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Quality of Life Research

, Volume 23, Issue 10, pp 2769–2777 | Cite as

The relationships between demographic and clinical characteristics and quality of life during and after radiotherapy: in women with breast cancer

  • Kristin HofsøEmail author
  • Kristin Bjordal
  • Lien My Diep
  • Tone Rustøen
Article

Abstract

Purpose

The purpose of this longitudinal study was to investigate quality of life (QOL) before, during, and after the course of radiotherapy (RT) and to identify risk factors for diminished QOL in women with breast cancer.

Methods

Patients (N = 188) completed the short-form 12 (SF-12), the Karnofsky Performance Status Scale, Memorial Symptom Assessment Scale, and the Self-Administrated Comorbidity Questionnaire 1 week prior to the start of RT. To assess changes in QOL, patients also completed the SF-12 1, 2, 3, and 6 months after the baseline. A random-intercept and slope model (mixed model) for each patient was used to estimate linear trends for the mental component score and physical component score of QOL (five time points for each patient). Descriptive statistics were used to analyze demographic and clinical characteristics.

Results

The physical component score (PCS) did not change significantly (p = 0.078) during the course of RT in women with breast cancer. An increase in the number of symptoms and a higher comorbidity profile was negatively related to the PCS. The mental component score (MCS) did not change from the start of RT until the 2-month assessment, but increased significantly after 2 months (p = 0.044). An increase in the number of symptoms was negatively related to the MCS.

Conclusion

The MCS and PCS of QOL remained stable at a diminished level except for the MCS which improved between 2 and 6 months after the start of RT. The total number of symptoms was the only variable that was negatively associated with both component scores (MCS and PCS) during the 6 months.

Keywords

Predictors Quality of life QOL Radiotherapy SF-12 

Notes

Acknowledgments

The Norwegian Cancer Society funded this study. The Norwegian Nurses Organisation and the Raagholt Foundation provided additional support for Kristin Hofsø. The investigators thank the nurses in the clinic who facilitated data collection, and all patients for taking the time to complete the questionnaires.

