) after breast cancer and determine if sociodemographic characteristics modify the observed relationships. Methods: A population-based sample of women with Stages 0–II breast cancer in the United States (N=1357) completed surveys including the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), and the Breast Cancer-Specific Quality of Life Questionnaire (QLQ BR-23). Regression models calculated mean QOL scores across primary surgical treatment and chemotherapy. Clinically significant differences in QOL were defined as 10 point difference (out of 100) between groups. Results: Meaningful differences in QOL by surgical treatment were limited to body image with women receiving mastectomy with reconstruction reporting lower scores than women receiving breast conserving surgery (p < 0.001). Chemotherapy lowered QOL scores overall across four QOL dimensions (p values < 0.001), with a disproportionately greater impact on those with lower levels of education. Younger women reported lower QOL scores for seven of nine QOL dimensions (p values < 0.001). Conclusions: Women should be reassured that few QOL differences exist based on surgical treatment, however, clinicians should recognize that the impact of treatment on QOL does vary by a woman’s age and educational level.


Breast cancer Quality of life Psychosocial 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Fisher, B, Anderson, S, Bryant, J, Margolese, RG,  et al. 2002Twenty year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancerNEJM34712331241CrossRefPubMedGoogle Scholar
  2. 2.
    Morrow, M, Bucci, C, Rademaker, A. 1998Medical contraindications are not a major factor in the underutilization of breast conserving therapyJ Am Coll Surg186269274CrossRefPubMedGoogle Scholar
  3. 3.
    Amichetti, M, Caffo, O, Arcicasa, M,  et al. 1999Quality of life in patients with ductal carcinoma in situ of the breast treated with conservative surgery and postoperative irradiationBreast Cancer Res Treat54109115CrossRefPubMedGoogle Scholar
  4. 4.
    Rakovitch, E, Franssen, E, Kim, J,  et al. 2003A comparison of risk perception and psychological morbidity in women with ductal carcinoma in situ and early invasive breast cancerBreast Cancer Res Treat77285293CrossRefPubMedGoogle Scholar
  5. 5.
    Shimozuma, K, Ganz, PA, Petersen, L, Hirji, K. 1999Quality of life in the first year after breast cancer surgery: Rehabilitation needs and patterns of recoveryBreast Cancer Res Treat564557CrossRefPubMedGoogle Scholar
  6. 6.
    Wapnir, IL, Cody, RP, Greco, , RS.,  1999Subtle differences in quality of life after breast cancer surgeryAnn Surg Oncol6359366PubMedGoogle Scholar
  7. 7.
    Schover, LR, Yetman, RJ, Tuason, LJ,  et al. 1995Partial mastectomy and breast reconstructionA comparison of their effects on psychosocial adjustment, body image, and sexuality. Cancer755464Google Scholar
  8. 8.
    Haes, JC, Curran, D, Aaronson, NK, Fentiman, IS. 2003Quality of life in breast cancer patients aged over 70 years, participating in the EORTC 10850 randomized clinical trialEur J Cancer39945951PubMedGoogle Scholar
  9. 9.
    Ganz, PA, Kwan, L, Stanton, AL,  et al. 2004Quality of Life at the end of primary treatment of breast cancer: First results from the Moving Beyond Cancer randomized trialJ Natl Cancer Inst96376387PubMedGoogle Scholar
  10. 10.
    Janni, W, Rjosk, D, Dimpfl, TH,  et al. 2001Quality of life influenced by primary surgical treatment for stage I–III breast cancer – Long term follow-up of a matched-pair analysisAnn Surg Oncol8542548PubMedGoogle Scholar
  11. 11.
    Moyer, A. 1997Psychosocial outcomes of breast-conserving surgery versus mastectomy: A meta-analytic reviewHealth Psychol16284298PubMedGoogle Scholar
  12. 12.
    Kiebert, GM, Haes, JC, Velde, CJ. 1991The impact of breast-conserving treatment and mastectomy on the quality of life of early-stage breast cancer patients: A reviewJ Clin Oncol910591070PubMedGoogle Scholar
  13. 13.
    Irwig, L, Bennetts, A. 1997Quality of life after breast conservation or mastectomy: A systematic reviewAust N Z J Surg67750754PubMedGoogle Scholar
