Trajectories of quality of life following breast cancer diagnosis

Physical health-related quality of life trajectories over two years following breast cancer diagnosis in older women: a secondary analysis

PURPOSE

To identify distinct trajectories of physical health-related quality of life (HRQoL) in older women over the first two years following breast cancer diagnosis, and to examine characteristics associated with trajectory group membership.

METHODS

A secondary analysis of a longitudinal study of women diagnosed with stage I-III breast cancer who completed surveys within eight months of diagnosis and six, twelve, and eighteen months later that focuses on a subset of women aged ≥ 65 years (N = 145).Physical HRQoL was assessed using the Physical Component Score (PCS) of the SF-36 Health Survey. Finite mixture modeling identified distinct PCS trajectories. Multivariable logistic regression identified variables predictive of low PCS group membership.

RESULTS

Two distinct patterns of PCS trajectories were identified. The majority (58%) of women had PCS above the age-based SF-36 population norms and improved slightly over time. However, 42% of women had low PCS that remained low over time. In multivariable analyses, older age, difficulty paying for basics, greater number of medical comorbidities, and higher body mass index were associated with low PCS group membership. Cancer treatment and psychosocial variables were not significantly associated.

CONCLUSION

A large subgroup of older women reported very low PCS that did not improve over time. Older age, obesity, multiple comorbidities, and lower socioeconomic status may be risk factors for poorer PCS in women with breast cancer. Incorporating routine comprehensive geriatric assessments that screen for these factors may help providers identify older women at risk for poorer physical HRQoL post breast cancer treatment.

Machine learning-derived model for predicting poor post-treatment quality of life in Korean cancer survivors

PURPOSE

A substantial number of cancer survivors have poor quality of life (QOL) even after completing cancer treatment. Thus, in this study, we used machine learning (ML) to develop predictive models for poor QOL in post-treatment cancer survivors in South Korea.

METHODS

This cross-sectional study used online survey data from 1,005 post-treatment cancer survivors in South Korea. The outcome variable was QOL, which was measured using the global QOL subscale of the European Organization of Cancer and Treatment for Cancer Quality of Life Questionnaire, where a global QOL score < 60.4 was defined as poor QOL. Three ML models (random forest (RF), support vector machine, and extreme gradient boosting) and three deep learning models were used to develop predictive models for poor QOL. Model performance regarding accuracy, area under the receiver operating characteristic curve, F1 score, precision, and recall was evaluated. The SHapely Additive exPlanation (SHAP) method was used to identify important features.

RESULTS

Of the 1,005 participants, 65.1% had poor QOL. Among the six models, the RF model had the best performance (accuracy = 0.85, F1 = 0.90). The SHAP method revealed that survivorship concerns (e.g., distress, pain, and fatigue) were the most important factors that affected poor QOL.

CONCLUSIONS

The ML-based prediction model developed to predict poor QOL in Korean post-treatment cancer survivors showed good accuracy. The ML model proposed in this study can be used to support clinical decision-making in identifying survivors at risk of poor QOL.

Health-related quality of life of premenopausal young breast cancer survivors undergoing endocrine therapy

PURPOSE

The incidence of breast cancer in premenopausal women in South Korea is higher compared to the West. This study aimed to identify factors associated with the health-related quality of life (HRQoL) among survivors with premenopausal young breast cancer undergoing endocrine therapy by examining the effects of menopausal symptoms, social support, and resilience on HRQoL.

METHODS

Cross-sectional study was used to select survivors with breast cancer undergoing endocrine therapy. The study instruments used included a basic information questionnaire, Menopause Rating Scale, Multidimensional Scale of Perceived Social Support, Connor-Davidson Resilience Scale, and Health-Related Quality of Life Instrument with 8 items. Researchers utilized independent t-tests, one-way analysis of variance, Pearson's correlation coefficients, and multiple linear regression to analyze the data. The data were collected from August to September 2021, and the questionnaire was administered via a link posted on a bulletin board of an online breast cancer survivors community. Finally, 133 questionnaires were included in the final analysis.

RESULTS

Among 150 participants, 133 completed the questionnaires. HRQoL was higher in the groups with a monthly income of ≥5 million KRW (β = 0.231, p = .011), fewer menopausal symptoms (β = -0.399, p < .001), and higher social support (β = 0.170, p = .038), and lower in the group receiving endocrine therapy and OFS (β = -0.192, p = .010). The explanatory power for HRQoL of premenopausal young breast cancer survivors undergoing endocrine therapy was 38.3% (F = 10.634, p < .001).

