Journal of Cancer Survivorship

, Volume 8, Issue 1, pp 131–142 | Cite as

Emotional well-being years post-treatment for breast cancer: prospective, multi-ethnic, and population-based analysis

  • Nancy K. JanzEmail author
  • Christopher R. Friese
  • Yun Li
  • John J. Graff
  • Ann S. Hamilton
  • Sarah T. Hawley



This study investigated factors associated with declines in emotional well-being (EWB) over time in breast cancer survivors.


Women with breast cancer (Stages I–III) residing in Los Angeles, CA, or Detroit, MI, and reported to the Surveillance, Epidemiology, and End Results registries between June 2005 and February 2007 completed surveys at 9 months and 4 years after diagnosis. EWB was measured by the Functional Assessment of Cancer Treatment-Breast. Using a stress coping framework, logistic regression models assessed associations between personal, social, and clinical correlates, appraisal (e.g., worry about recurrence) and coping factors (e.g., emotional support) to EWB declines.


Among eligible women who completed primary breast cancer treatment, 772 completed both surveys, and 192 (24.9 %) experienced EWB declines over time. Women with past or current depression were more likely to report EWB decline (p < 0.01). Survivors who perceived they did not receive enough information about risk of breast cancer recurrence during primary treatment were more likely to have EWB decline (OR 0.53, 95 % CI 0.32–0.87). Greater perceived likelihood of recurrence (OR 1.95, 95 % CI 1.01–5.29) and increased worry about recurrence (OR 1.38, 95 % CI 1.10–1.72) were associated with EWB decline. Higher spirituality beliefs and practices were associated with EWB decline.


A considerable number of breast cancer patients report emotional well-being declines over time. Early identification of women who are vulnerable, such as women with past depression, is crucial to improve quality of care. Women would benefit from education about cancer recurrence and tailored strategies to manage worry about recurrence over time.

Implication for cancer survivors

Understanding actual risk of recurrence and managing worry about recurrence is important for cancer survivors. Emotional concerns are common for individuals with cancer so survivors should feel free to reach out and discuss such concerns with providers well into the survivorship period.


Breast cancer Survivorship Emotional well-being Worry about recurrence 


Ethical standards

This study was approved by the University of Michigan Institutional Review Board. All persons gave their informed consent prior to their inclusion in the study.

Conflicts of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Nancy K. Janz
    • 1
    Email author
  • Christopher R. Friese
    • 2
  • Yun Li
    • 3
  • John J. Graff
    • 4
  • Ann S. Hamilton
    • 5
  • Sarah T. Hawley
    • 6
  1. 1.Department of Health Behavior and Health Education, School of Public HealthUniversity of MichiganAnn ArborUSA
  2. 2.School of Nursing Division IIIUniversity of MichiganAnn ArborUSA
  3. 3.Biostatistics, M4015 SPH II, 2029University of MichiganAnn ArborUSA
  4. 4.Cancer Institute of New JerseyRobert Wood Johnson Medical SchoolNew BrunswickUSA
  5. 5.University of Southern California Norris Center, Preventive MedicineLos AngelesUSA
  6. 6.University of Michigan Internal Medicine-General Medicine, NCRC 2800Ann ArborUSA

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