Multiple Predictors of Health-Related Quality of Life in Early Stage Breast Cancer. Data from a Year Follow-up Study Compared with the General Population Article DOI:
Cite this article as: Schou, I., Ekeberg, Ø., Sandvik, L. et al. Qual Life Res (2005) 14: 1813. doi:10.1007/s11136-005-4344-z Abstract
Prospective longitudinal health-related quality of life (QOL) data from 161 women newly diagnosed with breast cancer were compared to age-adjusted mean QOL scores from a general female population (n=949). In addition, multiple factors (demographic, personality trait, participation in treatment decision-making, information satisfaction, and medical data), which previous research has indicated affect the QOL of breast cancer patients, were simultaneously investigated in a multivariate model,
in order to determine which of these variables have the strongest influence on QOL one year after surgery. QOL was evaluated with the EORTC QLQ-C30 at time of diagnosis, three- and 12-months postoperatively. Women with breast cancer scored significantly lower on emotional, cognitive, and social functioning ( p < 0.01) at time of diagnosis compared to the general female population, and continued to score lower on cognitive ( p=0.008) and social ( p=0.009) functioning one-year after surgery. In addition to the initial QOL, breast conservation surgery was predictive of better physical functioning ( p=0.01) and body image ( p < 0.0001), while chemotherapy was predictive for poorer role functioning ( p=0.01) one year after surgery. Dispositional optimism was predictive for better emotional ( p=0.003) and social functioning ( p=0.01) one year after surgery. At time of diagnosis and throughout the post-diagnosis period, dispositional optimism was associated with better QOL and fewer symptoms. Keywords Breast cancer surgery Dispositional optimism–pessimism Quality of life References
Scheier MF, Carver CS, Bridges MW. Optimism, pessimism, and psychological well-being. In Chang EC, ed. Optimism and Pessimism, Washington: American Psychological Association. 2001; 189–216.
Fayers PM, Machin D. Quality of Life. Assessment, Analysis and Interpretation, West Sussex: Wiley & Sons Ltd, 2000.
Carver, CS, Lehman, JM, Antoni, MH 2003 Dispositional pessimism predicts illness-related disruption of social and recreational activities among breast cancer patients J Pers Soc Psychol 84 813 821 CrossRef PubMed Google Scholar Allison, PJ, Guichard, C, Gilain, L 2000 A prospective investigation of dispositional optimism as a predictor of health-related quality of life in head and neck cancer patients Qual Life Res 9 951 960 CrossRef PubMed Google Scholar Brenes, GA, Rapp, SR, Rejeski, WJ, Miller, ME 2002 Do optimism and pessimism predict physical functioning? J Behav Med 25 219 231 CrossRef PubMed Google Scholar Maruta, T, Colligan, RC, Malinchoc, M, Offord, KP 2002 Optimism–pessimism assessed in the 1960s and self-reported health status 30 years later Mayo Clin Proc 77 748 753 PubMed Google Scholar Achat, H, Kawachi, I, Spiro, A, DeMolles, D, Sparrow, D 2000 Optimism and depression as predictors of physical and mental health functioning: The normative aging study Ann Behav Med 22 127 130 PubMed Google Scholar 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 1768 1774 CrossRef PubMed Google Scholar Carlsson, M, Hamrin, E, Lindqvist , R. 1999 Psychometric assessment of life satisfaction questionnair (LSQ) and comparison of a randomised sample of Swedish women and those suffering from breast cancer Qual Life Res 8 245 253 CrossRef PubMed Google Scholar King, MT, Kenny, P, Shiell, A, et al. 2000 Quality of life three months and one year after first treatment for early stage breast cancer: Influence of treatment and patients characteristics Qual Life Res 9 789 800 CrossRef PubMed Google Scholar Rowland, JH, Desmond, KA, Meyerowitz, BE, et al. 2000 Role of breast reconstructive surgery in physical and emotional outcomes among breast cancer survivors J Natl Cancer Inst 92 1422 1429 CrossRef