CONCLUSION

Breast cancer survivors should be supported to participate in economic activity, utilize rehabilitation and intervention programs to alleviate menopausal symptoms, and benefit from a social support network formed by the hospital, community, and government.

Factors Associated with Poor Quality of Life in Breast Cancer Survivors: A 3-Year Follow-Up Study

The purpose of this study was to identify subgroups of quality of life (QOL) changes in breast cancer survivors (BCSs), and to determine factors associated with subgroups of consistently low or deteriorated QOL. We enrolled 101 women recently diagnosed with breast cancer in South Korea and asked them to complete a questionnaire at baseline (within 1 month of diagnosis), 1 year later (Year 1), 2 years later (Year 2), and 3 years later (Year 3). We assessed QOL using the global QOL subscale from the EORTC QLQ-C30. We defined low QOL as a global QOL score 10 points below the mean score of the general population. Based on low QOL as defined in this study, we identified subgroups of QOL changes over 3 years. We identified four subgroups of QOL changes: improved (47.4%), stable (30%), continuously low (8.8%), and deteriorated (13.8%), and considered the last two categories (22.6%) poor QOL. Logistic regression analyses demonstrated that significant determinants of poor QOL were insomnia at Year 1, fatigue and anxiety at Year 2, and fatigue, depression, and comorbidity at Year 3. In conclusion, persistent symptoms of insomnia, fatigue, anxiety, depression, and comorbidity are potential risk factors for poor QOL in BCSs.

Patient-reported mental health and well-being trajectories in oncology patients during radiation therapy: an exploratory retrospective cohort analysis using the Ontario Cancer Registry

PURPOSE

Mental health and well-being trajectories are not expected to be homogeneous in diverse clinical populations. This exploratory study aims to identify subgroups of patients with cancer receiving radiation therapy who have different mental health and well-being trajectories, and examine which socio-demographic, physical symptoms, and clinical variables are associated with such trajectories.

METHODS

Retrospective analysis of radiation therapy patients diagnosed with cancer in 2017 was conducted using data from the Ontario Cancer Registry (Canada) and linked with administrative health data. Mental health and well-being were measured using items from the Edmonton Symptom Assessment System-revised questionnaire. Patients completed up to 6 repeated measurements. We used latent class growth mixture models to identify heterogeneous mental health trajectories of anxiety, depression, and well-being. Bivariate multinomial logistic regressions were conducted to explore variables associated with the latent classes (subgroups).

RESULTS

The cohort (N = 3416) with a mean age of 64.5 years consisted of 51.7% females. Respiratory cancer was the most common diagnosis (30.4%) with moderate to severe comorbidity burden. Four latent classes with distinct anxiety, depression, and well-being trajectories were identified. Decreasing mental health and well-being trajectories are associated with being female; living in neighborhoods with lower income, greater population density, and higher proportion of foreign-born individuals; and having higher comorbidity burden.

CONCLUSIONS

The findings highlight the importance of considering social determinants of mental health and well-being, in addition to symptoms and clinical variables, when providing care for patients undergoing radiation therapy.

Decision Tree Analyses for Prediction of QoL over a One-Year Period in Breast Cancer Patients: An Added Value of Patient-Reported Outcomes

Despite the current shift in medicine towards patient-centered care, clinicians rarely utilize patient-reported outcomes (PROs) in everyday practice. We examined the predictors of quality- of-life (QoL) trajectories in breast cancer (BC) patients during the first year after primary treatment. A total of 185 BC patients referred for postoperative radiotherapy (RT) filled in the EORTC QLQ-C30 Questionnaire assessing global QoL, functioning and cancer-related symptoms before starting RT; directly after RT; and 3, 6 and 12 months after RT. We used decision tree analyses to examine which baseline factors best allowed for predicting the one-year trajectory of the global QoL after BC treatment. We tested two models: 'basic', including medical and sociodemographic characteristics, and 'enriched', additionally including PROs. We recognized three distinct trajectories of global QoL: 'high', 'U-shape' and 'low'. Of the two compared models, the 'enriched' model allowed for a more accurate prediction of a given QoL trajectory, with all indicators of model validation being better. In this model, baseline global QoL and functioning measures were the key discriminators of QoL trajectory. Taking PROs into account increases the accuracy of the prediction model. Collecting this information in the clinical interview is recommended, especially for patients with lower QoL.

Trajectories of quality of life in breast cancer survivors during the first year after treatment: a longitudinal study

BACKGROUND

Although quality of life (QOL) improves over time for most breast cancer patients after their treatment, some patients may show different patterns of QOL. Beyond determining distinct QOL trajectories, identifying characteristics of patients who have different trajectories can help identify breast cancer patients who may benefit from intervention. We aimed to identify trajectories of QOL in breast cancer patients for one year after the end of primary treatment, to determine the factors influencing these changes.

