Skip to main content

Advertisement

SpringerLink
Log in

Trends in health-related quality of life of female breast cancer survivors using the Medical Expenditure Panel Survey (MEPS), 2008–2016

  • Published:
Quality of Life Research Aims and scope Submit manuscript

Abstract

Purpose

In recent years, breast cancer detection and treatment have advanced. As a result, increased attention to breast cancer survivorship should have improved their health-related quality of life (HRQoL). Our aim was to examine the trends in the HRQoL of female breast cancer survivors between 2008 and 2016, to determine whether or not the increased focus on survivorship has translated into improved HRQoL. Furthermore, stratified analyses were conducted by race/ethnicity and age group and these were compared to a similar group of women without a breast cancer history.

Methods

Repeated cross-sectional analyses using the Medical Expenditure Panel Survey between 2008 and 2016 were conducted. Pooled ordinary least squares (OLS) regression was used to examine the trends in physical component scores (PCS-12) and mental component scores (MCS-12) among breast cancer survivors and a similar population of women without a breast cancer history. Analyses stratified by race/ethnicity and age group were also conducted.

Results

Among breast cancer survivors, after adjusting for confounders, there was no change in PCS-12 scores over time, but the MCS-12 scores increased by 0.27 points (95% CI 0.09–0.45). Those without a history of breast cancer had mean PCS-12 scores that were 0.13 points greater each year (95% CI 0.02–0.24) while their mean MCS-12 scores were 0.10 (95% CI 0.00–0.21) points greater each year. After stratifying by race/ethnicity, Hispanic breast cancer survivors had a small increase in PCS-12 (β: 0.65; 95% CI 0.01–1.29), and MCS-12 scores (β: 0.70; 95% CI 0.06–1.33) over time. Similar small effects were found when stratified by age group, both among breast cancer survivors and those without a history of breast cancer. The younger age group (< 50 years) reported poorer MCS-12 than the older population (age 50 years and above).

Conclusion

Our study generated findings showing the trends in the HRQoL of breast cancer survivors and compared these to a similar population of women without a history of breast cancer. This paper highlights the importance of focusing on the mental health of young breast cancer survivors to improve their prospects at a good quality of life post-breast cancer diagnosis and treatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Siegel, R. L., Miller, K. D., & Jemal, A. (2017). Cancer statistics, 2017. CA: A Cancer Journal for Clinicians, 67(1), 7–30.

    Google Scholar 

  2. Siegel, R. L., Miller, K. D., & Jemal, A. (2019). Cancer statistics, 2019. CA: A Cancer Journal for Clinicians, 69(1), 7–34.

    Google Scholar 

  3. DiSipio, T., Hayes, S., Newman, B., & Janda, M. (2008). Health-related quality of life 18 months after breast cancer: Comparison with the general population of Queensland Australia. Support Care in Cancer, 16(10), 1141–1150.

    Article  Google Scholar 

  4. Lee, E. S., Lee, M. K., Kim, S. H., Ro, J. S., Kang, H. S., Kim, S. W., Lee, K. S., & Yun, Y. H. (2011). Health-related quality of life in survivors with breast cancer 1 year after diagnosis compared with the general population: A prospective cohort study. Annals of Surgery, 253(1), 101–108.

    Article  PubMed  Google Scholar 

  5. Noone, A. M., Howlader, N., Krapcho, M., Miller, D., Brest, A., Yu, M., Ruhl, J., Tatalovich, Z., Mariotto, A., Lewis, D. R., & Chen, H. S. (2018). SEER cancer statistics review, 1975–2015. National Cancer Institute.

    Google Scholar 

  6. Berry, D. A., Cronin, K. A., Plevritis, S. K., Fryback, D. G., Clarke, L., Zelen, M., Mandelblatt, J. S., Yakovlev, A. Y., Habbema, J. D., Feuer, E. J., & Cancer Intervention and Surveillance Modeling Network (CISNET) Collaborators. (2005). Effect of screening and adjuvant therapy on mortality from breast cancer. New England Journal of Medicine, 353(17), 1784–1792.

    Article  CAS  Google Scholar 

  7. Miller, K. D., Nogueira, L., Mariotto, A. B., Rowland, J. H., Yabroff, K. R., Alfano, C. M., Jemal, A., Kramer, J. L., & Siegel, R. L. (2019). Cancer treatment and survivorship statistics, 2019. CA: A Cancer Journal for Clinicians, 69(5), 363–385.

