Predictors of Quality of Life among Ethnically Diverse Breast Cancer Survivors
- 327 Downloads
Few studies have examined predictors of quality of life (QOL) of breast cancer survivors over time. Breast cancer survivors (n = 116) were asked to complete measures of QOL, mood, spirituality, and social support every 6 months from 2 to 4 years post treatment. Overall QOL at 4 years was predicted by previous physical and functional well-being, the breast cancer-specific items, and vigor and current levels of social support (Adj R 2 = .72, F = 30.53, p < .001). Physical QOL was predicted by previous levels of physical and functional well-being and current levels of functional and social/family well-being (Adj R 2 = .84, F = 44.30, p < .001). Functional well-being was predicted by prior levels of physical, functional, and social/family well-being and current levels of physical well-being and vigor (Adj R 2 = .72, F = 3–.53, p < .001). Emotional well-being was predicted by previous levels of emotional well-being and current physical well-being, the breast cancer-specific items, and anxiety (Adj R 2 = .60, F = 26.30, p < .001). Social/family well-being was predicted by previous levels of social/family well-being, social support, and confusion (Adj R 2 = .71, F = 34.18, p < <000). The breast cancer-specific items were predicted by age, previous levels of the breast cancer-specific items, confusion, and current levels of emotional and functional well-being and spirituality (Adj R 2 = .58, F = 17.57, p < .001). Overall and specific dimensions of QOL at 4 years were predicted by different combinations of QOL, mood, and spirituality. Interventions should be tailored to which dimensions of QOL are affected and other types of QOL as well as social support, mood, and spirituality as coping mechanisms that influence the specific dimension of QOL affected.
KeywordsBreast cancer Quality of life Racial/ethnic/cultural differences Social support Spirituality
This research was supported by a Research Infrastructure in Minority Institutions (RIMI) grant 5 P20 MD000544-02 from the National Center for Minority Health and Health Disparities, National Institutes of Health, to San Francisco State University. We would also like to recognize our interviewers and research assistants: Yaffa Alter, Julie Armin, Jacqueline Bishop, Gloria Boehm, Tina Chan, Qiu Chen, Heather Law, Erin McCoy, Ana Freire, Mariaelena Gonzalez, Ann Gilliard, Regina Lagman, Mabel Lam, Laureen Hom, Jonathon Lee, Beverly Lynn, Sachiko Reed, Sann Situ, Chris Van Onselen, Shelley Volz, and Ivy Wong. The collection of cancer incidence data used in this study was supported by the California Department of Public Health as part of the statewide cancer reporting program mandated by California Health and Safety Code Section 103885; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under contract N01-PC-35136 awarded to the Cancer Prevention Institute of California, contract N01-PC-35139 awarded to the University of Southern California, and contract N02-PC-15105 awarded to the Public Health Institute; and the Centers for Disease Control and Prevention’s National Program of Cancer Registries, under agreement #U55/CCR921930-02 awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s), and endorsement by the State of California, Department of Public Health, the National Cancer Institute, and the Centers for Disease Control and Prevention or their contractors and subcontractors is not intended nor should be inferred.
Compliance with Ethical Standards
All recruitment procedures followed HIPPA regulations. IRB approval was obtained from all participating investigators’ research institutions and the Cancer Prevention Institute of California (CPIC).
- Ashing-Giwa, K. T., Padilla, G., Tejero, J., Kraemer, J., Wright, K., Coscarelli, A.....Hills, D. (2004). Understanding the breast cancer experience of women: a qualitative study of African American, Asian American, Latina, and Caucasian cancer survivors. Psycho-Oncology, 13, 408-428. doi: 10.1002/pon.750.
- Badger, T. A., Braden, C. J., Mishel, M. H., & Longman, A. (2004). Depression burden, psychological adjustment and quality of life in women with breast cancer: patterns over time. Research in Nursing and Health, 27, 9–28. doi: 10.1002/nur.20002.
- Bormann, J. E., Gifford, A. L., Shively, M., Smith, T. L., Redwine, L., Kelly A..... & Belding, W. (2006). Effects of spiritual mantram repetition in HIV outcomes: a randomized clinical trial. Annals of Behavioral Medicine, 29(4), 359–376. doi: 10.1007/s10865-006-9063-6.
- Bowen, D. J., Alfano, C. M., McGregor, B. A., Kuniyuki, A., Bernstein, L., Meeske, K… & Barbash, R. B. (2007). Possible socioeconomic and ethnic disparities in quality of life in a cohort of breast cancer survivors. Breast Cancer Research and Treatment, 106, 85–95. doi: 10.1007/s10549-006-9479-2.
- Cella, D. F. (1997). Manual: functional assessment of chronic illness therapy (FACIT) scales. Chicago: Center on Outcomes, Research, and Education, Evanston Northwestern Healthcare and Northwestern University.Google Scholar
- Cheng, S-Y., Lai, Y-H., Chen S-C., Shun, S-C., Liao, Y-M., Tu, S-H....Chen, C-M. (2011). Changes in quality of life among newly diagnosed breast cancer patients in Taiwan. Journal of Clinical Nursing, 21, 70–79. doi: 10.1111/j.1365-2702.2011.03735.x.
- Eton, D. T., Cella, D., Yost, K. J., Yount, S. E., Peterman, A. H., Neuberg, D. S… & Wood, W. C. (2004). A combination of distribution- and anchor-based approaches determined minimally important differences (MIDs) for four endpoints in a breast cancer scale. Journal of Clinical Epidemiology, 57, 898–910. doi: 10.1016/j.jclinepi.2004.01.012.