METHODS

This longitudinal study recruited 140 breast cancer patients. Patients' QOL, symptom experience, self-efficacy, and social support were assessed using the Functional Assessment of Cancer Therapy Scale-G, Memorial Symptom Assessment Scale-Short Form, Self-Efficacy Scale for Self-Management of Breast Cancer, and Interpersonal Support Evaluation List-12. Data were collected immediately after the end of primary treatment (T1) and at three (T2), six (T3), and 12 months (T4) after primary treatment. Group-based trajectory modeling was used to identify distinct subgroups of patients with similar patterns of QOL change after treatment. A one-way analysis of variance was used to determine which variables were associated with trajectory membership. A multinomial logistic regression was performed to identify factors associated with trajectory group membership.

RESULTS

We analyzed 124 patients (mean age: 48.75 years). Latent class analysis of the QOL identified three trajectory groups: the low QOL group (n = 27; 21.1%), moderate QOL group (n = 57; 45.3%), and high QOL group (n = 40; 33.6%). The low QOL group showed consistently low QOL after the end of primary treatment, and the moderate QOL group showed a slight decrease in QOL from T1 to T3, which returned to the T1 level at T4. The high QOL group maintained a consistently high QOL. By multinomial logistic regression, psychological symptoms (odds ratio [OR] 0.46, 95% confidence interval [CI] 0.22-0.99) predicted a moderate QOL, and both psychological symptoms (OR 0.19, 95% CI 0.07-0.51) and belonging support (OR 1.60, 95% CI 1.06-2.39) predicted a high QOL.

CONCLUSION

Identifying high-risk groups for reduced QOL after the end of primary treatment is necessary. Moreover, psychosocial interventions should be provided to alleviate psychological symptoms and increase belonging support to enhance patients' QOL. Trial registration Not registered.

Long Term Effects of a Social Capital-Based Exercise Adherence Intervention for Breast Cancer Survivors With Moderate Fatigue: A Randomized Controlled Trial

OBJECTIVES

This study reports on the long-term effects of the Better Life After Cancer: Energy, Strength, and Support (BLESS) program, a 12-week social capital-based exercise adherence program for breast cancer survivors (BCS), implemented using a randomized controlled trial design. The study investigated outcomes related to cancer-related fatigue (CRF), quality of life (QOL), physical activity, depression, anxiety, sleep quality, and social capital.

METHODS

Participants who had moderate or greater CRF were randomly assigned to the intervention (n = 24), consisting of supervised and home-based exercise, or the control (n = 26), who received exercise leaflets. Generalized estimating equations models were fitted for the outcome variables. The assessment points were baseline (M1), immediately after completing the intervention at 12 weeks (M2), 1 month (M3), and 6 months post-intervention (M4).

RESULTS

A significant reduction in the total CRF score was found for both groups. We observed a significant time by group effect at M2, indicating a reduction of behavioral/severity CRF scores and a higher increase of physical activity. Also, there was an increase in the QOL score of both groups at M2, M3, and M4, compared to M1. Both groups had reduced anxiety at M3 and M4 compared to M1. The time by group effect for depression, sleep quality and social capital was not statistically significant.

CONCLUSION

This 12-week exercise adherence program improved behavioral/severity CRF and physical activity post-intervention. Both the experimental group and control group showed significant improvements in CRF, QOL, and anxiety domains compared to the baseline, which extended to 6 months post-intervention.

TRIAL REGISTRATION

Korean Clinical Research Information Service (KCT0005763).

Attachment insecurity predicts outcomes in an ACT-CBT group therapy for adults in a physical rehabilitation centre

Adapting to chronic illness or disability is accompanied by acute and ongoing illness stressors. Psychological factors such as emotional distress and low self-efficacy are common experiences in chronic illness and disability and interfere with adaptation and psychosocial outcomes such as health-related quality of life. Transdiagnostic group psychotherapy may provide a parsimonious approach to psychological treatment in rehabilitation care by targeting shared illness stressors across mixed chronic illnesses and disabilities, and shared processes that maintain psychological symptoms. Attachment theory may explain individual differences in outcomes and help identify individuals at risk of poor health-related quality of life trajectories. Adults (N=109) participated in an 8-week process-based ACT-CBT psychotherapy group at a tertiary care physical rehabilitation centre between 2016 and 2020. Participants completed measures of emotional distress, self-efficacy, health-related quality of life, and attachment at pre- and post-treatment. Multilevel analyses indicated that patients improved on most outcomes at post-treatment. Attachment anxiety at pre-treatment was associated with more positive outcomes. Reliable change indices suggest clinically meaningful change for the majority of participants, but most were not recovered. Results provide proof-of-concept for the transdiagnostic group intervention and suggest that a longer course of treatment may be clinically indicated. Results warrant replication with larger and more diverse samples, and more robust designs.