    Google Scholar 

  8. Amatya, B., Khan, F., & Galea, M. P. (2017). Optimizing post-acute care in breast cancer survivors: A rehabilitation perspective. Journal of Multidisciplinary Healthcare, 10, 347–357.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Runowicz, C. D., Leach, C. R., Henry, N. L., Henry, K. S., Mackey, H. T., Cowens-Alvarado, R. L., Cannady, R. S., Pratt-Chapman, M. L., Edge, S. B., Jacobs, L. A., Hurria, A., Marks, L. B., LaMonte, S. J., Warner, E., Lyman, G. H., & Ganz, P. A. (2016). American cancer society/American society of clinical oncology breast cancer survivorship care guideline. CA: A Cancer Journal for Clinicians, 66(1), 43–73.

    Google Scholar 

  10. Shin, W. K., et al. (2017). The association between physical activity and health-related quality of life among breast cancer survivors. Health and Quality of Life Outcomes, 15(1), 132.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Mokhatri-Hesari, P., & Montazeri, A. (2020). Health-related quality of life in breast cancer patients: Review of reviews from 2008 to 2018. Health and Quality of Life Outcomes, 18(1), 338.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Andrykowski, M. A., Lykins, E., & Floyd, A. (2008). Psychological health in cancer survivors. Seminars in Oncology Nursing, 24(3), 193–201.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Deimling, G. T., et al. (2002). Cancer survivorship and psychological distress in later life. Psycho-Oncology, 11(6), 479–494.

    Article  PubMed  Google Scholar 

  14. HealthyPeople.gov. (2020). Health-related quality of life and well-being. Available from https://www.healthypeople.gov/2020/topics-objectives/topic/health-related-quality-of-life-well-being. Accessed 5 Feb 2020.

  15. Ashing-Giwa, K., Ganz, P. A., & Petersen, L. (1999). Quality of life of African-American and white long term breast carcinoma survivors. Cancer: Interdisciplinary International Journal of the American Cancer Society, 85(2), 418–426.

    Article  CAS  Google Scholar 

  16. Health-related quality of life concepts. 2018 [cited 2019 February 23]; Available from https://www.cdc.gov/hrqol/concept.htm. Accessed 23 Feb 2019. 

  17. Ware, J. E., Jr., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30(6), 473–483.

    Article  PubMed  Google Scholar 

  18. Brazier, J. E., Harper, R., Jones, N. M., O’Cathain, A., Thomas, K. J., Usherwood, T., & Westlake, L. (1992). Validating the SF-36 health survey questionnaire: New outcome measure for primary care. BMJ, 305(6846), 160–164.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Mols, F., Vingerhoets, A. J., Coebergh, J. W., & van de Poll-Franse, L. V. (2005). Quality of life among long-term breast cancer survivors: A systematic review. European Journal of Cancer, 41(17), 2613–2619.

    Article  PubMed  Google Scholar 

  20. Greaney, M. L., Cohen, S. A., Blissmer, B. J., Earp, J. E., & Xu, F. (2019). Age-specific trends in health-related quality of life among US adults: Findings from National Health and Nutrition Examination Survey, 2001–2016. Quality of Life Research, 28(12), 3249–3257.

    Article  PubMed  Google Scholar 

  21. Klein, D., Mercier, M., Abeilard, E., Puyraveau, M., Danzon, A., Dalstein, V., Pozet, A., Guizard, A. V., Henry-Amar, M., & Velten, M. (2011). Long-term quality of life after breast cancer: A French registry-based controlled study. Breast Cancer Research and Treatment, 129(1), 125–134.

    Article  PubMed  Google Scholar 

  22. Ahn, S. H., Park, B. W., Noh, D. Y., Nam, S. J., Lee, E. S., Lee, M. K., Kim, S. H., Lee, K. M., Park, S. M., & Yun, Y. H. (2007). Health-related quality of life in disease-free survivors of breast cancer with the general population. Annals of Oncology, 18(1), 173–182.

