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

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Abstract

Provision of social support and rehabilitation for patients with physical, mental, and functional problems after cancer treatment is important for long-term health-related quality of life (HRQOL). Effective use of human and financial healthcare resources requires identification of patients requiring rehabilitation. The objectives of the current study were to clarify the patterns of physical and psychosocial recovery over time, to evaluate the associations among baseline variables, treatment-related factors and HRQOL at 6 months, 1, and 2 years after breast cancer surgery, and to identify the significant factors predicting HRQOL at each point. A multicenter longitudinal study was performed to evaluate physical conditions, anxiety, depression, and HRQOL at 1 month (baseline), 6 months, 1, and 2 years after surgery in 196 patients (mean age: 53.3 years old) with early breast cancer and no postoperative recurrence. Physical conditions were evaluated using a patient-reported symptom checklist. HRQOL was rated using the functional assessment of cancer treatment scale-general (FACT-G) and the breast cancer subscale (FACT-B). Anxiety and depression were rated using the hospital anxiety and depression scale (HADS). More than 50% of patients had local problems of “tightness”, “arm weakness.” and “arm lymphedema”, and systemic problems of “reduced energy, fatigue, and general weakness” postoperatively. The HRQOL score significantly improved 1 year after surgery, and scores for physical, emotional and functional well-being also increased with time, whereas the score for social well-being was the highest at baseline and decreased with time. Depression and anxiety significantly improved with time. Concomitant disease, marital status, and the presence of a partner, anxiety and depression at baseline, pathological lymph node involvement, and adjuvant intravenous chemotherapy were significant factors predicting FACT-G scores at 6 months, 1, and 2 years after surgery. Depression at baseline was a strong predictor of HRQOL up to 2 years after surgery. These results suggest that physical rehabilitation is required for tightness and lymphedema to improve long-term postoperative physical function. A further study of psychosocial interventions is required to improve depression and social well-being after breast cancer surgery.

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References

  1. Matsuda T, Marugame T, Kamo K, Katanoda K, Ajiki W, Sobue T, The Japan Cancer Surveillance Research Group (2009) Cancer incidence and incidence rates in Japan in 2003: based on data from 13 population-based cancer registries in the Monitoring of Cancer Incidence in Japan (MCIJ) project. Jpn J Clin Oncol 39:850–858

    Article  PubMed  Google Scholar 

  2. Horner MJ, Ries LAG, Krapcho M, Neyman N, Aminou R, Howlader N, Altekruse SF, Feuer EJ, Huang L, Mariotto A, Miller BA, Lewis DR, Eisner MP, Stinchcomb DG, Edwards BK (eds) (2009) SEER cancer statistics review, 1975–2006. National Cancer Institute, Bethesda. http://seer.cancer.gov/csr/1975_2006/. Based on November 2008 SEER data submission, posted to the SEER web site, 2009

  3. Shimozuma K (2002) Quality of life assessment. Breast Cancer 9:100–106

    Article  PubMed  Google Scholar 

  4. American Society of Clinical Oncology (1996) Outcomes of cancer treatment for technology assessment and cancer treatment guidelines. J Clin Oncol 14:671–679

    Google Scholar 

  5. Bloom JR, Petersen DM, Kang SH (2007) Multi-dimensional quality of life among long-term (5+ years) adult cancer survivors. Psychooncology 16:691–706

    Article  PubMed  Google Scholar 

  6. Dorval M, Maunsell E, Deschênes L, Brisson J, Mâsse B (1998) Long-term quality of life after breast cancer: comparison of 8-year survivors with population controls. J Clin Oncol 16:487–494

    PubMed  CAS  Google Scholar 

  7. Casso D, Buist DS, Taplin S (2004) Quality of life of 5–10 year breast cancer survivors diagnosed between age 40 and 49. Health Qual Life Outcomes 2:25

    Article  PubMed  Google Scholar 

  8. Ganz PA, Desmond KA, Leedham B, Rowland JH, Meyerowitz BE, Belin TR (2002) Quality of life in long-term, disease-free survivors of breast cancer: a follow-up study. J Natl Cancer Inst 94:39–49

    Article  PubMed  Google Scholar 

  9. Helgeson V, Tomich P (2005) Surviving cancer: a comparison of 5-year disease-free breast cancer survivors with healthy women. Psychooncology 14:307–317