- Fisch, M. J., Titzer, M. L., Kristeller, J. L., Shen, J., Loehrer, P. J., Jung, S-H… Einhorn, L. H. (2003). Assessment of quality of life in outpatients with advanced cancer: the accuracy of clinician estimations and the relevance of spiritual well-being—a Hoosier Oncology group study. Journal of Clinical Oncology, 21, 2754–2759. doi: 10.1200/JCO.2003.06.093.
- Hartl, K., Engel, J., Herschbach, P., Reinecker, H., Sommer, H., & Friese, K. (2009). Personality traits and psychosocial stress: quality of life over 2 years following breast cancer diagnosis and psychological impact factors. Psycho-Oncology, 19, 160–169. doi: 10.1002/pon.1536.CrossRefGoogle Scholar
- Janz, N. K., Mujahid, M. S., Hawley, S. T., Griggs, J. J., Alderman, A., Hamilton, A. S...., Katz, S. J. (2009). Racial/ethnic differences in quality of life after diagnosis of breast cancer. Journal of Cancer Survivorship, 3, 212–222. doi: 10.1007/s11764-009-0097-y.
- Janz, N. K., Friese, C. R., Li, Y., Graff, J. J., Hamilton, A. S., & Hawley, S. T. (2014). Emotional well- being years post-treatment for breast cancer: prospective, multi-ethnic, and population-based analysis. Journal of Cancer Survivorship, 8, 131–142. doi: 10.1007/s11764-013-0309-3.CrossRefGoogle Scholar
- Kwan, M. L., Ergas, I. J., Somkin, C. P., Quesenberry, C. P. Jr, Neugut, A. L., Hershman, D. L… & Kushi, L. H. (2010). Quality of life of women recently diagnosed with invasive breast cancer: the Pathways Study. Breast Cancer Research and Treatment, 123, 507–24. doi: 10.1007/s10549-010-0764-8.
- Luckett, T., Goldstein, D., Butow, P. N., Gebski, V., Aldridge, L. J., McGrane, J....& King, M. T. (2011). Psychological morbidity and quality of life of ethnic minority patients with cancer: a systematic review and meta-analysis. Lancet Oncology, 12, 1240–1248. doi: 10.1016/S1470-2045(11)70212-1
- McNair, D. M., Lorr, M., & Droppleman, L. F. (1981). Profile of mood states (2nd ed.). San Diego: Educational and Industrial Testing Service.Google Scholar
- Morgan, P. D., Gaston-Johansson, F., & Mock, V. (2006). Spiritual well-being, religious coping, and the quality of life of African American breast cancer treatment: a pilot study. The ABNF Journal, 17(2), 73–77.Google Scholar
- Murphy, P. A., Canada, A. L., Fitchett, G., Stein, K., Portier, K., Crammer, C., & Peterman, A. H. (2009). An examination of the 3-factor model and structural invariance across racial/ethnic groups for the FACIT-Sp: a report from the American Cancer Society’s Study of Cancer Survivors-II (SCS-II). Psycho-Oncology, 19(3), 264–272. doi: 10.1002/pon.1559.CrossRefGoogle Scholar
- Noal, S., Levy, C., Hardouin, A., Rieux, C., Heutte, N., Segura, C…& Jolly, F. (2011). One-year longitudinal study of fatigue, cognitive functions, and quality of life after adjuvant radiotherapy for breast cancer. International Journal of Radiation Oncology, 81(3), 795–803. doi: 1 0.1016/j.ijrobp.2010.06.037.Google Scholar
- Paskett, E. D., Herndon, J. E. 2nd, Day, J. M., Stark, N. N., Winer, E. P., Grubbs, S. S., Pavy, M. D.... Bittoni, M. A.; Cancer and Leukemia Group B. (2008). Applying a conceptual model for examining health-related quality of life in long-term breast cancer survivors: CALGB study 79804. Psycho-Oncology, 17, 1108–1120. doi: 10.1002/pon.1329.
- Peterman, A. H., Fitchett, G., Brady, M. J., Hernandez, L., & Cella, D. (2002). Measuring spiritual well-being in people with cancer: the functional assessment of chronic illness therapy-spiritual well-being scale (FACIT-Sp). Annals of Behavioral Medicine, 24, 49–58. doi: 10.1207/S15324796ABM2401_06.CrossRefGoogle Scholar
- Taira, N., Shimozuma, K., Shirowla, T., Ohsumi, S., Kuroi, K., Saji, S....Katsumata, N. (2011). Associations among baseline variables, treatment-related factors and health-related quality of life 2 years after breast cancer surgery. Breast Cancer Research & Treatment, 128, 735–747. doi: 10.1007/s10549-011-1631-y.
- Thuné-Boyle, I. C., Stygall, J. A., Keshtgar, M. R., & Newman, S. P. (2006). Do religious/spiritual coping strategies affect illness adjustment in patients with cancer? A systematic review of the literature. Social Science and Medicine, 63, 151–164. doi: 10.1016/j.socscimed.2005.11.055.CrossRefGoogle Scholar
- Wenzel, L. B., Fairclough, D. L., Brady, M. J., Cella, D., Garrett, K. M., Kluhsman, B. C....& Marcus, A. C. (1999). Age-related differences in the quality of life of breast carcinoma patients after treatment. Cancer, 86, 1768–1774. doi: 10.1002/(SICI)1097-0142(19991101)86:9<1768::AID-CNCR19>3.0.CO;2-O.