Factors influencing psychological distress and effects of stepwise psychological care on quality of life in patients undergoing chemotherapy after breast cancer surgery

OBJECTIVE

To investigate factors influencing psychological distress and the effect of stepwise psychological care on the quality of life in patients undergoing chemotherapy after breast cancer surgery.

METHODS

A retrospective study was conducted on 96 patients undergoing chemotherapy after breast cancer surgery. The patients were evenly divided into a routine care group (control group) and a stepwise psychological care group (observation group) according to the care method. The correlation between the psychological distress and the Self-Rating Anxiety Scale (SAS) score was investigated. The impact of care intervention on the psychological distress, SAS score, and the quality of life of patients before and after intervention were explored. Relevant factors that affect the psychological distress of patients undergoing chemotherapy after breast cancer surgery were also investigated.

RESULTS

A univariate analysis showed that age, residence, monthly income, education level, medical insurance status, occupation, surgery method, and anxiety score all contributed to the degree of psychological distress in patients with breast cancer mastectomy (all P<0.05). A multivariate regression analysis demonstrated that young age, low monthly income, no medical insurance, mastectomy, and high SAS score were risk factors for the psychological distress of patients who underwent mastectomy (all P<0.05). The psychological distress was positively correlated with anxiety scores of patients undergoing chemotherapy after breast cancer surgery (r=0.249, P=0.005). Both psychological distress and anxiety scores of the observation group after stepwise psychological care were significantly lower than those before treatment and those of the control group (both P<0.05). After treatment, both groups of patients showed better scores in additional concerning items, social/family well-being, functional well-being, physical well-being, emotional well-being, and overall quality of life than before treatment (all P<0.05). Of note, the observation group demonstrated better quality of life than that of the control group.

CONCLUSION

Age, low monthly income, radical mastectomy, and no medical insurance prior to undergoing chemotherapy after breast cancer surgery are independent factors that affect psychological distress. The distress was positively correlated with anxiety. Thus, stepwise psychological care may alleviate patients' psychological distress and anxiety.

Health-Related Quality of Life After Nipple-Sparing Mastectomy: Results From the INSPIRE Registry

INTRODUCTION

Nipple-sparing mastectomy (NSM) with immediate breast reconstruction (IBR) is increasingly used for both breast cancer (TNSM) and risk reduction (RRNSM). The aim of the study is to report the results of the INSPIRE registry assessing health-related quality of life (HRQoL) comparing baseline and 1-year follow-up, regarding surgical indications and chemotherapy (CT) received.

METHODS

INSPIRE is a prospective database including women undergoing NSM and IBR from 18 countries. HRQoL was measured using EORTC QLQC30 and QLQ-BR23 before surgery and after 1 year.

RESULTS

A total of 677 women were included, of whom 537 (79.3%) underwent TNSM and 140 (21.6%) RRNSM: in total, 806 NSM (556 TNSM and 250 RRNSM). Nipple involvement was present in 7.73% of TNSM and incidental carcinoma in 1.2% of the RRNSM group. Out of the overall 537 patients with systemic treatment, 177 (32.96%) received neoadjuvant chemotherapy (NCT) and 118 (21.92%) adjuvant chemotherapy (CT). A total of 227 patients (28.16%) developed at least one complication postoperatively, 164 (29.5%) in the TNSM group and 63 (25.2%) in the RRNSM group. The TNSM group improved in global health status and emotional functioning after 1 year. No differences were found when comparing HRQoL at 1 year between patients who received NCT and those who received adjuvant CT. The RRNSM group showed improvement in HRQoL, with better emotional functioning and fatigue after 1 year.

CONCLUSIONS

This registry reports HRQoL findings after NSM. The impact of CT on worse HRQoL is independent from its timing. Patients with RRNSM showed an improved HRQoL at 1-year follow-up. Discussion of HRQoL outcomes with patients will facilitate the informed decision-making when considering NSM.

Association between aspects of social support and health-related quality of life domains among African American and White breast cancer survivors

PURPOSE

Social support is associated with breast cancer survivors' health-related quality of life (HRQoL). More nuanced information is needed regarding aspects of social support associated with different HRQoL domains among diverse populations. We assessed the association between emotional/informational and tangible support and five HRQoL domains and evaluated race as an effect modifier.