    Article  CAS  PubMed  Google Scholar 

  23. LeMasters, T., Madhavan, S., Sambamoorthi, U., & Kurian, S. (2013). A population-based study comparing HRQoL among breast, prostate, and colorectal cancer survivors to propensity score matched controls, by cancer type, and gender. Psycho-Oncology, 22(10), 2270–2282.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Helgesson, O., Lissner, L., Månsson, J., & Bengtsson, C. (2007). Quality of life in cancer survivors as observed in a population study of Swedish women. Scandinavian Journal of Primary Health Care, 25(4), 220–225.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Peuckmann, V., Ekholm, O., Rasmussen, N. K., 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 Research and Treatment, 104(1), 39–46.

    Article  PubMed  Google Scholar 

  26. Koch, L., Jansen, L., Herrmann, A., Stegmaier, C., Holleczek, B., Singer, S., Brenner, H., & Arndt, V. (2013). Quality of life in long-term breast cancer survivors—a 10-year longitudinal population-based study. Acta Oncologica, 52(6), 1119–1128.

    Article  PubMed  Google Scholar 

  27. Lee, S. H., Min, Y. S., Park, H. Y., & Jung, T. D. (2012). Health-related quality of life in breast cancer patients with lymphedema who survived more than one year after surgery. Journal of Breast Cancer, 15(4), 449–453.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Moadel, A. B., Shah, C., Wylie-Rosett, J., Harris, M. S., Patel, S. R., Hall, C. B., & Sparano, J. A. (2007). Randomized controlled trial of yoga among a multiethnic sample of breast cancer patients: Effects on quality of life. Journal of Clinical Oncology, 25(28), 4387–4395.

    Article  PubMed  Google Scholar 

  29. Mishra, S. I., Scherer, R. W., Geigle, P. M., Berlanstein, D. R., Topaloglu, O., Gotay, C. C., & Snyder, C. (2012). Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database of Systematic Reviews. https://doi.org/10.1002/14651858.CD007566.pub2

    Article  Google Scholar 

  30. Pennington, K. P., & McTiernan, A. (2018). The role of physical activity in breast and gynecologic cancer survivorship. Gynecologic Oncology, 149(1), 198–204.

    Article  PubMed  Google Scholar 

  31. Ochoa, C., Casellas-Grau, A., Vives, J., Font, A., & Borràs, J. M. (2017). Positive psychotherapy for distressed cancer survivors: Posttraumatic growth facilitation reduces posttraumatic stress. International Journal of Clinical and Health Psychology, 17(1), 28–37.

    Article  PubMed  Google Scholar 

  32. Cozzens, S. E. (2010). Quality of life returns from basic research. Health Research Policy and Systems, 8, 18.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Blewett, L. A., Risa Griffin, J.A.R.D., Williams, K. C.W. (2019). IPUMS Health Surveys: Medical Expenditure Panel Survey, Version 1.1[Data set]. Minneapolis, MN: IPUMS, 2019. https://doi.org/10.18128/D071.V1.1. Available from https://meps.ipums.org.

  34. National Cancer Institute: Office of cancer survivorship definitions. [cited 2019 April 5]; Available from https://cancercontrol.cancer.gov/ocs/statistics/definitions.html. Accessed 5 Apr 2019. 

  35. Paskett, E. D., Alfano, C. M., Davidson, M. A., Andersen, B. L., Naughton, M. J., Sherman, A., McDonald, P. G., & Hays, J. (2008). Breast cancer survivors’ health-related quality of life : Racial differences and comparisons with noncancer controls. Cancer, 113(11), 3222–3230.

    Article  PubMed  Google Scholar 

  36. Weaver, K. E., Forsythe, L. P., Reeve, B. B., Alfano, C. M., Rodriguez, J. L., Sabatino, S. A., Hawkins, N. A., & Rowland, J. H. (2012). Mental and physical health–related quality of life among US cancer survivors: Population estimates from the 2010 National Health Interview Survey. Cancer Epidemiology and Prevention Biomarkers, 21(11), 2108–2117.

    Article  Google Scholar 

  37. Eide, M. J., Krajenta, R., Johnson, D., Long, J. J., Jacobsen, G., Asgari, M. M., Lim, H. W., & Johnson, C. C. (2010). Identification of patients with nonmelanoma skin cancer using health maintenance organization claims data. American Journal of Epidemiology, 171(1), 123–128.

