Abstract
Purpose
Little is known about the importance of various factors which impair the quality of life (QOL) in survivors of breast cancer 1 year after diagnosis and over 1 year after diagnosis in China. Hence, the goal of this article is to quantitatively evaluate the factors which play an active role in impairing QOL 1 year after diagnosis and over 1 year after diagnosing survivors.
Methods
A population-based cross-sectional study was conducted at 34 Cancer Recovery Clubs across China from May 2014 to January 2015. The simplified Chinese version of the Quality of Life Questionnaire-Core 30 items (EORTC QLQ-C30) and the Breast Cancer-specific module QLQ-23 were used to measure QOL in 10794 Chinese women with breast cancer (1 year after diagnosis: 1029, over 1 year after diagnosis: 9765). Forward stepwise multivariable regression analysis was used to identify the most predictive factors for limitations on QOL. Partial R 2 values were calculated to appraise the independent proportion of explained variance within QOL by each factor included in the model.
Results
The participants had higher scores of role functioning, sexual function, sexual enjoyment, and financial difficulties. The uppermost predictors of functional status and QOL were financial difficulties and fatigue for the 1 year after diagnosis, respectively, and fatigue, financial difficulties, and systemic side effects for the long-term survivors. These symptoms explained approximately 28–53% of the variability within the function scores and QOL expect for sexual enjoyment and sexual functioning. Although sociodemographic and clinical factors had a relative importance to sexual function and sexual enjoyment, they were even smaller and had less of an impact on other dimensions.
Conclusions
People who were more active and had an optimistic attitude towards life had relatively higher function scores. For the breast cancer patients 1 year after diagnosis, reducing the burden of fatigue might be a more preferable way to improve their functional status and QOL. Nevertheless, focusing on fatigue symptoms and systemic therapy side effects synchronously may present an especially worthwhile endeavor to enhance the long-term survivors’ functional status and QOL.
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References
World Health Organization (2017) http://www.who.int/mediacentre/factsheets/fs297/en/
Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, Jemal A, Yu XQ, He J (2016) Cancer statistics in China, 2015. CA Cancer J Clin 66:115–132. doi:10.3322/caac.21338
Coyne P, Navidi M, Wuchukwu OI (2011) Survivorship in breast cancer—factors affecting quality of life. Eur J Surg Oncol 37:986–987
Conde DM, Pinto-Neto AM, Cabello C, Santos-Sá D, Costa-Paiva L, Martinez EZ (2005) Quality of life in Brazilian breast cancer survivors age 45–65 years: associated factors. Breast J 11(6):425–432
Hopwood P, Haviland J, Mills J, Sumo G, Bliss JM (2007) The impact of age and clinical factors on quality of life in early breast cancer: an analysis of 2208 women recruited to the UK Start Trial (Standardisation of breast radiotherapy trial). Breast 16(3):241–251
Ryu YM, Yi M (2013) The factors influencing quality of life in women with breast cancer. Asian Oncol Nurs 13:121
Hwang E, Yi M (2014) Factors influencing quality of life in patients with breast cancer on hormone therapy. J Korean Acad Nurs 44:108
Ohsumi S, Shimozuma K, Morita S, Hara F, Takabatake D, Takashima S, Taira N, Aogi K, Takashima S (2009) Factors associated with health-related quality-of-life in breast cancer survivors: influence of the type of surgery. Jpn J Clin Oncol 39:491