METHODS

African American and White women (n = 545) diagnosed with hormone-receptor-positive breast cancer completed a survey that assessed sociodemographic, clinical, and psychosocial factors. We assessed bivariate relationships between emotional/informational and tangible support along with overall HRQoL and each HRQoL domain.We tested interactions between race and emotional/informational and tangible social support using linear regression.

RESULTS

The sample included African American (29%) and White (71%) breast cancer survivors. Emotional/informational social support had a statistically significant positive association with emotional well-being (β = .08, p = 0.005), social well-being (β = 0.36, p < 0.001), functional well-being (β = .22, p < .001), breast cancer concerns (β = .16, p = 0.002), and overall HRQoL (β = .83, p < .001). Similarly, tangible social support had a statistically significant positive association with emotional well-being (β = .14, p = 0.004), social well-being (β = .51, p < .001), functional well-being (β = .39, p < .001), and overall HRQoL (β = 1.27, p < .001). The interactions between race and social support were not statistically significant (p > 0.05).

CONCLUSIONS

Results underscore the importance of the different social support types among breast cancer survivors, regardless of survivors' race.

IMPLICATIONS FOR CANCER SURVIVORS

Population-based interventions can be standardized and disseminated to provide guidance on how to increase emotional/information and tangible support for all breast cancer survivors by caregivers, health providers, and communities.

Meaning Making for Psychological Adjustment and Quality of Life in Older Long-Term Breast Cancer Survivors

Objectives: This study aims to explore in depth the meaning and meaning discrepancies among older Norwegian breast cancer survivors in light of the meaning making model by Park (2013).

Design: We utilized a qualitative design collecting data using semi-structured interviews of 23 elderly breast cancer survivors 7–8 years after treatment. The interviews followed an interview guide structured along three main themes: “everyday life activities,” “follow-up-care experiences” and “health status and QoL.”

Results: Several health problems were reported by the women in the aftermaths of the disease, such as sleeping problems, pain, and fatigue—including cognitive and emotional impairments. Meaning discrepancies were concentrated on six main themes: shifting perspectives and priorities, growing sense of autonomy, widening the limits of normality, dissociating oneself from the disease, embracing alternative health services, and feeling lucky. The women engaged in a wide range of coping techniques as efforts to change global meaning, and to develop a more positive view on the cancer experience. Common coping efforts across the six main themes were social comparison, denial, positive reappraisal, problem-focused coping, and revaluing ordinary events.

Conclusion: Many cancer patients report on unmet needs for help with their meaning making, and the facilitation of meaning making processes is rarely included in the follow-up care of cancer survivors. The findings of the present study may help health care professionals provide care for women who have experienced breast cancer. The concrete knowledge of common coping efforts in the meaning making process may contribute to the development of future interventions and for gaining a deeper understanding for older survivors of breast cancer.

Determinants of quality of life in women immediately following the completion of primary treatment of breast cancer: A cross-sectional study

Backgrounds

Many breast cancer patients experience significant distress immediately following the completion of primary treatment. Women who report low levels of quality of life (QOL) early in this phase of transitional survivorship tend to experience diminished long-term adjustment. However, since most of the prior studies on survivors were conducted on patients at various times, studies on QOL of women during the end of primary treatment have been insufficient. This study aimed to identify determinants of QOL in women with breast cancer immediately following the completion of treatment.

Methods

A cross-sectional study was conducted on 140 disease-free breast cancer patients who had completed therapy in the past 1 month at university hospitals. Functional Assessment of Cancer Therapy-Breast (FACT-B), Memorial Symptom Assessment Scale-Short Form (MSAS-SF), Self-Efficacy Scale for Self-Management of Breast Cancer (SESSM-B), and Interpersonal Support Evaluation List-12 (ISEL-12) scales were used to assess predictors and QOL. The data were analyzed using the Pearson correlation, t-test, ANOVA, and hierarchical multiple regression.

Results

The mean score of QOL for breast cancer survivors was 97.23 (±20.01). Chemotherapy and perceived economic status were significantly associated with QOL in terms of sociodemographic and disease/treatment-related characteristics. Physical and psychological symptoms and social support had a significant association with QOL. The regression analyses showed that physical and psychological symptoms and belonging support were statistically significant in predicting the QOL of breast cancer survivors.