    Article  PubMed  Google Scholar 

  38. Why are data for non-melanoma skin cancer sometimes excluded? National Cancer Registry, Ireland, 2014. Available from https://www.ncri.ie/faqs/interpret-use-our-data/why-are-data-non-melanoma-skin-cancer-sometimes-excluded. Accessed 12 Apr 2021. 

  39. Anderson, W. F., Katki, H. A., & Rosenberg, P. S. (2011). Incidence of breast cancer in the United States: Current and future trends. Journal of the National Cancer Institute, 103(18), 1397–1402.

    Article  PubMed  PubMed Central  Google Scholar 

  40. DeSantis, C. E., Ma, J., Gaudet, M. M., Newman, L. A., Miller, K. D., Goding Sauer, A., Jemal, A., & Siegel, R. L. (2019). Breast cancer statistics, 2019. CA: A Cancer Journal for Clinicians, 69(6), 438–451.

    Google Scholar 

  41. Alagizy, H. A., Soltan, M. R., Soliman, S. S., Hegazy, N. N., & Gohar, S. F. (2020). Anxiety, depression and perceived stress among breast cancer patients: Single institute experience. Middle East Current Psychiatry, 27(1), 1–10.

    Article  Google Scholar 

  42. Institute of Medicine Committee on Psychosocial Services to Cancer Patients/Families in a Community S. (2008). The national academies collection: Reports funded by National Institutes of Health. In N. E. Adler & A. E. K. Page (Eds.), Cancer care for the whole patient: Meeting psychosocial health needs.Washington: National Academy of Sciences.

    Google Scholar 

  43. Taberna, M., Gil Moncayo, F., Jané-Salas, E., Antonio, M., Arribas, L., Vilajosana, E., Peralvez Torres, E., & Mesía, R. (2020). The multidisciplinary team (MDT) approach and quality of care. Frontiers in Oncology, 10, 85.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Zack, M. M., & C.f.D. Control, and Prevention. (2013). Health-related quality of life—United States, 2006 and 2010. MMWR Surveillance Summaries, 62(Suppl 3), 105–111.

    Google Scholar 

  45. Nahleh, Z. A., Dwivedi, A., Khang, T., Sattar, A., Tfayli, A. H., Farrag, S., & Mallawaarachchi, I. (2016). Decreased health related quality of life among hispanic breast cancer survivors. MOJ Women’s Health, 2(1), 1–5.

    Google Scholar 

  46. Landale, N. S., Oropesa, R. S., & Bradatan C. (2006). Hispanic families in the United States: Family structure and process in an era of family change. In National Research Council (US) Panel on Hispanics in the United States; Tienda, M.,& Mitchell, F., (Eds.), Hispanics and the Future of America. National Academies Press (US). Available from https://www.ncbi.nlm.nih.gov/books/NBK19902/. Accessed 23 Aug 2020. 

  47. Alemi, Q., Stempel, C., Koga, P. M., Montgomery, S., Smith, V., Sandhu, G., Villegas, B., & Requejo, J. (2018). Risk and protective factors associated with the mental health of young adults in Kabul Afghanistan. BMC Psychiatry, 18(1), 71–71.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Naughton, M. J., & Weaver, K. E. (2014). Physical and mental health among cancer survivors: Considerations for long-term care and quality of life. North Carolina Medical Journal, 75(4), 283–286.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Hussain, S. K., Altieri, A., Sundquist, J., & Hemminki, K. (2008). Influence of education level on breast cancer risk and survival in Sweden between 1990 and 2004. International Journal of Cancer, 122(1), 165–169.

    Article  CAS  PubMed  Google Scholar 

  50. Nowara, E., & Suwiński, R. (2012). Impact of educational differences as measure of socioeconomic status on survival for breast cancer patients. Contemporary oncology (Poznan, Poland), 16(4), 345–349.

    Google Scholar 

  51. Bahk, J., Jang, S.-M., & Jung-Choi, K. (2017). Increased breast cancer mortality only in the lower education group: Age-period-cohort effect in breast cancer mortality by educational level in South Korea, 1983–2012. International Journal for Equity in Health, 16(1), 56.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Heck, K. E., & Pamuk, E. R. (1997). Explaining the relation between education and postmenopausal breast cancer. American Journal of Epidemiology, 145(4), 366–372.