References

  1. 1.
    Reidunsdatter, R. J., Rannestad, T., Frengen, J., Frykholm, G., & Lundgren, S. (2011). Early effects of contemporary breast radiation on health-related quality of life—Predictors of radiotherapy-related fatigue. Acta Oncologica, 50(8), 1175–1182.PubMedCrossRefGoogle Scholar
  2. 2.
    Hofso, K., Rustoen, T., Cooper, B. A., Bjordal, K., & Miaskowski, C. (2013). Changes over time in occurrence, severity, and distress of common symptoms during and after radiation therapy for breast cancer. Journal of Pain and Symptom Management, 45(6), 980–1006.PubMedCrossRefGoogle Scholar
  3. 3.
    Lee, T. S., Kilbreath, S. L., Refshauge, K. M., Pendlebury, S. C., Beith, J. M., & Lee, M. J. (2008). Quality of life of women treated with radiotherapy for breast cancer. Supportive Care in Cancer, 16(4), 399–405.PubMedCrossRefGoogle Scholar
  4. 4.
    Knobf, M. T., & Sun, Y. (2005). A longitudinal study of symptoms and self-care activities in women treated with primary radiotherapy for breast cancer. Cancer Nursing, 28(3), 210–218.PubMedCrossRefGoogle Scholar
  5. 5.
    Wengstrom, Y., Haggmark, C., Strander, H., & Forsberg, C. (2000). Perceived symptoms and quality of life in women with breast cancer receiving radiation therapy. European Journal of Oncology Nursing, 4(2), 78–88.PubMedCrossRefGoogle Scholar
  6. 6.
    Browall, M., Ahlberg, K., Karlsson, P., Danielson, E., Persson, L. O., & Gaston-Johansson, F. (2008). Health-related quality of life during adjuvant treatment for breast cancer among postmenopausal women. European Journal of Oncology Nursing, 12(3), 180–189.PubMedCrossRefGoogle Scholar
  7. 7.
    Whelan, T. J., Levine, M., Julian, J., Kirkbride, P., & Skingley, P. (2000). The effects of radiation therapy on quality of life of women with breast carcinoma: results of a randomized trial. Ontario Clinical Oncology Group. Cancer, 88(10), 2260–2266.PubMedCrossRefGoogle Scholar
  8. 8.
    Hofso, K., Miaskowski, C., Bjordal, K., Cooper, B. A., & Rustoen, T. (2012). Previous chemotherapy influences the symptom experience and quality of life of women with breast cancer prior to radiation therapy. Cancer Nursing, 35(3), 167–177.PubMedCrossRefGoogle Scholar
  9. 9.
    Budischewski, K., Fischbeck, S., & Mose, S. (2008). Quality of life of breast cancer patients in the course of adjuvant radiotherapy. Supportive Care in Cancer, 16(3), 299–304.PubMedCrossRefGoogle Scholar
  10. 10.
    Back, M., Ahern, V., Delaney, G., Graham, P., Steigler, A., & Wratten, C. (2005). Absence of adverse early quality of life outcomes of radiation therapy in breast conservation therapy for early breast cancer. Australasian Radiology, 49(1), 39–43.PubMedCrossRefGoogle Scholar
  11. 11.
    Noal, S., Levy, C., Hardouin, A., Rieux, C., Heutte, N., Segura, C., et al. (2011). One-year longitudinal study of fatigue, cognitive functions, and quality of life after adjuvant radiotherapy for breast cancer. International Journal of Radiation Oncology Biology Physics, 81(3), 795–803.CrossRefGoogle Scholar
  12. 12.
    King, M. T., Kenny, P., Shiell, A., Hall, J., & Boyages, J. (2000). Quality of life three months and one year after first treatment for early stage breast cancer: Influence of treatment and patient characteristics. Quality of Life Research, 9(7), 789–800.PubMedCrossRefGoogle Scholar
  13. 13.
    Salonen, P., Kellokumpu-Lehtinen, P. L., Tarkka, M. T., Koivisto, A. M., & Kaunonen, M. (2011). Changes in quality of life in patients with breast cancer. Journal of Clinical Nursing, 20(1–2), 255–266.PubMedCrossRefGoogle Scholar
  14. 14.
    Hopwood, P., Haviland, J., Mills, J., Sumo, G., & Bliss, M. (2007). The impact of age and clinical factors on quality of life in early breast cancer: An analysis of 2208 women recruited to the UK START Trial (Standardisation of Breast Radiotherapy Trial). Breast, 16(3), 241–251.PubMedCrossRefGoogle Scholar
  15. 15.
    Parker, P. A., Youssef, A., Walker, S., Basen-Engquist, K., Cohen, L., Gritz, E. R., et al. (2007). Short-term and long-term psychosocial adjustment and quality of life in women undergoing different surgical procedures for breast cancer. Annals of Surgical Oncology, 14(11), 3078–3089.PubMedCrossRefGoogle Scholar
  16. 16.