Conclusions

The variables of symptom experience and social support must be acknowledged when improving women’s QOL immediately after their completion of primary breast cancer treatment. Greater focus on the reduction of symptom distress and increasing a sense of belonging could improve QOL among breast cancer survivors.

Long-term quality of life among breast cancer survivors eligible for screening at diagnosis: a systematic review and meta-analysis

OBJECTIVES

This study aimed to explore the long-term quality of life (QoL) among breast cancer survivors eligible for mammographic screening at diagnosis and compare that to QoL among women with no history of breast cancer.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

A systematic review of randomised controlled trials and observational studies published between January 2000 and July 2019 was performed. Eight studies were included in the review. Six studies with QoL measurement scales (0-100) were included in the meta-analysis. We used fixed and random effects models to obtain Cohen's d with 95% confidence interval (CI). Heterogeneity among studies was evaluated by the I² statistics.

RESULTS

Information about 6145 breast cancer survivors diagnosed between 1995 and 2012 and followed for >1-10 years was analysed. Four studies used SF-36/RAND-36, three studies used EORTC QLQ-C30, one study used FACT-G and one study used FACT-B. The mean score of QoL for breast cancer survivors varied from 63.0 (RAND SF-36, 0-100) to 110.5 (FACT-B, 0-123). Two studies showed better, three studies showed similar and two studies showed poorer mean scores for breast cancer survivors compared with women with no history of breast cancer. The meta-analysis showed no significant differences in QoL for breast cancer survivors compared with women with no history of breast cancer (Cohen's d = -0.07, 95% confidence interval [CI] -0.14 to 0.00 and I² = 83.7% for the fixed effect model; Cohen's d = -0.00, 95% CI -0.18 to 0.17 and I² = 82.4% for the random effects model).

CONCLUSION

QoL did not differ between breast cancer survivors eligible for mammographic screening at diagnosis and followed for >1-10 years and women with no history of breast cancer.

Quality of life trajectories during the first three years after diagnosis of breast cancer: the NEON-BC study

BACKGROUND

We aimed to identify and characterize quality of life trajectories up to 3 years after breast cancer diagnosis.

METHODS

A total of 460 patients were evaluated at baseline (before treatments), and after 1- and 3-years. Patient-reported outcomes, including quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, QLQ-C30), anxiety, depression and sleep quality, were assessed in all evaluations. Model-based clustering was used to identify quality of life trajectories.

RESULTS

We identified four trajectories without intersection during 3 years. The two trajectories characterized by better quality of life depicted relatively stable scores; in the other trajectories, quality of life worsened until 1 year, though in one of them the score at 3 years improved. Sociodemographic and clinical characteristics at baseline did not differ between trajectories, except for mastectomy, which was higher in the worst trajectory. Anxiety, depression and poor sleep quality increased from the best to the worst trajectory.

CONCLUSIONS

The type of surgery and the variation of other patient-reported outcomes were associated with the course of quality of life over 3 years. More research to understand the heterogeneity of individual trajectories within these major patterns of variation is needed.

Breast cancer survivors: physical and mental quality of life 10 years following diagnosis, a case-control study

PURPOSE

Improvements in diagnosis and treatment of Breast Cancer (BC) have resulted in an increase in the life expectancy of survivors and in the importance of quality of life in BC survivorship care. The current study aimed to assess the Health-Related Quality Of Life (HRQOL) of BC survivors and to investigate the association of comorbidities with HRQOL compared to a group of women with no history of cancer.

METHODS

Women were residents of the central district in Israel, the case group included 250 women diagnosed with BC between 1999 and 2003, with no prior cancer history and no evidence of disease after 8-12 years. The comparison group included 250 women with no cancer history, individually matched to cases by age and area of residence. Data were collected through in-person interviews, and HRQOL was assessed using the Short Form-36 (SF-36) questionnaire. Regression analyses were performed evaluating the influence of demographic, socioeconomic, lifestyle characteristics and comorbidities on physical and mental HRQOL.

RESULTS

The physical and mental summary scores means, were 48.5 ± 11.1 and 49.2 ± 10.8 compared to 51.5 ± 10.2 and 50.9 ± 10.6, in BC survivors and the comparison group, respectively (p = 0.002 and p = 0.097). BC survivors and controls did not differ in number and type of comorbidities and for both groups a negative association was seen with HRQOL. Controlling for age, income, number of comorbidities, BMI and physical activity, BC survivor had decreased physical (b = -2.49, p = 0.001) and mental summary scores (b = -1.27, p = 0.18).

CONCLUSION

HRQOL of BC survivors should gain more attention in the area of cancer care, especially when comorbidities are present.

