Skip to main content
Log in

Quality of life in breast cancer patients: a cluster analytic approach

  • Conference Report
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Quality of life (QOL) questionnaires are integrated into clinical trials in order to evaluate different treatments, and rarely used in a diagnostic sense. The aim of this study was to identify clinically meaningful subgroups by means of established QOL tools. Since January 1995, a field study funded by the German Ministry of Health was conducted to evaluate quality of care of breast cancer patients in eastern Thuringia. During the follow-up period, the European Organization of Research and Treatment of Cancer (EORTC), Quality of Life C30 and the breast specific module BR23 were mailed. One-hundred-fifty-eight women answered both questionnaires. A cluster analysis was performed to distinguish subgroups on the basis of QOL-BR23 scores. According to the QOL outcomes, four subgroups could be described. There was a strong relation to operative treatment (p<0.05), while no association with the adjuvant treatment strategy was observed. The subsets identified on the basis of BR23 scores were significantly related to all C30 domains. It was possible to demonstrate the clinical validity in terms of clinical and sociodemographic data. No association was found with the marital status or the highest level of education, while a worsening of the financial situation was associated. It could be shown that a distinction of patient subgroups based on clinically meaningful BR23 data is possible. Subgroups with specific profiles could be identified. In the future, the characterisation of subgroups could provide a possibility to generate indications for specific supportive interventions.

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

Access this article

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

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti H, Flechtner H, Fleishman SB, de Haes JC, Kaasa S, Klee M, Osoba D, Razavi D, Rofe RB, Schraub S, Sneeuw K, Sullivan M, Takeda F: The European organization for research and treatment of cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85 (5): 365-376, 1993

    Google Scholar 

  2. Bloom JR, Stewart SL, Johnston M, Blanks P: Intrusiveness of illness and quality of life on young women with breast cancer. Psycho-Oncology 7: 89-100, 1998

    Google Scholar 

  3. Bower JE, Ganz PA, Desmond KA, Rowland JH, Meyerowitz BE, Belin TR: Fatigue in breast cancer survivors: Occurrence, correlates and impact on quality of life. J Clin Oncol 18(4): 743-752, 2000

    Google Scholar 

  4. Carlsson M and Hamrin E. Psychological and psychosocial aspects of breast cancer and breast cancer treatment: A literature review. Cancer Nursing 17: 418-428, 1994

    Google Scholar 

  5. Curran D, van Dongen JP, Aaronson NK, Kiebert G, Fentiman IS, Mignolet F, Bartelink H: Quality of life on early breast cancer patients treated with radical mastectomy or breastconserving procedures: Results of EORTC trial 10801. Eur J Cancer 34(3): 307-314, 1998

    Google Scholar 

  6. Fallowfield L: Psychosocial adjustment after treatment for early breast cancer. Oncol Hunt 4(4): 89-97, 1990

    Google Scholar 

  7. Ferrell BR, Dow KH, Grant M: Measurement of the quality of life in cancer survivors. Qual Life Res 4(6): 523-531, 1995

    Google Scholar 

  8. Ganz PA, Coscarelli A, Fred C, Kahn B, Polinsky ML, Petersen L: Breast cancer survivors: Psychosocial concerns and quality of life. Breast Canc Res Treat 38: 183-199, 1996

    Google Scholar 

  9. Ganz PA, Schlag AC, Lee JJ, Polinsky ML, Tan SJ: Breast conservation versus mastectomy. Is there a difference in psychological adjustment or quality of life in the year after surgery? Cancer 69(7): 1729-1738, 1992

    Google Scholar 

  10. Gill T, Feinstein RL: A critical appraisal of the quality of quality-of-life measurements. JAMA 272: 619-626, 1994

    Google Scholar 

  11. Groensvold M, Klee MC, Sprangers MAG, Aaronson NK: Validation of the EORTC QLQ30 quality of life, questionnaire through combined qualitative and quantitative assessment of patient-observer agreement. J Clin Epidemiol 50(4): 441-450, 1997

    Google Scholar 

  12. Guadagnoli E, Schapiro C, Gurwitz JH, Silliman A, Weeks JC, Borbas C, Soumerai SB: Age related pattern of care: Evidence against ageism in the treatment of early-stage breast cancer. J Clin Oncol 15(69): 2338-2344, 1997

    Google Scholar 

  13. Hack TF, Degner LF: Coping with breast cancer: A cluster analytic approach. Breast Cancer Res Treat 54: 185-194, 1999

    Google Scholar 

  14. Hall A, Fallowfield L: Psychological outcome of treatment for early breast cancer: A review. Stress Med 5: 167-175, 1989

    Google Scholar 

  15. Hürny C, Bernhard J, Coates AS, Castiglione-Gertsch M, Perterson HF, Gelber RD, Forbes JF, Rudenstam CM, Simoncini E, Crivellari D, Goldhirsch A, Senn HJ: Impact of adjuvant therapy on quality of life in women with node-positive operable breast cancer. International breast cancer study group. Lancet 347: 1279-1284, 1996

    Google Scholar 

  16. Kemeny M, Wellisch DK, Schain WS: Psychosocial Outcome in a randomized surgical trial for treatment of primary breast cancer. Cancer 2: 35-43, 1988

