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Predictors of the course of quality of life during therapy in women with primary breast cancer

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Abstract

Purpose

Multimodal therapies affect the quality of life (QoL) of patients with primary breast cancer (PBC). The objectives of this prospective study were to explore the changes in QoL from diagnosis to conclusion of adjuvant therapy and to identify predictive factors of QoL.

Methods

Before surgery (t1), before onset of adjuvant treatment (t2) and after completion of adjuvant chemo- or radiotherapy (t3), patients with PBC (n = 759) completed the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire, Charlson Comorbidity Index, Patient Health Questionnaire and Perceived Involvement in Care Scales. Predictors of the course of global QoL were estimated using multinomial logistic regression. Effect estimates are odds ratios (OR) and their 95% confidence intervals (CIs).

Results

Global QoL improved between t1 and t3, while physical functioning, emotional functioning and fatigue deteriorated. QoL before surgery was more often poor in patients <60 years (OR 2.2, 95% CI 1.5–3.1) and in those with comorbid mental illnesses (OR 8.6, CI 5.4–13.7). Forty-seven percentage reported good global QoL both at t1 and at t3. QoL improved in 28%, worsened in 10% and remained poor in 15%. Compared to patients with consistently good global QoL, a course of improving QoL was more often seen in patients who had received a mastectomy and in those with intense fear of treatment before surgery. A course of decreasing QoL was more often found in patients who were treated with chemotherapy. QoL stayed poor in patients with chemotherapy, mastectomy and intense fear. There was no evidence that radiotherapy, progressive disease or perceived involvement impact the course of QoL.

Conclusions

Younger age and comorbid mental illnesses are associated with poor QoL pre-therapeutically. QoL is more likely to stay or become poor in patients who receive chemotherapy.

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References

  1. Brandberg, Y., Michelson, H., Nilsson, B., Bolund, C., Erikstein, B., Hietanen, P., et al. (2003). Quality of life in women with breast cancer during the first year after random assignment to adjuvant treatment with marrow supported high-dose chemotherapy with cyclophosphamide, thiotepa, and carboplatin or tailored therapy with fluorouracil, epirubicin, and cyclophosphamide: Scandinavian Breast Group Study 9401. Journal of Clinical Oncology, 21, 3659–3664.

    Article  CAS  PubMed  Google Scholar 

  2. D’Hoore, W., Sicotte, C., & Tilquin, C. (1993). Risk adjustment in outcome assessment: The Charlson Comorbidity Index. Methods of Information in Medicine, 32, 382–387.

    PubMed  Google Scholar 

  3. Duijts, S. F. A., van Egmond, M. P., Spelten, E., van Muijen, P., Anema, J. R., & van der Beek, A. J. (2014). Physical and psychosocial problems in cancer survivors beyond return to work: A systematic review. Psycho-Oncology, 23, 481–492.

    Article  PubMed  Google Scholar 

  4. Eisenbraun, J., Scheer, R., Kröz, M., Schad, F., & Huber, R. (2011). Quality of life in breast cancer patients during chemotherapy and concurrent therapy with a mistletoe extract. Phytomedicine, 18, 151–157.

    Article  CAS  PubMed  Google Scholar 

  5. Galea, M. H., Blamey, R. W., Elston, C. E., & Ellis, I. O. (1992). The Nottingham Prognostic Index in primary breast cancer. Breast Cancer Research and Treatment, 22, 207–219.

    Article  CAS  PubMed  Google Scholar 

  6. Gavric, Z., & Vukovic-Kostic Z. (2016). Assessment of quality of life of women with breast cancer. Global Journal of Health Science 8, 52792.

  7. Ganz, P. A., Kwan, L., Stanton, A. L., Bower, J. E., & Belin, T. R. (2011). Physical and psychosocial recovery in the year after primary treatment of breast cancer. Journal of Clinical Oncology, 29, 1101–1109.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Fayers, P. M., & Machin, D. (2007). Quality of life: The assessment, analysis and interpretation of patient-reported outcomes. Hoboken: Wiley.

    Book  Google Scholar 

  9. Goedendorp, M. M., Andrykowski, M. A., Donovan, K. A., Jim, H. S., Philips, K. M., Small, B. J., et al. (2012). Prolonged impact of chemotherapy on fatigue in breast cancer survivors. Cancer, 118, 3833–3841.

    Article  PubMed  Google Scholar 

  10. Haberman, M. R., & Bush, N. (2003). Quality of Life Methodological and Measurement Issues. In R. C. King & P. S. Hinds (Eds.), Quality of life: From nursing and patient perspectives, theory, research, practice (2nd ed., pp. 171–198). Boston: Jones and Bartlett Publishers.

    Google Scholar 

  11. Härtl, K., Schennach, R., Müller, M., Engel, J., Reinecker, H., Sommer, H., et al. (2010). Quality of life, anxiety, and oncological factors: A follow-up study of breast cancer patients. Psychosomatics, 51, 112–123.

    Article  PubMed  Google Scholar 

  12. Härtl, K., Engel, J., Herschbach, P., Reinecker, H., Sommer, H., & Friese, K. (2010). Personality traits and psychosocial stress: Quality of life over 2 years following breast cancer diagnosis and psychological impact factors. Psychooncology, 19, 160–169.