    Article  PubMed  Google Scholar 

  10. Ahles TA, Saykin AJ, Furstenberg CT, Cole B, Mott LA, Titus-Ernstoff L, Skalla K, Bakitas M, Silberfarb PM (2005) Quality of life of long-term survivors of breast cancer and lymphoma treated with standard-dose chemotherapy or local therapy. J Clin Oncol 23:4399–4405

    Article  PubMed  CAS  Google Scholar 

  11. Carver CS, Smith RG, Petronis VM, Antoni MH (2006) Quality of life among long-term survivors of breast cancer: different types of antecedents predict different classes of outcomes. Psychooncology 15:749–758

    Article  PubMed  Google Scholar 

  12. Joly F, Espié M, Marty M, Héron JF, Henry-Amar M (2000) Long-term quality of life in premenopausal women with node-negative localized breast cancer treated with or without adjuvant chemotherapy. Br J Cancer 83:577–582

    Article  PubMed  CAS  Google Scholar 

  13. Ashing-Giwa K, Ganz PA, Petersen L (1999) Quality of life of African-American and white long term breast carcinoma survivors. Cancer 85:418–426

    Article  PubMed  CAS  Google Scholar 

  14. Bloom JR, Stewart SL, Chang S, Banks PJ (2004) Then and now: quality of life of young breast cancer survivors. Psychooncology 13:147–160

    Article  PubMed  Google Scholar 

  15. Tomich P, Helgeson V (2002) Five years later: a cross-sectional comparison of breast cancer survivors with healthy women. Psychooncology 11:154–169

    Article  PubMed  Google Scholar 

  16. Kornblith AB, Herndon JE II, Weiss RB, Zhang C, Zuckerman EL, Rosenberg S, Mertz M, Payne D, Jane Massie M, Holland JF, Wingate P, Norton L, Holland JC (2003) Long-term adjustment of survivors of early-stage breast carcinoma, 20 years after adjuvant chemotherapy. Cancer 98:679–689

    Article  PubMed  Google Scholar 

  17. Dorval M, Maunsell E, Deschênes L, Brisson J (1998) Type of mastectomy and quality of life for long term breast carcinoma survivors. Cancer 15:2130–2138

    Article  Google Scholar 

  18. Schou I, Ekeberg Ø, Sandvik L, Hjermstad MJ, Ruland CM (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. Qual Life Res 14:1813–1823

    Article  PubMed  Google Scholar 

  19. Lu W, Cui Y, Chen X, Zheng Y, Gu K, Cai H, Zheng W, Shu XO (2009) Changes in quality of life among breast cancer patients three years post-diagnosis. Breast Cancer Res Treat 114:357–369

    Article  PubMed  Google Scholar 

  20. Peuckmann V, Ekholm O, Rasmussen NK, Møller S, Groenvold M, Christiansen P, Eriksen J, Sjøgren P (2007) Health-related quality of life in long-term breast cancer survivors: nationwide survey in Denmark. Breast Cancer Res Treat 104:39–46

    Article  PubMed  Google Scholar 

  21. Fehlauer F, Tribius S, Mehnert A, Rades D (2005) Health-related quality of life in long term breast cancer survivors treated with breast conserving therapy: impact of age at therapy. Breast Cancer Res Treat 92:217–222

    Article  PubMed  Google Scholar 

  22. Cimprich B, Ronis DL, Martinez-Ramos G (2002) Age at diagnosis and quality of life in breast cancer survivors. Cancer Pract 10:85–93

    Article  PubMed  Google Scholar 

  23. Broeckel JA, Jacobsen PB, Balducci L, Horton J, Lyman GH (2000) Quality of life after adjuvant chemotherapy for breast cancer. Breast Cancer Res Treat 62:141–150

    Article  PubMed  CAS  Google Scholar 

  24. Ganz PA, Greendale GA, Petersen L, Kahn B, Bower JE (2003) Breast cancer in younger women: reproductive and late health effects of treatment. J Clin Oncol 21:4184–4193

    Article  PubMed  Google Scholar 

  25. Bull AA, Meyerowitz BE, Hart S, Mosconi P, Apolone G, Liberati A (1999) Quality of life in women with recurrent breast cancer. Breast Cancer Res Treat 54:47–57

    Article  PubMed  CAS  Google Scholar 

  26. Kendall AR, Mahue-Giangreco M, Carpenter CL, Ganz PA, Bernstein L (2005) Influence of exercise activity on quality of life in long-term breast cancer survivors. Qual Life Res 14:361–371

