Quality of life among long‐term survivors of breast cancer: different types of antecedents predict different classes of outcomes

Abstract

SUMMARYQuality of life (QOL) has many aspects, both in the short-term and in the long-term. Different aspects of QOL may have different types of precursors: demographic, medical, and psychosocial. We examined this possibility in a group of long-term breast cancer survivors. Early-stage breast cancer patients (N ¼ 163) who had provided information about medical, demographic, and psychosocial variables during the year after surgery completed a multidimensional measure of QOL 5-13 years later. Initial chemotherapy and higher stage predicted greater financial problems and greater worry about appearance at follow-up. Being partnered at diagnosis predicted many psychosocial benefits at follow-up. Hispanic women reported greater distress and social avoidance at follow-up. Initial trait optimism predicted diverse aspects of better psychosocial QOL at follow-up, but not other aspects of QOL. Thus, different aspects of QOL at long-term follow-up had different antecedents. Overall, psychological outcomes were predicted by psychosocial variables, presence of a partner at diagnosis, and ethnicity. Financial outcomes, in contrast, were predicted by medical variables, which otherwise predicted little about long-term QOL. This divergence among aspects of QOL should receive closer attention in future work.

Associations among baseline variables, treatment-related factors and health-related quality of life 2 years after breast cancer surgery

“…This finding requires further analysis, since cancer progression generally correlates with poor HRQOL [11,20]. Of the treatment-related factors, intravenous systemic chemotherapy after surgery was the strongest significant predictor for HRQOL.…”

“…The improvement of overall HRQOL after surgery for breast cancer is generally dependent on the time from diagnosis to treatment [5]. However, breast cancer patients after diagnosis have poorer physical functioning in comparison with healthy controls [6][7][8][9], and more frequent malaise [10][11][12]. Furthermore, breast cancer patients feel more stress and anxiety about the future compared to the general population and have lower mental domain scores [13][14][15].…”

“…This includes clarifying patterns of physical and psychosocial recovery over time, identifying social backgrounds, clinicopathological and treatment-related factors that influence long-term HRQOL, and identifying areas and persons requiring support in the future. Factors with significant effects on long-term HRQOL after treatment of breast cancer include age [18][19][20][21][22][23][24][25], race [9,25], educational status [19][20][21], income [7,8,13], marriage [11,13,21,24,25], recurrence [9,26], disease period [11,20], surgical procedure [7,19,20], chemotherapy [8,10,11,14,20,24], physical activities [27] and culture [25,28]. In our previous longitudinal prospective study, the factors predicting HRQOL at one year after surgery were mood disturbance, poor body image, lower income and positive axillary nodes one month after surgery [17].…”

Enhancing adaptation during treatment and the role of individual differences

“…Using this measure, we recently determined that different aspects of long-term quality of life have quite different antecedents. 42 Most outcomes that are psychosocial in nature are predicted best by personality and social integration (as in the analyses discussed above). However, another important aspect of well being-financial worries-was predicted only by medical variables.…”

The rationale, design, and implementation of the American Cancer Society's studies of cancer survivors

“…34,[47][48][49] Cancer survivors also have reported problems with life and health insurance, 34,50,51 employment, 12,[52][53][54][55] and social reintegration. 56,57 Although a growing body of research has begun to document the problems cancer survivors experience, several factors have limited the generalizability of these findings. Most studies of QOL in long-term cancer survivors have been conducted at major cancer centers and often suffer from an under representation of minority, poor, rural, and other hard-to-reach populations.…”