  14. 14.
    Ganz, PA, Coscarelli, A, Fred, C,  et al. 1996Breast cancer survivors: Psychosocial concerns and quality of lifeBreast Cancer Res Treat38183199PubMedGoogle Scholar
  15. 15.
    Rowland, JH, Desmond, KA,  et al. 2000Role of breast reconstructive surgery in physical and emotional outcomes among breast Cancer survivorsJNCI9214221429PubMedGoogle Scholar
  16. 16.
    Hartl, K, Janni, W, Kastner, R,  et al. 2003Impact of medical and demographic factors on long-term quality of life and body image of breast cancer patientsAnn Oncol1410641071Google Scholar
  17. 17.
    Fallowfield, LJ, Baum, M, Maguire, GP. 1986Effects of breast conservation on psychological morbidity associated with diagnosis and treatment of early breast cancerBMJ (Clinical Research Ed)29313311334Google Scholar
  18. 18.
    Nissen, MJ, Swenson, KK, Ritz, LJ,  et al. 2001Quality of life after breast carcinoma surgeryCancer9112381246PubMedGoogle Scholar
  19. 19.
    Panel National Institutes of Health Consensus Development2001National Institutes of Health Consensus Development Conference Statement: Adjuvant Therapy for Breast Cancer, November 1–3, 2000J Natl Cancer Inst93979989Google Scholar
  20. 20.
    Goldhirsch, A, Glick, JH, Gelber, Rd, Coates, AS, Senn, HJ. 2001Meeting Highlights: International Consensus Panel on the Treatment of Primary Breast CancerJ Clin Oncol1938173827Google Scholar
  21. 21.
    Wenzel, LB, Fairclough, DL, Brady, MJ,  et al. 1999Age-related differences in the quality of life of breast carcinoma patients after treatmentCancer8617681774PubMedGoogle Scholar
  22. 22.
    Ganz, PA, Greendale, GA, Petersen, L,  et al. 2003Breast cancer in younger women: Reproductive and late health effects of treatmentJ Clin Oncol2141844193PubMedGoogle Scholar
  23. 23.
    Watters, JM, Yau, JC, O’Rourke, K,  et al. 2003Functional status is well-maintained in older women during adjuvant chemotherapy for breast cancerAnn Oncol1417441750PubMedGoogle Scholar
  24. 24.
    Spencer, SM, Lehman, JM, Wynings, C,  et al. 1999Concerns about breast cancer and relations to psychosocial well-being in a multiethnic sample of early-stage patientsHealth Psychol18159168PubMedGoogle Scholar
  25. 25.
    Culver, JL, Arena, PL, Antoni, MH, Carver, CS. 2002Coping and distress among women under treatment for early stage breast cancer: Comparing African Americans, Hispanics and non-Hispanic WhitesPsychooncology11495504PubMedGoogle Scholar
  26. 26.
    Anema, MG, Brown, BE. 1995Increasing survey responses using the total design methodJ Contin Educ Nurs26109114PubMedGoogle Scholar
  27. 27.
    Gatz, M, Harris, JR, Turk-Charles, S. 1995The meaning of health for older womenIn: Stanton AL, Gallant S (eds), The Psychology of Women’s Health: Progress and Challenges in Research and Application. Washington, DC: American Psychological Association, :491491529Google Scholar
  28. 28.
    Aaronson, NK, Ahmedzai, S, Bergman, B,  et al. 1993The European Organization for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncologyJ Natl Cancer Inst85365376PubMedGoogle Scholar
  29. 29.
    Sprangers, MA, Groenvold, M, Arraras, JI,  et al. 1996The European organization for research and treatment of cancer breast cancer-specific quality-of-life questionnaire module: First results from a three-country field studyJ Clin Oncol1427562768PubMedGoogle Scholar
  30. 30.
    Niezgoda, HE, Pater, JL. 1993A validation study of the domains of the core EORTC Quality of Life QuestionnaireQual Life Res2319325PubMedGoogle Scholar
  31. 31.
    McLachlan, SA, Devins, GM, Goodwin, PJ. 1999Factor analysis of the psychosocial items of the EORTC QLQ-C30 in metastatic breast cancer patients participating in a psychosocial intervention studyQual Life Res8311317PubMedGoogle Scholar
  32. 32.
    Hjermstad, MJ, Fossa, SD, Bjordal, K, Kaasa, S. 1995Test/retest study of the European organization for research and treatment of cancer core quality-of-life questionnaireJ Clin Oncol1312491254PubMedGoogle Scholar
  33. 33.