    Article  PubMed  Google Scholar 

  27. Scott NW, Fayers PM, Aaronson NK, Bottomley A, de Graeff A, Groenvold M, Koller M, Petersen MA, Sprangers MA, EORTC Quality of Life Group; Quality of Life Cross-Cultural Meta-Analysis Group (2008) The relationship between overall quality of life and its subdimensions was influenced by culture: analysis of an international database. J Clin Epidemiol 61:788–795

    Article  PubMed  Google Scholar 

  28. Shimozuma K, Ganz PA, Petersen L, Hirji K (1999) Quality of life in the first year after breast cancer surgery: rehabilitation needs and patterns of recovery. Breast Cancer Res Treat 56:45–57

    Article  PubMed  CAS  Google Scholar 

  29. Cella DF, Tulsky DS, Gray G et al (1993) The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. J Clin Oncol 11:570–579

    PubMed  CAS  Google Scholar 

  30. Brady MJ, Cella DF, Mo F et al (1997) Reliability and validity of the Functional Assessment of Cancer Therapy—Breast Quality of Life Instrument. J Clin Oncol 15:974–986

    PubMed  CAS  Google Scholar 

  31. Fumimoto H, Kobayashi K, Chang CH, Eremenco S, Fujiki Y, Uemura S, Ohashi Y, Kudoh S (2001) Cross-cultural validation of an international questionnaire, the General Measure of the Functional Assessment of Cancer Therapy scale (FACT-G), for Japanese. Qual Life Res 10:701–709

    Article  PubMed  CAS  Google Scholar 

  32. Shimozuma K, Ohashi Y, Yoshimura K, Iha S, Saeki H, Kuroi K, Katsumata N, Okamoto T, Yamamoto Y, Tanaka K, Sonoo H (2000) Reliability and validity of the Japanese version of the Functional Assessment of Cancer Therapy-Breast (FACT-B) quality-of-life instrument; Women’s Health Outcome Study (WHOS)-01. Qual Life Res 9:287

    Google Scholar 

  33. Shimozuma K, Eguchi N (2001) Development and clinical application of QOL measurement instruments for cancer patients (I)—making Japanese versions of QOL questionnaires developed in North American or European countries and validation of reliability and validity of FACT-B, a QOL questionnaire for breast cancer patients (in Japanese). Working paper of Japan Medical Association Research Institute. http://www.jmari.med.or.jp/research/research.php?type=&mode=1&cno=&author=%B2%BC%BA%CA%B9%B8%C6%F3%CF%BA

  34. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67:361–370

    Article  PubMed  CAS  Google Scholar 

  35. Hermann C (1997) International experiences with the Hospital Anxiety and Depression scale: a review of validation data and clinical results. J Psychosom Res 42:17–41

    Article  Google Scholar 

  36. Hopwood P, Howell A, Maguire P (1991) Screening for psychiatric morbidity in patients with advanced breast cancer: validation of two self-report questionnaires. Br J Cancer 64:353–356

    Article  PubMed  CAS  Google Scholar 

  37. Ibbotson T, Maguire P, Selby P et al (1994) Screening for anxiety and depression in cancer patients: the effects of disease and treatment. Eur J Cancer 33A:37–40

    Article  Google Scholar 

  38. Kugaya A, Akechi T, Okuyama T, Okamura H, Uchitomi Y (1998) Screening for psychological distress in Japanese cancer patients. Jpn J Clin Oncol 28:333–338

    Article  PubMed  CAS  Google Scholar 

  39. Freeman SR, Washington SJ, Pritchard T, Barr L, Baildam AD, Bundred NJ (2003) Long term results of a randomised prospective study of preservation of the intercostobrachial nerve. Eur J Surg Oncol 29:213–215

    Article  PubMed  CAS  Google Scholar 

  40. Yang EJ, Park WB, Seo KS, Kim SW, Heo CY, Lim JY (2010) Longitudinal change of treatment-related upper limb dysfunction and its impact on late dysfunction in breast cancer survivors: a prospective cohort study. J Surg Oncol 101:84–91

    Article  PubMed  Google Scholar 

  41. Rietman JS, Geertzen JH, Hoekstra HJ, Baas P, Dolsma WV, de Vries J, Groothoff JW, Eisma WH, Dijkstra PU (2006) Long term treatment related upper limb morbidity and quality of life after sentinel lymph node biopsy for stage I or II breast cancer. Eur J Surg Oncol 32:148–152