PubMed Google Scholar Amichette, M, Caffo, O 2001 Quality of life in patients with early stage breast carcinoma treated with conservation surgery and radiotherapy A Italian monoinstitutional study. Tumori 87 78 84 Google Scholar Cimprich, B, Ronis, DL, Martinez-Ramos, G 2002 Age at diagnosis and quality of life in breast cancer survivors Cancer Pract 10 85 93 CrossRef PubMed Google Scholar Ganz, PA, Desmond, KA, Leedham, B, et al. 2002 Quality of life in long-term disease-free survivors of breast cancer: A follow-up study J Natl Cancer Inst 94 39 49 PubMed Google Scholar Mandelblatt, JS, Edge, SB, Merol, NJ, et al. 2003 Predictors of long-term outcomes on older breast cancer survivors: Perceptions versus patterns care J Clin Oncol 21 855 863 CrossRef PubMed Google Scholar Stewart, MA 1995 Effective physician–patient communication and health outcomes: A review CMAJ 152 1423 1433 PubMed Google Scholar Curran, D, van, Dongen JP, Aaronson, NK, et al. 1998 Quality of Life of early-stage breast cancer patients treated with radical mastectomy or breast-conserving procedures: Results of EORTC trial 10801.The European organization for Research and Treatment of Cancer (EORTC), Breast Cancer Co-operative Group (BCCG) Eur J Cancer 34 307 314 CrossRef PubMed Google Scholar Kenny, P, King, MT, Shiell, A, et al. 2000 Early stage breast cancer: Cost and quality of life one year after treatment by mastectomy or conservative surgery and radiation therapy Breast 9 37 44 CrossRef PubMed Google Scholar Hartl, K, Janni, W, Kastner, R, et al. 2003 Impact of medical and demographic factors on long-term quality of life and body image of breast cancer patients Ann Oncol 14 1064 1071 CrossRef PubMed Google Scholar Shimozuma, K, Ganz, PA, Petersen, J, Hirji, K 1999 Quality of life in the first years after breast cancer surgery: Rehabilitation needs and patterns of recovery Breast Cancer Res Treat 56 45 57 CrossRef PubMed Google Scholar Janni, W, Rjosk, D, Dimpfl, T, et al. 2001 Quality of life influenced by primary surgical treatment for stage I–III breast cancer–long term follow-up of a matched-pair analysis Ann Surg Oncol 8 542 548 PubMed Google Scholar Andersen, MR, Urban, N 1999 Involvement in decision-making and breast cancer survivors quality of life Ann Behav Med 21 201 209 PubMed Google Scholar Deadman, JM, Leinster, SJ, Owens, RG, Dewey, ME, Slade, PD 2001 Taking responsibility for cancer treatment Soc Sci Med 53 669 677 CrossRef PubMed Google Scholar Petersen, S, Schwartz, RC, Sherman-Slate, E, Frost, H, Straub, JL, Damjanov, N 2003 Relationship of depression and anxiety to cancer patients’ medical decision-making Psychol Rep 93 323 334 PubMed Google Scholar Street, RL Jr, Voigt, B 1997 Patient participation in deciding breast cancer treatment and subsequent quality of life Med Decis Making 17 298 306 PubMed Google Scholar Moyer, A, Salovey, P 1998 Patient participation in treatment decision making and the psychological consequences of breast cancer surgery Women Health 4 103 116 Google Scholar Tomich, PL, Helgeson, VS 2002 Five years later: A cross-sectional comparison of breast cancer survivors with health women Psycho Oncol 11 154 169 CrossRef Google Scholar Dorval, M, Maunsell, E, Deschenes, L, et al. 1998 Long-term quality of life after breast cancer: Comparison of 8-year survivors with population controls J Clin Oncol 16 487 494 PubMed Google Scholar Ganz, PA, Rowland, JH, Desmond, K, et al. 1998 Life after breast cancer: Understanding women’s health-related quality of life and sexual functioning J Clin Oncol 16 501 514 PubMed Google Scholar Andrykowski, MA, Curran, SL, Lightner, R 1998 Off-treatment fatigue in breast cancer survivors: A controlled comparison J Behav Med 21 1 18 CrossRef PubMed Google Scholar Stone, P, Richards, M, A’Hern, R, et al. 2000 A study to investigate the prevalence, severity and correlates of fatigue among patients with cancer in comparison with a control group of volunteers’ cancer Ann Oncol 11 561 567 CrossRef PubMed Google Scholar