    Osoba, D, Zee, B, Pater, J,  et al. 1994Psychometric properties and responsiveness of the EORTC quality of Life Questionnaire (QLQ-C30) in patients with breast, ovarian and lung cancerQual Life Res3353364PubMedGoogle Scholar
  34. 34.
    Jordhoy, MS, Fayers, P, Loge, JH,  et al. 2001Quality of life in advanced cancer patients: the impact of sociodemographic and medical characteristicsBr J Cancer8514781485PubMedGoogle Scholar
  35. 35.
    Kerr, J, Engel, J, Schlesinger-Raab, A,  et al. 2003Communication, quality of life and age: Results of a 5-year prospective study in breast cancer patientsAnn Oncol14421427PubMedGoogle Scholar
  36. 36.
    King, , MT.,  1996The interpretation of scores from the EORTC quality of life questionnaire QLQ-C30Qual Life Res5555567PubMedGoogle Scholar
  37. 37.
    Osoba, D, Rodrigues, G, Myles, J, Zee, B, Pater, J. 1998Interpreting the significance of changes in health-related quality-of-life scoresJ Clin Oncol16139144PubMedGoogle Scholar
  38. 38.
    Arora, NK, Gustafson, DH, Hawkins, RP,  et al. 2001Impact of surgery and chemotherapy on the quality of life of younger women with breast cancerCancer9212881298PubMedGoogle Scholar
  39. 39.
    Zweifler, M, Rodriguez, E, Reilly, J,  et al. 2001Breast reconstruction among inner city women with breast carcinomaAnn Plast Surg475359PubMedGoogle Scholar
  40. 40.
    Nissen, MJ, Swenson, KK, Kind, EA. 2002Quality of life after postmastectomy breast reconstructionOncol Nurs Forum29547553PubMedGoogle Scholar
  41. 41.
    Lantz PM, Janz NK, Fagerlin A, et al. Satisfaction with surgery outcomes and the decision process in a population-based sample of women with breast cancer. Health Serv Res 2004 (In Press)Google Scholar
  42. 42.
    Ganz, PA, Rowland, JH, Desmond, K,  et al. 1998Life after breast cancer: Understanding women’s health-related quality of life and sexual functioningJ Clin Oncol.16501514PubMedGoogle Scholar
  43. 43.
    Lindley, C, Vasa, S, Sawyer, WT, Winer, EP. 1998Quality of life and preferences for treatment following systemic adjuvant therapy for early-stage breast cancerJ Clin Oncol1613801387PubMedGoogle Scholar
  44. 44.
    Mor, V, Malin, M, Allen, S. 1994Age differences in the psychosocial problems encountered by breast cancer patientsJ Natl Cancer Inst Monogr16191197PubMedGoogle Scholar
  45. 45.
    Engel, J, Kerr, J, Schlesinger-Raab, A,  et al. 2003Predictors of Quality of Life of breast cancer patientsActa Oncol42710718PubMedGoogle Scholar
  46. 46.
    Bloom, JR, Stewart, SL, Johnston, M, Banks, P. 1998Intrusiveness of illness and quality of life in young women with breast cancerPsychooncology789100PubMedGoogle Scholar
  47. 47.
    Pikler, V, Winterowd, C. 2003Racial and body image differences in coping for women diagnosed with breast cancerHealth Psychol22632637PubMedGoogle Scholar
  48. 48.
    Giedzinska, AS, Meyerowitz, BE. 2004Health-Related Quality of Life in a Multiethnic Sample of Breast Cancer SurvivorsAnn Behav Med283951PubMedGoogle Scholar
  49. 49.
    King, MT, Kenny, P, Shiell, A,  et al. 2000Quality of life three months and 1-year after first treatment for early stage breast cancer: Influence of treatment and patient characteristicsQual Life Res9789800PubMedGoogle Scholar

Copyright information

© Springer 2005

Authors and Affiliations

  • Nancy K. Janz
    • 1
  • Mahasin Mujahid
    • 2
  • Paula M. Lantz
    • 3
  • Angela Fagerlin
    • 4
    • 5
  • Barbara Salem
    • 4
  • Monica Morrow
    • 6
  • Dennis Deapen
    • 7
  • Steven J. Katz
    • 3
    • 4
    • 5
  1. 1.Department of Health Behavior and Health Education, School of Public HealthUniversity of MichiganAnn Arbor
  2. 2.Department of Epidemiology, School of Public HealthUniversity of MichiganAnn Arbor
  3. 3.Department of Health Management and PolicyUniversity of MichiganAnn Arbor
  4. 4.Department of Internal MedicineUniversity of Michigan Health SystemAnn Arbor
  5. 5.Veterans AffairsAnn Arbor Healthcare SystemAnn Arbor
  6. 6.Department of Surgical OncologyFox Chase Cancer CenterPhiladelphia
  7. 7.Department of Preventive Medicine, KECK School of MedicineUniversity of Southern CaliforniaU.S.A

Personalised recommendations