    Article  PubMed  CAS  Google Scholar 

  42. Chlebowski RT, Aiello E, McTiernan A (2002) Weight loss in breast cancer patient management. J Clin Oncol 20:1128–1143

    Article  PubMed  Google Scholar 

  43. Doyle C, Kushi LH, Byers T, Courneya KS, Demark-Wahnefried W, Grant B, McTiernan A, Rock CL, Thompson C, Gansler T, Andrews KS, 2006 Nutrition, Physical Activity and Cancer Survivorship Advisory Committee, American Cancer Society (2006) Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices. CA Cancer J Clin 56:323–353

    Article  PubMed  Google Scholar 

  44. Schagen SB, van Dam FS, Muller MJ, Boogerd W, Lindeboom J, Bruning PF (1999) Cognitive deficits after postoperative adjuvant chemotherapy for breast carcinoma. Cancer 85:640–650

    Article  PubMed  CAS  Google Scholar 

  45. Schagen SB, Muller MJ, Boogerd W, Mellenbergh GJ, van Dam FS (2006) Change in cognitive function after chemotherapy: a prospective longitudinal study in breast cancer patients. J Natl Cancer Inst 98:1742–1745

    Article  PubMed  CAS  Google Scholar 

  46. Jenkins V, Shilling V, Deutsch G, Bloomfield D, Morris R, Allan S, Bishop H, Hodson N, Mitra S, Sadler G, Shah E, Stein R, Whitehead S, Winstanley J (2006) A 3-year prospective study of the effects of adjuvant treatments on cognition in women with early stage breast cancer. Br J Cancer 94:828–834

    Article  PubMed  CAS  Google Scholar 

  47. Debess J, Riis JØ, Engebjerg MC, Ewertz M (2010) Cognitive function after adjuvant treatment for early breast cancer: a population-based longitudinal study. Breast Cancer Res Treat 121:91–100

    Article  PubMed  CAS  Google Scholar 

  48. Paganini-Hill A, Clark LJ (2000) Preliminary assessment of cognitive function in breast cancer patients treated with tamoxifen. Breast Cancer Res Treat 64:165–176

    Article  PubMed  CAS  Google Scholar 

  49. Palmer JL, Trotter T, Joy AA, Carlson LE (2008) Cognitive effects of tamoxifen in pre-menopausal women with breast cancer compared to healthy controls. J Cancer Surviv 2:275–282

    Article  PubMed  Google Scholar 

  50. Schilder CM, Seynaeve C, Beex LV, Boogerd W, Linn SC, Gundy CM, Huizenga HM, Nortier JW, van de Velde CJ, van Dam FS, Schagen SB (2010) Effects of tamoxifen and exemestane on cognitive functioning of postmenopausal patients with breast cancer: results from the neuropsychological side study of the tamoxifen and exemestane adjuvant multinational trial. J Clin Oncol 28:1294–1300

    Article  PubMed  CAS  Google Scholar 

  51. Phillips KA, Ribi K, Sun Z, Stephens A, Thompson A, Harvey V, Thürlimann B, Cardoso F, Pagani O, Coates AS, Goldhirsch A, Price KN, Gelber RD, Bernhard J (2010) Cognitive function in postmenopausal women receiving adjuvant letrozole or tamoxifen for breast cancer in the BIG 1–98 randomized trial. Cognitive function in postmenopausal women receiving adjuvant letrozole or tamoxifen for breast cancer in the BIG 1–98 randomized trial. Breast 19:388–395

    Article  PubMed  Google Scholar 

  52. Fors EA, Bertheussen GF, Thune I, Juvet LK, Elvsaas IK, Oldervoll L, Anker G, Falkmer U, Lundgren S, Leivseth G (2010) Psychosocial interventions as part of breast cancer rehabilitation programs? Results from a systematic review. Psychooncology. doi:10.1002/pon.1844

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Taira, N., Shimozuma, K., Shiroiwa, T. et al. Associations among baseline variables, treatment-related factors and health-related quality of life 2 years after breast cancer surgery. Breast Cancer Res Treat 128, 735–747 (2011). https://doi.org/10.1007/s10549-011-1631-y

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  • DOI: https://doi.org/10.1007/s10549-011-1631-y

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