The psychosocial determinants of quality of life in breast cancer survivors: a scoping review

Background

Breast cancer care today involves state-of-the-art biomedical treatment but can fail to address the broader psychosocial and quality-of-life (QoL) issues associated with the transition to breast cancer survivorship. This scoping review examines the evidence on the influence of psychosocial determinants on QoL in breast cancer survivors.

Methods

Scoping review methodology was used to: (1) identify the research question(s); (2) identify relevant studies; (3) undertake study selection; (4) extract data; (5) collate, summarise and report the results.

Results

A total of 33 studies met the inclusion criteria. The majority of studies were conducted in the US (n = 22, 67%) and were mainly cross-sectional (n = 26, 79%). Sixteen psychosocial determinants of QoL were identified. Social support (n = 14, 42%), depression (n = 7, 21%) and future appraisal and perspective (n = 7, 21%) were the most frequently investigated determinants. Twelve different QoL measures were used. A range of different measurement tools were also used per psychosocial determinant (weighted average = 6). The 14 studies that measured the influence of social support on QoL employed 10 different measures of social support and 7 different measures of QoL. In general, across all 33 studies, a higher level of a positive influence and a lower level of a negative influence of a psychosocial determinant was associated with a better QoL e.g. higher social support and lower levels of depression were associated with a higher/better QoL. For some determinants such as spirituality and coping skills the influence on QoL varied, but these determinants were less commonly investigated.

Conclusion

Consensus around measures of QoL and psychological determinants would be valuable and would enable research to determine the influence of psychosocial determinants on QoL adequately. Research in other healthcare settings beyond the US is required, in order to understand the influence of organisation and follow-up clinical and supportive care on psychosocial determinants and QoL and to improve the quality of care in breast cancer survivors.

Trajectories of health-related quality of life among people with a physical disability and/or chronic disease during and after rehabilitation: a longitudinal cohort study

Purpose

To identify Health-related Quality of Life (HR-QoL) trajectories in a large heterogeneous cohort of people with a physical disability and/or chronic disease during and after rehabilitation and to determine which factors before discharge are associated with longitudinal trajectory membership.

Methods

A total of 1100 people with a physical disability and/or chronic disease were included from the longitudinal cohort study Rehabilitation, Sports and Active lifestyle. All participants participated in a physical activity promotion programme in Dutch rehabilitation care. HR-QoL was assessed using the RAND-12 Health Status Inventory questionnaire at baseline (T0: 3–6 weeks before discharge) and at 14 (T1), 33 (T2) and 52 (T3) weeks after discharge from rehabilitation. A data-driven approach using Latent Class Growth Mixture modelling was used to determine HR-QoL trajectories. Multiple binomial multivariable logistic regression analyses were used to determine person-, disease- and lifestyle-related factors associated with trajectory membership.

Results

Three HR-QoL trajectories were identified: moderate (N = 635), high (N = 429) and recovery (N = 36). Trajectory membership was associated with person-related factors (age and body mass index), disease-related factors (perceived fatigue, perceived pain and acceptance of the disease) and one lifestyle-related factor (alcohol consumption) before discharge from rehabilitation.

Conclusions

Most of the people who participated in a physical activity promotion programme obtained a relatively stable but moderate HR-QoL. The identified HR-QoL trajectories among our heterogeneous cohort are disease-overarching. Our findings suggest that people in rehabilitation may benefit from person-centred advice on management of fatigue and pain (e.g. activity pacing) and the acceptance of the disability.

Electronic supplementary material

The online version of this article (10.1007/s11136-020-02647-7) contains supplementary material, which is available to authorized users.

Pre-diagnostic allostatic load and health-related quality of life in a cohort of Black breast cancer survivors

PURPOSE

To determine the association of pre-diagnostic allostatic load (AL) with health-related quality of life (HRQOL) among Black women with breast cancer.

METHODS

In a sample of 409 Black women with non-metastatic breast cancer enrolled in the Women's Circle of Health Follow-Up Study (WCHFS), two pre-diagnostic AL measures were estimated using medical records data from up to 12 months prior to breast cancer diagnosis: AL-lipid/metabolic profile-based measure and AL-inflammatory profile-based measure. HRQOL was assessed approximately 24 months post diagnosis, using the Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B) instrument, including 5 subscale scores [presented by physical well-being (PWB), social & family well-being (SFWB), emotional well-being (EWB), functional well-being (FWB), and breast cancer-specific scale (BCS)] and 3 derived total scores [presented by trial outcome index (TOI), Functional Assessment of Cancer Therapy-General (FACT-G) and FACT-B]. We used multivariable logistic regression models, using dichotomized AL scores (lower AL: 0-3 points, higher AL: 4-8 points), to assess the associations between the two pre-diagnostic AL measures and HRQOL.