Moro-Valdezate D, Buch-Villa E, Peiró S, Morales-Monsalve MD, Caballero-Gárate A, Martínez-Agulló Á, Checa-Ayet F, Ortega-Serrano J (2014) Factors associated with health-related quality of life in a cohort of Spanish breast cancer patients. Breast Cancer 21:442–452
Ward MA (2013) Factors affecting quality of life in breast cancer survivors. Proceedings: 9th annual symposium: graduate research and scholarly projects. Wichita State University, Wichita, pp 10–11
Bernhard J, Hürny C, Coates AS, Peterson HF, Castiglionegertsch M, Gelber RD, Galligioni E, Marini G, Thürlimann B, Forbes JF (1998) Factors affecting baseline quality of life in two international adjuvant breast cancer trials. International Breast Cancer Study Group (IBCSG). Br J Cancer 78:686–693
Albtoosh LA, Alatiyyat NM (2014) Factor effects quality of life among breast cancer survival patient. SSRN Elect J. doi:10.2139/ssrn.2378593
Hamer J, Mcdonald R, Zhang L, Verma S, Leahey A, Ecclestone C, Bedard G, Pulenzas N, Bhatia A, Chow R (2017) Quality of life (QOL) and symptom burden (SB) in patients with breast cancer. Support Care Cancer 25:409
Tiezzi MF, de Andrade JM, Romão AP, Tiezzi DG, Lerri MR, Carrara HA, Lara LA (2017) Quality of Life in women with breast cancer treated with or without chemotherapy. Cancer Nurs 40:108
Tang F, Wang J, Tang Z, Kang M, Deng Q, Yu J (2016) Quality of life and its association with physical activity among different types of cancer survivors. PloS one 11:e0164971
Smith AW, Alfano CM, Reeve BB, Irwin ML, Bernstein L, Baumgartner K, Bowen D, Mctiernan A, Ballardbarbash R (2009) Race/Ethnicity, physical activity and quality of life in breast cancer survivors. Cancer Epidemiol Biomark Prev 18:656–663
Irukulla M, Vaghmare R, Joseph D, Ahmed SF, Jonnadula J, Valiyaveettil D (2016) Impact of comorbidities on quality of life in breast cancer patients. Indian J Cardiovasc Dis J women (IJCD) 1:1–5
Dodd MJ, Cho MH, Bank KA, Cooper BA, Lee KA, Miaskowski C (2005) Impact of Symptom Clusters on Quality of Life (QOL) Dimensions in Breast Cancer Patients. In: 16 th International Nursing Research Congress
Ahmed AE, Alharbi AG, Alsadhan MA, Almuzaini AS, Almuzaini HS, Ali YZ, Jazieh AR (2017) The predictors of poor quality of life in a sample of Saudi women with breast cancer. Breast Cancer 9:51–58. doi:10.2147/BCTT.S125206
Arndt V, Stegmaier C, Ziegler H, Brenner H (2006) A population-based study of the impact of specific symptoms on quality of life in women with breast cancer 1 year after diagnosis. Cancer 107:2496–2503. doi:10.1002/cncr.22274
Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC (2005) The European Organization for research and treatment of cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. JNCI 85:365–376
Sprangers MA, Groenvold M, Arraras JI, Franklin J, Te VA, Muller M, Franzini L, Williams A, de Haes HC, Hopwood P (1996) The European Organization for research and treatment of cancer breast cancer-specific quality-of-life questionnaire module: first results from a three-country field study. J Clin Oncol 14:2756
Tang Z, Wang JW, Zhang QY, Sun L, Tang FR, Kang M, Yu JM (2015) QLQ-BR23 and EORTC QLQ-C30 for the measurement of the impact of rehabilitation exercise on quality of life in breast cancer patients. Fudan Univ J Med Sci 42:589–595
Fayers PM, Aaronson NK, Bjordal K (2001) The EORTC QLQ-C30 scoring manual. EORTC Data Center, Brussels
Scott NW, Fayers PM, Aaronson NK, Bottomley A, De Graeff A, Groenvold M, Gundy C, Koller M, Petersen MA, Mirjam AG Sprangers on behalf of the EORTC Quality of Life Group (2008) EORTC QLQ-C30 Reference values. EORTC Quality of Life Study Group. pp 1–427
Chie WC, Chang KJ, Huang CS, Kuo WH (2003) Quality of life of breast cancer patients in Taiwan: validation of the Taiwan Chinese version of the EORTC QLQ-C30 and EORTC QLQ-BR23. Psycho 12(7):729–735. doi:10.1002/pon.727