    Article  CAS  PubMed  Google Scholar 

  53. Marlow, N. M., Pavluck, A. L., Bian, J., Ward, E. M., & Halpern, M. T. (2009). The relationship between insurance coverage and cancer care: A literature synthesis [Internet]. Research Triangle Park (NC): RTI Press.

    Book  Google Scholar 

  54. Clauser, S. B., Arora, N. K., Bellizzi, K. M., Haffer, S. C., Topor, M., & Hays, R. D. (2008). Disparities in HRQOL of cancer survivors and non-cancer managed care enrollees. Health Care Financing Review, 29(4), 23–40.

    PubMed  PubMed Central  Google Scholar 

  55. Baker, F., Denniston, M., Haffer, S. C., & Liberatos, P. (2009). Change in health-related quality of life of newly diagnosed cancer patients, cancer survivors, and controls. Cancer, 115(13), 3024–3033.

    Article  PubMed  Google Scholar 

  56. Nahleh, Z. A., Dwivedi, A., Khang, T., Sattar, A., Tfayli, A. H., Farrag, S., & Mallawaarachchi, I. (2016). Decreased health related quality of life among Hispanic breast cancer survivors. MOJ Womens Health, 2(1), 1–5. https://doi.org/10.15406/mojwh.2016.02.00016

    Article  Google Scholar 

  57. Klein, J., Hofreuter-Gätgens, K., Lüdecke, D., Fisch, M., Graefen, M., & von dem Knesebeck, O. (2016). Socioeconomic status and health-related quality of life among patients with prostate cancer 6 months after radical prostatectomy: A longitudinal analysis. British Medical Journal Open, 6(6), e010968.

    Google Scholar 

  58. Huguet, N., Kaplan, M. S., & Feeny, D. (2008). Socioeconomic status and health-related quality of life among elderly people: Results from the Joint Canada/United States Survey of Health. Social Science and Medicine, 66(4), 803–810.

    Article  PubMed  Google Scholar 

  59. Kim, J.-H., & Park, E.-C. (2015). Impact of socioeconomic status and subjective social class on overall and health-related quality of life. BMC Public Health, 15(1), 1–15.

    Article  Google Scholar 

  60. Wang, S. Y., Hsu, S. H., Gross, C. P., Sanft, T., Davidoff, A. J., Ma, X., & Yu, J. B. (2016). Association between time since cancer diagnosis and health-related quality of life: A population-level analysis. Value in Health, 19(5), 631–638.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Setia, M. S. (2016). Methodology series module 3: Cross-sectional studies. Indian Journal of Dermatology, 61(3), 261–264.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

This research was supported by the Susan G. Komen Graduate Training and Disparities Research Program (GTDR17497435).

Author information

Authors and Affiliations

  1. Department of Epidemiology, Human Genetics and Environmental Sciences, University of Texas-Houston School of Public Health, The University of Texas Health Science Center at Houston, 7000 Fannin Street, Houstonα, TX, 77030, USA

    Inimfon Jackson & Paul Rowan

  2. Division of Management, Policy, and Community Health, The University of Texas, Houston School of Public Health, Houston, TX, USA

    Paul Rowan

  3. Cizik School of Nursing, The University of Texas Health Science Center At Houston, Houston, TX, USA

    Nikhil Padhye

  4. Department of Epidemiology, Human Genetics and Environmental Sciences, Center for Infectious Diseases, University of Texas-Houston School of Public Health, The University of Texas Health Science Center At Houston, Houston, TX, USA

    Lu-Yu Hwang

  5. Division of Health Promotion and Behavioral Sciences, Center for Health Promotion and Prevention Research, University of Texas School of Public Health, The University of Texas Health Science Center At Houston, Houston, TX, USA

    Sally W. Vernon

Authors
  1. Inimfon Jackson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paul Rowan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nikhil Padhye
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lu-Yu Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sally W. Vernon
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Inimfon Jackson.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The Committee for the Protection of Human Subjects (CPHS) considered this study exempt from Institutional Review Board (IRB) review because the publicly available dataset contains no personally identifiable information.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 774 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jackson, I., Rowan, P., Padhye, N. et al. Trends in health-related quality of life of female breast cancer survivors using the Medical Expenditure Panel Survey (MEPS), 2008–2016. Qual Life Res 30, 3547–3558 (2021). https://doi.org/10.1007/s11136-021-02895-1

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-021-02895-1

Keywords

Search

Navigation