    Article  PubMed  Google Scholar 

  13. Hatam, N., Ahmadloo, N., Kia Daliri, A., Bastani, P., & Askarian, M. (2011). Quality of life and toxicity in breast cancer patients using adjuvant TAC (docetaxel, doxorubicin, cyclophosphamid), in comparison with FAC (doxorubicin, cyclophosphamide, 5-fluorouracil). Archives of Gynecology and Obstetrics, 284, 215–220.

    Article  CAS  PubMed  Google Scholar 

  14. Hayes, S. C., Johansson, K., Stout, N. L., Prosnitz, R., Armer, J. M., Gabram, S., et al. (2012). Upper-body morbidity after breast cancer. Cancer, 118, 2237–2249.

    Article  PubMed  Google Scholar 

  15. Lee, E. S., Lee, M. K., Kim, S. H., Ro, J. S., Kang, H. S., Kim, S. W., et al. (2011). Health-related quality of life in survivors with breast cancer 1 year after diagnosis compared with the general population. Annals of Surgery, 253, 101–108.

    Article  PubMed  Google Scholar 

  16. Lerman, C. E., Brody, D. S., Caputo, G. C., Smith, D. G., Lazaro, C. G., & Wolfson, H. G. (1990). Patients’ perceived involvement in care scale: Relationship to attitudes about illness and medical care. Journal of General Internal Medicine, 5, 29–33.

    Article  CAS  PubMed  Google Scholar 

  17. Löwe, B., Spitzer, R. L., Zipfel, S., & Herzog, W. (2002). PHQ-D Gesundheitsfragebogen für Patienten. Karlsruhe: Pfizer.

    Google Scholar 

  18. Lu, W., Cui, Y., Chen, X., Zheng, Y., Gu, K., Cai, H., et al. (2009). Changes in quality of life among breast cancer patients three years post-diagnosis. Breast Cancer Research and Treatment, 114, 357–369.

    Article  PubMed  Google Scholar 

  19. Montazeri, A., Vahdaninia, M., Harirchi, I., Ebrahimi, M., Khaleghi, F., & Jarvandi, S. (2008). Quality of life in patients with breast cancer before and after diagnosis: An eighteen months follow-up study. BMC Cancer, 8, 330.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Navines, R., Castellvi, P., & Moreno-Espana, J. (2012). Depressive and anxiety disorders in chronic hepatitis C patients: Reliability and validity of the Patient Health Questionnaire. Journal of Affective Disorders, 138, 343–351.

    Article  CAS  PubMed  Google Scholar 

  21. Salonen, P., Kellokumpu-Lehtinen, P. L., Tarkka, M. T., Koivisto, A. M., & Kaunonen, M. (2010). Changes in quality of life in patients with breast cancer. Journal of Clinical Nursing, 20, 255–266.

    Article  PubMed  Google Scholar 

  22. Schou, I., Ekeberg, Ø., Sandvik, L., Hjermstad, M. J., & Ruland, C. M. (2005). 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. Quality of Life Research, 14, 1813–1823.

    Article  PubMed  Google Scholar 

  23. Schwarz, R., & Hinz, A. (2001). Reference data for the quality of life questionnaire EORTC QLQ-C30 in the general German population. European Journal of Cancer, 37, 1345–1351.

    Article  CAS  PubMed  Google Scholar 

  24. Singer, S., Kuhnt, S., & Zwerenz, R. (2011). Age- and sex-standardised prevalence rates of fatigue in a large hospital-based sample of cancer patients. British Journal of Cancer, 105, 445–451.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Stanton, A. L., Rowland, J. H., & Ganz, P. A. (2015). Life after diagnosis and treatment of cancer in adulthood: Contributions from psychosocial oncology research. American Psychologist, 70, 159–174.

    Article  PubMed  Google Scholar 

  26. Stubblefield, M. D., McNeely, M. L., Alfano, C. M., & Mayer, D. K. (2012). A prospective surveillance model for physical rehabilitation of women with breast cancer. Chemotherapy-Induced Peripheral Neuropathy. Cancer, 118, 2250–2260.

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Würzburg University Hospital, Würzburg, Germany

    Achim Wöckel & M. Krockenberger

  2. Department of Obstetrics and Gynecology, Ulm University Hospital, Ulm, Germany

    L. Schwentner & W. Janni

  3. Landshut, Germany

    R. Kreienberg

  4. eScience lab, University Bremen, Bremen, Germany

    M. Wischnewsky

  5. Department of Obstetrics and Gynecology, Esslingen Hospital, Esslingen am Neckar, Germany

    Kühn Thorsten

  6. Department of Obstetrics and Gynecology, Memmingen Hospital, Memmingen, Germany

    Flock Felix

  7. Department of Obstetrics and Gynecology, Clinic of Kempten, Academic Teaching Hospital - University of Ulm, Ulm, Germany

    Felberbaum Riccardo

  8. Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Centre, Mainz, Germany

    M. Blettner & S. Singer

Authors
  1. Achim Wöckel
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  2. L. Schwentner
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  3. M. Krockenberger
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  4. R. Kreienberg
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  7. Kühn Thorsten
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  8. Flock Felix
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  10. M. Blettner
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  11. S. Singer
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Correspondence to Achim Wöckel.

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Wöckel, A., Schwentner, L., Krockenberger, M. et al. Predictors of the course of quality of life during therapy in women with primary breast cancer. Qual Life Res 26, 2201–2208 (2017). https://doi.org/10.1007/s11136-017-1570-0

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  • DOI: https://doi.org/10.1007/s11136-017-1570-0

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