    Warm, M., Gatermann, C., Kates, R., Mallmann, P., Paepke, S., Harbeck, N., et al. (2008). Postoperative sense of well-being and quality of life in breast cancer patients do not depend on type of primary surgery. Onkologie, 31(3), 99–104.PubMedCrossRefGoogle Scholar
  17. 17.
    Nissen, M. J., Swenson, K. K., Ritz, L. J., Farrell, J. B., Sladek, M. L., & Lally, R. M. (2001). Quality of life after breast carcinoma surgery: A comparison of three surgical procedures. Cancer, 91(7), 1238–1246.PubMedCrossRefGoogle Scholar
  18. 18.
    Ahn, S. H., Park, B. W., Noh, D. Y., Nam, S. J., Lee, E. S., Lee, M. K., et al. (2007). Health-related quality of life in disease-free survivors of breast cancer with the general population. Annals of Oncology, 18(1), 173–182.PubMedCrossRefGoogle Scholar
  19. 19.
    Arndt, V., Stegmaier, C., Ziegler, H., & Brenner, H. (2008). Quality of life over 5 years in women with breast cancer after breast-conserving therapy versus mastectomy: A population-based study. Journal of Cancer Research and Clinical Oncology, 134(12), 1311–1318.PubMedCrossRefGoogle Scholar
  20. 20.
    Engel, J., Kerr, J., Schlesinger-Raab, A., Sauer, H., & Holzel, D. (2003). Axilla surgery severely affects quality of life: Results of a 5-year prospective study in breast cancer patients. Breast Cancer Research and Treatment, 79(1), 47–57.PubMedCrossRefGoogle Scholar
  21. 21.
    Lu, W., Cui, Y., Zheng, Y., Gu, K., Cai, H., Li, Q., et al. (2007). Impact of newly diagnosed breast cancer on quality of life among Chinese women. Breast Cancer Research and Treatment, 102(2), 201–210.PubMedCrossRefGoogle Scholar
  22. 22.
    Clinical Gov.Trial. (2013). webpage [Electronic version]. http://www.clinicaltrials.gov/ct2/results?term=NCT00769301&Search=Search.
  23. 23.
    Schag, C. C., Heinrich, R. L., & Ganz, P. A. (1984). Karnofsky Performance Status revisited: Reliability, validity, and guidelines. Journal of Clinical Oncology, 2(3), 187–193.PubMedGoogle Scholar
  24. 24.
    Sangha, O., Stucki, G., Liang, M. H., Fossel, A. H., & Katz, J. N. (2003). The Self-Administered Comorbidity Questionnaire: a new method to assess comorbidity for clinical and health services research. Arthritis and Rheumatism, 49(2), 156–163.PubMedCrossRefGoogle Scholar
  25. 25.
    Portenoy, R. K., Thaler, H. T., Kornblith, A. B., Lepore, J. M., Friedlander-Klar, H., Kiyasu, E., et al. (1994). The Memorial Symptom Assessment Scale: An instrument for the evaluation of symptom prevalence, characteristics and distress. European Journal of Cancer, 30A(9), 1326–1336.PubMedCrossRefGoogle Scholar
  26. 26.
    Ware, J. E., Kosinski, M., & Keller, S. D. (1996). A 12- item, short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 3, 220–223.CrossRefGoogle Scholar
  27. 27.
  28. 28.
    Breast Cancer Org. (2010). webpage [Electronic version]. http://www.breastcancer.org/symptoms/types/dcis/diagnosis.jsp.
  29. 29.
    Mapi Research Institute (2004). Mapi Institute linguistic validation. [Electronic version] www.mapi-trust.com.
  30. 30.
    Valeberg, B. T., Miaskowski, C., Hanestad, B. R., Bjordal, K., Paul, S., & Rustoen, T. (2008). Demographic, clinical, and pain characteristics are associated with average pain severity groups in a sample of oncology outpatients. The Journal of Pain, 9(10), 873–882.PubMedCrossRefGoogle Scholar
  31. 31.
    Ljosaa, T. M., Rustoen, T., Mork, C., Stubhaug, A., Miaskowski, C., Paul, S. M., et al. (2010). Skin pain and discomfort in psoriasis: An exploratory study of symptom prevalence and characteristics. Acta Dermato Venereologica, 90(1), 39–45.PubMedCrossRefGoogle Scholar
  32. 32.
    Gandek, B., Ware, J. E., Aaronson, N. K., Apolone, G., Bjorner, J. B., Brazier, J. E., et al. (1998). Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: Results from the IQOLA Project. International Quality of Life Assessment. Journal of Clinical Epidemiology, 51(11), 1171–1178.PubMedCrossRefGoogle Scholar
  33. 33.
    Miaskowski, C., Cooper, B. A., Paul, S. M., Dodd, M., Lee, K., Aouizerat, B. E., et al. (2006). Subgroups of patients with cancer with different symptom experiences and quality-of-life outcomes: A cluster analysis. Oncology Nursing Forum, 33(5), E79–E89.PubMedCrossRefGoogle Scholar
  34. 34.