RESULTS

Higher pre-diagnostic AL was associated with poorer FWB and lower FACT-G, but these associations were statistically significant for the AL-inflammatory profile-based measure (FWB: OR 1.63, 95% CI 1.04, 2.56; FACT-G: OR 1.62, 95% CI 1.04, 2.54), but not the AL-lipid/metabolic profile-based measure (FWB: OR 1.45, 95% CI 0.81, 2.59; FACT-G: OR 1.33, 95% CI 0.75, 2.37).

CONCLUSION

These findings suggest that higher AL, particularly when measured using the inflammatory profile-based measure, was associated with poorer HRQOL, namely FWB and FACT-G, among Black breast cancer survivors.

The Needs Self-Rating Questionnaire for Breast Cancer (NSQ-BC): Development of a tool for the needs assessment of women with breast cancer in mainland China

RATIONALE, AIMS, AND OBJECTIVES

A needs assessment tool considering the cultural background of mainland China has not been reported. This study developed a Needs Self-rating Questionnaire for Breast Cancer (NSQ-BC) based on Maslow's hierarchy of needs for mainland Chinese patients.

METHODS

The Delphi technique and pilot cross-sectional surveys (two rounds) were performed for item selection. In the Delphi technique, items were selected according to the experts' perspective on the item's significance (ie, 1-5 Likert-scale ratings of importance; mean > 4.0 and coefficients of variation <0.25). In the pilot cross-sectional surveys, items were selected according to internal consistency reliability (Cronbach's α ≥ 0.70), discriminant validity (stronger correlations of the item with the hypothesized subscale than for other subscales), and convergent validity (hypothesized item-subscale correlations ≥0.40). All decisions were made based on the results of statistical analyses, recommendations of the experts, and in-depth discussion among research team members.

RESULTS

Following the two evaluation rounds, the revised NSQ-BC comprised 26 items across five subscales of needs: physical, psychological, respect/self-esteem, information, and rehabilitation. Item ratings from the expert panellists met the aforementioned criteria (ie, Kendall's W = 0.329, P < 0.001). Except for the "respect/self-esteem needs" subscale, Cronbach's α for all subscales exceeded 0.70. All items had acceptable discriminant and convergent validity. Additionally, two new items-good environment/facilities and economic support-were added to the NSQ-BC, as recommended by the experts.

CONCLUSIONS

The NSQ-BC was developed fully via the comprehensive use of Delphi technique and pilot cross-sectional surveys. It provides evidence of a proper instrument for needs assessment and evaluation among women with breast cancer in mainland China.

Municipality-based pragmatic rehabilitation stratified in accordance with individual needs-results from a longitudinal survey study

OBJECTIVE

Evidence on municipality-based cancer rehabilitation is sparse. This longitudinal study explores the following: (1) Rehabilitation needs, (2) effectiveness of municipality-based rehabilitation, and (3) whether rehabilitative services are stratified according to individual needs in breast cancer patients.

METHODS

We collected data from a longitudinal survey among 82 breast cancer patients referred to municipality-based rehabilitation at the Copenhagen Centre for Cancer and Health. Rehabilitation needs, health-related quality of life (HRQoL), and functional status were collected using patient-reported outcomes (PROs) including distress thermometer, problem list, Functional Assessment of Cancer Therapy-Breast questionnaire (FACT-B), and upper body function with the abbreviated disability of the arm, shoulder, and hand (Quick-DASH) questionnaire. Data collection time points are as follows: entry, follow-up, and end of intervention.

RESULTS

At referral, scores were (mean (range)) distress 4.0 (0-10), problems 9.5 (0-24), and FACT-B 103.0 (49.8-135.5). HRQoL increased during rehabilitation (FACT-B ∆ mean 8.1 points (> MID, p < 0.0001)); 56% had a positive change, 34% no difference, and 11% a decline. Those with the lowest FACT-B entry score had significantly longer duration of rehabilitation (10.9 vs 8.7 months, p < 0.001), higher number of services (7.0 vs 5.3, p < 0.003), and participated more in group-based exercise (+3 sessions: 57% vs 8%, p < 0.001).

CONCLUSION

This is the first study to report on pragmatic municipality-based cancer rehabilitation. The results suggest that services are aimed at patients with rehabilitation needs, improve HRQoL, and are properly stratified to those who need it the most. We suggest future monitoring of municipality-based rehabilitation services to ensure quality of care.