Health‐related quality of life among breast cancer survivors and noncancer controls over 10 years: Pink SWAN

Abstract

BACKGROUND:The goal of this study was to compare health-related quality of life (HRQL) from diagnosis to 10 years postdiagnosis among breast cancer survivors (BCS) and women without cancer over the same period and to identify BCS subgroups exhibiting different HRQL trajectories. METHODS: Our analysis included 141 BCS and 2086 controls from the Study of Women's Health Across the Nation (SWAN), a multiracial/ethnic cohort study of mid-life women assessed approximately annually from 1995 to 2015. Pink SWAN participants reported no cancer at SWAN enrollment and developed (cases) or did not develop (controls) incident breast cancer after enrollment. We assessed HRQL with SF-36 Mental Component Summary and Physical Component Summary scores. We modeled each as a function of case/control status, years since diagnosis, years since diagnosis squared, and the interaction terms between case/control status and the 2 time variables in linear models. We characterized heterogeneity in postdiagnosis HRQL of cases using group-based trajectories. RESULTS: BCS had significantly lower HRQL compared with controls at diagnosis and 1 year postdiagnosis. By 2 years, BCS and controls no longer differed significantly. Among BCS, 2 trajectory groups were identified for both scores. For the Mental Component Summary, 88.4% of BCS had consistently good and 11.6% had very low scores. For the Physical Component Summary, 73.9% had good scores, and 26.1% had consistently low scores. Prediagnosis perceived stress and current smoking were related to being in the low mental trajectory group, and a higher number of comorbidities was related to being in the low physical trajectory group. CONCLUSION: Although the majority of BCS have HRQL similar to non-cancer controls after 2 years, subgroups of BCS continue to have low HRQL. Prediagnosis stress, comorbidities, and smoking are vulnerability factors for long-term, low HRQL in BCS. Cancer 2020;126:2296-2304.

Psychological Resilience and Health-Related Quality of Life in 418 Swedish Women with Primary Breast Cancer: Results from a Prospective Longitudinal Study

“…Intense BC treatments can induce many side effects over the cancer trajectory, which could explain the decline that also occurred in the physical aspects of HRQoL at one year post diagnosis. Lower levels of HRQoL in BC patients compared to the population norms have been demonstrated in previous studies [ 11 , 36 ], but studies exploring resilience in relation to HRQoL are limited. Despite differences in the HRQoL instruments, our findings are in agreement with the results reported by Ristevska-Dimitrovska et al, Zhang et al, and Tu et al, demonstrating that the levels of resilience are positively related to the levels of HRQoL in BC patients [ 8 , 9 , 16 ].…”

“…High-resilience patients will more effectively manage their new life situations [ 3 ]. Due to its favorable survival rate, HRQoL has become an important outcome measure for BC patients [ 10 , 11 ], and by adding resilience, it might be possible to predict HRQoL and to identify those most in need of additional rehabilitation interventions [ 5 ].…”

Patient-reported outcomes in postmenopausal breast cancer survivors – comparisons with normative data

“…In contrast, regarding the more specific subscales, BC survivors reported higher levels of symptoms, e.g., fatigue and dyspnea, as well as larger deficits in role, emotional, social and cognitive functioning [17][18][19][20][21]. Other studies used the 36-item Short-Form Health Survey (SF-36) questionnaire [22] and likewise found impairment in HRQoL in BC survivors compared to the reference populations [23][24][25][26]. It should be noted in one study, differences where moderated by time since diagnosis with the largest differences closest to diagnosis [24], and in two other studies differences between BC survivors and control groups were only found one year postdiagnosis with follow-up periods of respectively two years and ten years [25,26].…”

Long-term health-related quality of life of breast cancer survivors remains impaired compared to the age-matched general population especially in young women. Results from the prospective controlled BREX exercise study

“…Two cross-sectional studies reported that HRQoL approached the level of the general population or controls without cancer after approximately five years [4,25]. Several longitudinal studies with longer follow-up periods extending up to ten years post-diagnosis, however, have reported that a new downward shift in HRQoL was seen after an initial improvement in the first years and that survivors had lower HRQoL, more symptoms, and decreased functions even ten or more years after treatment [2,3,27,28]. A delayed decline in HRQoL might reflect late effects resulting from cancer and its treatment, such as cardiac, respiratory, or musculoskeletal problems that may appear more than five years after treatment [29,30].…”