    Pud, D., Ben, A. S., Cooper, B. A., Aouizerat, B. E., Cohen, D., Radiano, R., et al. (2008). The symptom experience of oncology outpatients has a different impact on quality-of-life outcomes. Journal of Pain and Symptom Management, 35(2), 162–170.PubMedCrossRefGoogle Scholar
  35. 35.
    Ware, J. E., Kosinski, M., & Keller, S. D. (1995). How to score the SF-12 physical and mental summary scales. Boston, MA: New England Medical Center, Health Institute.Google Scholar
  36. 36.
    Ware, J. E., Kosinski, M, Jr, Turner-Bowker, D. M., & Gandek, B. (2007). User’s manual for the SF-12v2 Health Survey (with a supplement documenting SF-12 Health Survey). Boston, MA: Quality Metric Incorporated, Lincoln, Rhode Island and Health Assessment Lab.Google Scholar
  37. 37.
    Rabe-Hesketh, S., & Skrondal, A. (2008). Multilevel and longitudinal modeling using Stata (2nd ed.). College Station: Stata Press.Google Scholar
  38. 38.
    Corp, S. (2009). STATA statistical software. College Station, TX: Stata Corporation LP.Google Scholar
  39. 39.
    Simon, G. E., Revicki, D. A., Grothaus, L., & Vonkorff, M. (1998). SF-36 summary scores: Are physical and mental health truly distinct? Medical Care, 36(4), 567–572.PubMedCrossRefGoogle Scholar
  40. 40.
    Taft, C., Karlsson, J., & Sullivan, M. (2001). Do SF-36 summary component scores accurately summarize subscale scores? Quality of Life Research, 10(5), 395–404.PubMedCrossRefGoogle Scholar
  41. 41.
    Stiegelis, H. E., Ranchor, A. V., & Sanderman, R. (2004). Psychological functioning in cancer patients treated with radiotherapy. Patient Education and Counseling, 52(2), 131–141.PubMedCrossRefGoogle Scholar
  42. 42.
    Dunn, L. B., Aouizerat, B. E., Cooper, B. A., Dodd, M., Lee, K., West, C., et al. (2012). Trajectories of anxiety in oncology patients and family caregivers during and after radiation therapy. European Journal of Oncology Nursing, 16(1), 1–9.PubMedCentralPubMedCrossRefGoogle Scholar
  43. 43.
    Ganz, P. A., Kwan, L., Stanton, A. L., Krupnick, J. L., Rowland, J. H., Meyerowitz, B. E., et al. (2004). Quality of life at the end of primary treatment of breast cancer: First results from the moving beyond cancer randomized trial. Journal of the National Cancer Institute, 96(5), 376–387.PubMedCrossRefGoogle Scholar
  44. 44.
    Bower, J. E., Ganz, P. A., Desmond, K. A., Rowland, J. H., Meyerowitz, B. E., & Belin, T. R. (2000). Fatigue in breast cancer survivors: Occurrence, correlates, and impact on quality of life. Journal of Clinical Oncology, 18(4), 743–753.PubMedGoogle Scholar
  45. 45.
    Tchen, N., Juffs, H. G., Downie, F. P., Yi, Q. L., Hu, H., Chemerynsky, I., et al. (2003). Cognitive function, fatigue, and menopausal symptoms in women receiving adjuvant chemotherapy for breast cancer. Journal of Clinical Oncology, 21(22), 4175–4183.PubMedCrossRefGoogle Scholar
  46. 46.
    Wenzel, L. B., Fairclough, D. L., Brady, M. J., Cella, D., Garrett, K. M., Kluhsman, B. C., et al. (1999). Age-related differences in the quality of life of breast carcinoma patients after treatment. Cancer, 86(9), 1768–1774.PubMedCrossRefGoogle Scholar
  47. 47.
    Beadle, B. M., Woodward, W. A., & Buchholz, T. A. (2011). The impact of age on outcome in early-stage breast cancer. Seminars in Radiation Oncology, 21(1), 26–34.PubMedCentralPubMedCrossRefGoogle Scholar
  48. 48.
    Norwegian Breast Cancer Group (NBCG). (2010). webpage [Electronic version]. http://www.nbcg.no/nbcg.blaaboka.html.
  49. 49.
    Engel, J., Kerr, J., Schlesinger-Raab, A., Eckel, R., Sauer, H., & Holzel, D. (2003). Predictors of quality of life of breast cancer patients. Acta Oncologica, 42(7), 710–718.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  • Kristin Hofsø
    • 1
    Email author
  • Kristin Bjordal
    • 2
  • Lien My Diep
    • 3
  • Tone Rustøen
    • 4
    • 5
  1. 1.Centre for Shared Decision Making and Collaborative ResearchOslo University HospitalOsloNorway
  2. 2.Division of Cancer Medicine, Surgery and Transplantation, Department of OncologyOslo University HospitalOsloNorway
  3. 3.Department for Biostatistics, Epidemiology and Health EconomicsOslo University HospitalOsloNorway
  4. 4.Division of Emergencies and Critical CareOslo University HospitalOsloNorway
  5. 5.Unit of Nursing Science, Institute of Health and Society, Faculty of MedicineUniversity of OsloOsloNorway

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