Chirikos, TN, Russell-Jacobs, A, Jacobsen, PB 2002 Functional impairment and the economic consequences of female breast cancer Women Health 36 1 20 CrossRef Google Scholar Hjermstad, MJ, Fayers, PM, Bjordal, K, et al. 1998 Health-related quality of life in the General Norwegian population assessed by the European organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire: The QLQ-C3=(+3) J Clin Oncol 16 1188 1196 PubMed Google Scholar Schou, I, Ekeberg, Ø, Ruland, CM, et al. 2002 Do women newly diagnosed with breast cancer and consulting surgeon assess decision-making equally? Breast 11 434 441 CrossRef PubMed Google Scholar Aaronson, NK, Ahmedzai, S, Bergman, B, et al. 1993 The European organization for Research and Treatment of cancer QLQ-C30: A Quality-of-life instrument for use in international clinical trials in oncology J Natl Cancer Inst 85 365 376 PubMed Google Scholar
Fayers P, Aaronson N, Bjordal K, et al. EORTC QLQ-C30
Scoring Manual. 3 ed. Brussels: Edition January, 2001
Versonesi, U, Kleist, S, Redmond, K, et al. 1999 Caring about women and cancer (CAWAC): A European survey of the perspectives and experiences of women with female cancers Eur J Cancer 35 1667 1675 CrossRef PubMed Google Scholar Kåresen, R, Langmark, F 2000 Psychological and economic status of Norwegian women operated for breast or gynaecologic cancer Tidsskr nor Lægeforen 120 2708 2741 Google Scholar Scheier, MF, Carver, CS, Bridges, MW 1994 Distinguishing optimism from neuroticism (and trait anxiety, self-mastery and self-esteem): A re-evaluation of the life orientation test J Per Soc Psychol 67 1063 1078 CrossRef Google Scholar Hjermstad, MJ, Fayers, PM, Bjordal, K, et al. 1998 Using reference data on quality of life–the importance of adjusting for age and gender, exemplified by the EORTC QLQ-C30 (+3) Eur J Cancer 34 1381 1389 CrossRef PubMed Google Scholar Cohen, J 1988Statistical Power Analysis for the Behavioural Sciences, 2 ed. Lawrence Erlbaum Associates Hillsdale, NJ Google Scholar Warner, NJ, King, M, Langlands, AO, et al. 1999 Symptoms 2 weeks, 3 months and 12 months after treatment of early breast cancer: The patients’ perspectives Breast 8 273 277 CrossRef PubMed Google Scholar Kerr, J, Engel, J, Schesingerr-Raab, A, et al. 2003 Communication, quality of life and age: Results of a 5-year prospective study in breast cancer patients Ann Oncol 14 421 427 CrossRef PubMed Google Scholar Olin, JJ 2001 Cognitive function after systematic therapy for breast cancer Oncology 15 613 618 PubMed Google Scholar Dam, FS, Schagen, SB, Muller, MJ, et al. 1998 Impairement of cognitive function in women receiving adjuvant treatment for high-risk breast cancer: High-dose versus standard-dose chemotherapy J Natl Cancer Inst 90 210 218 CrossRef PubMed Google Scholar Warner, E, Keshavjee, al-N, Shupak, R, Bellini, A 1997 Rheumatic symptoms following adjuvant therapy for breast cancer Am J Clin Oncol 29 322 326 CrossRef Google Scholar King, MT 1996 The interpretation of scores from the EORTC quality of life questionnaire QlQ-C30 Qual Life Res 5 555 567 CrossRef PubMed Google Scholar Cella, D 2000 Discussion of issues concerning the quality of life in cancer patients Int J Pharm Med 14 95 97 CrossRef Google Scholar Engel, J, Kerr, J, Schlesinger-Raab, , et al. 2003 Predictors of quality of life of breast cancer patients Acta Oncol 42 710 718 CrossRef PubMed Google Scholar Al-Ghazal, SK, Fallowfield, L, Blamey, RW 2000 Comparison of psychological aspects and patients satisfaction following breast cancer surgery, simple mastectomy and breast reconstruction Eur J Cancer 36 1938 1943 CrossRef PubMed Google Scholar Engel, J, Kerr, J, Schlesinger-Raab, , et al. 2004 Quality of life following breast-conserving therapy or mastectomy: results of a 5-year prospective study Breast J 10 223 231 CrossRef PubMed Google Scholar Ganz, PA, Desmond, KA, Belin, TR, et al. 1999 Predictors of sexual health in women after a breast cancer diagnosis J Clin Oncol 17 2371 2380 PubMed Google Scholar