King PKMT, Shiell A, Hall J, Boyages J (2000) Quality of life three months and one year after first treatment for early stage breast cancer: influence of treatment and patient characteristics. Qual Life Res 9:789–800
Kim HJ (2007) Symptom prevalence and intensity in breast cancer patients receiving treatment. In: The 18th International Nursing Research Congress Focusing on Evidence-Based Practice
Berger AM, Visovsky C, Hertzog M, Holtz S, Jr LF (2012) Usual and worst symptom severity and interference with function in breast cancer survivors. J Support Oncol 10:112
Zafar SY, Peppercorn JM, Schrag D, Taylor DH, Goetzinger AM, Zhong X, Abernethy AP (2013) The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient’s experience. Oncologist 18:381–390. doi:10.1634/theoncologist.2012-0279
Chino F, Peppercorn J, Jr DHT, Lu Y, Samsa G, Abernethy AP, Zafar SY (2014) Self-reported financial burden and satisfaction with care among patients with cancer. Oncologist 19:414
Ramsey SD, Bansal A, Fedorenko CR, Blough DK, Overstreet KA, Shankaran V, Newcomb P (2016) Financial insolvency as a risk factor for early mortality among patients with cancer. J Clin Oncol 34:980
Curt GA (2000) Impact of fatigue on quality of life in oncology patients. Semin Hematol 37:14
Spiegel D, Sands S, Koopman C (1994) Pain and depression in patients with cancer. Cancer 74:2570–2578
Blesch KS, Paice JA, Wickham R, Harte N, Schnoor DK, Purl S, Rehwalt M, Kopp PL, Manson S, Coveny SB (1991) Correlates of fatigue in people with breast or lung cancer. Oncol Nurs Forum 18:81
Ferrell BR, Grant MM, Funk BM, Otis-Green SA, Garcia NJ (1998) Quality of life in breast cancer survivors: implications for developing support services. Oncol Nurs Forum 25:887–895
Maunsell E, Brisson J, Deschênes L (1993) Arm problems and psychological distress after surgery for breast cancer. Can J Surg 36:315
Bower JE, Ganz PA, Desmond KA, Rowland JH, Meyerowitz BE, Belin TR (2000) Fatigue in breast cancer survivors: occurrence, correlates, and impact on quality of life. J Clin Oncol 18:743
Cella D (2004) The longitudinal relationship of hemoglobin, fatigue and quality of life in anemic cancer patients: results from five randomized clinical trials. Ann Oncol 15:979–986. doi:10.1093/annonc/mdh235
Scott JA, Lasch KE, Barsevick AM, Piault-Louis E (2011) Patients’ experiences with cancer-related fatigue: a review and synthesis of qualitative research. Oncol Nurs Forum 38:E191–E203
Wanchai A, Armer JM, Stewart BR (2011) Nonpharmacologic supportive strategies to promote quality of life in patients experiencing cancer-related fatigue: a systematic review. Clin J Oncol Nurs 15:203–214
Spence RR, Heesch KC, Brown WJ (2010) Exercise and cancer rehabilitation: a systematic review. Cancer Treat Rev 36:185–194
Brown JC, Huedo-Medina TB, Pescatello SM, Ferrer RA, Johnson BT, Pescatello LS (2011) the efficacy of exercise interventions on fatigue among cancer survivors: a meta-analysis. Med Sci Sports Exerc 43:277–278
Berger AM, Gerber LH, Mayer DK (2012) Cancer-related fatigue: implications for breast cancer survivors. Cancer 118:2261
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We thank the study participants and the research staff for their contribution to this project.
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Xia, J., Tang, Z., Deng, Q. et al. Predictors of the quality of life in Chinese breast cancer survivors. Breast Cancer Res Treat 167, 537–545 (2018). https://doi.org/10.1007/s10549-017-4512-1
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DOI: https://doi.org/10.1007/s10549-017-4512-1