    Google Scholar 

  17. Kiebert GM, de-Haes JC, van de Velde CJ: The impact of breast conserving treatment and mastectomy on the quality of life of early stage breast cancer patients: A review. J Clin Oncol 9: 1059-1070, 1991

    Google Scholar 

  18. Koller M, Heitmann K, Kussmann J, Lorenz W: Symptom reporting in cancer patients II. Cancer 86(8), 1609-1620, 1999

    Google Scholar 

  19. Lasry JCM, Margolese RG, Poisson R, Shibata H, Fleischer D, LaFleur D, LeGault S, Taillefer S: Depression and body image following mastectomy and lumpectomy. J Chronic Disease 40: 529-534, 1987

    Google Scholar 

  20. Margolis G, Goodman RL, Rubin A: Psychological effects of breast-conserving treatment and mastectomy. Psychosomatics 31: 33-39, 1990

    Google Scholar 

  21. Maunsell E, Brisson J, DeschÊnes L: Psychological distress after initial treatment for breast cancer: A comparison of partial and total mastectomy. J Clin Epidemiol 42: 765-771, 1989

    Google Scholar 

  22. Maunsell E, Brisson C, Dubies L, Lauzier S, Fraser A: Work problems after breast cancer: An exploratory qualitative study. Psycho-Oncology 8(6): 467-473, 1999

    Google Scholar 

  23. Mor V, Malin M, Allen S: Age differences in psychosocial problems encountered by breast cancer patients. Mongr Natl Cancer Inst 16: 191-197, 1994

    Google Scholar 

  24. Moyer A.: Psychosocial outcomes of breast-conserving surgery versus mastectomy: A meta-analytic review. Health Psychol 16: 284-298, 1997

    Google Scholar 

  25. Nelson DV, Friedman LC, Baer PE, Lane M, Smith FE: Subtypes of psychosocial adjustment to breast cancer. J Behav Med 17(2): 127-141, 1994

    Google Scholar 

  26. Omne-Pontén M, Holmberg L, Burns T, Adami HO, Bergstrom R: Determinants of the psycho-social outcome after operation of breast cancer. Results of a prospective comparative interview study following mastectomy and breast conservation. Eur J Cancer 28A: 1062-1067, 1992

    Google Scholar 

  27. Pozo C, Carver CS, Noriega V, Harris SD, Robinson DS, Ketcham AS, Legaspi A, Moffat FL, Clark KC: Effects of mastectomy versus lumpectomy on emotional adjustment to breast cancer: A prospective study of the first year post surgery. J Clin Oncol 10: 1292-1298, 1992

    Google Scholar 

  28. Schain WS, Fetting JH: Modified radical mastectomy versus breast conservation: Psychosocial considerations. Sem Oncol 19: 239-243, 1992

    Google Scholar 

  29. Shapiro DE, Boggs SR, Rodrigue JR, Urry HL, Algina JJ, Hellman R, Ewen F: Stage II breast cancer: Differences between four coping patterns in side effects during adjuvant chemotherapy. J Psychosom Res 43: 143-157, 1997.

    Google Scholar 

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

    Google Scholar 

  31. Silliman RA, Troyan SL, Guadagnoli E, Kaplan SH, Green-field S: The impact of age, material status, and physicianpatient interaction on the care of older women with breast carcinoma. Cancer 80: 1326-1334, 1997

    Google Scholar 

  32. Sneeuw KC, Aaronson NK, Sprangers MA, Detmar SB, Wever LD, Schornagel JH: Comparison of patient and proxy EORTC QLQ-C30 rations in assessing the quality of life in cancer patients. J Clin. Epidemiol 51(7): 617-631, 1998

    Google Scholar 

  33. Sprangers M, Groenvold M, Arraras J, Franklin J, te Velde A, Muller M, Franzini L, Williams A, de Haes HC, Hopwood P, Cull A, Aaronson NK: The European organization for research and treatment of cancer-breast cancer-specific quality-of-life questionnaire module: First results form a three country field study. J Clin Oncol 14 (10): 2756-2768, 1996

    Google Scholar 

  34. Tasmuth T, von Smitten K, Karlso E: Pain and other symptoms during the first year after radical and conservative surgery for breast cancer. Br J Cancer 74: 2024-2031, 1996

    Google Scholar 

  35. Wellisch DK, DiMateo R, Silverstein M, Landsverk J, Hoffman R, Waisman J, Handel N, Waisman-Smith E: Psychosomatic outcomes of breast cancer therapies: Lumpectomy versus mastectomy. Psychosomatics 30: 365-373, 1989

    Google Scholar 

  36. Wenzel LB, Fairclough DL, Brady MJ, Cella D, Garrett KM, Kluhsman BC, Crane LA, Marcus AC: Age-related differences in the quality of life of breast cancer patients after treatment. Cancer 86(9): 1768-1774, 1999

    Google Scholar 

  37. Williams A, de Haes HC, Hopwood P, Cull A, Aaronson NK: 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: 2756-2768, 1996

    Google Scholar 

  38. Yilmazer N, Aydenir A, Özkan S, Asleay I, Bilge N: A comparison of body image, self esteem and social support in total mastectomy and breast conserving therapy in Turkish women. Support Care Cancer 2: 238-241, 1994

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Nagel, G., Schmidt, S., Strauss, B. et al. Quality of life in breast cancer patients: a cluster analytic approach. Breast Cancer Res Treat 68, 75–87 (2001). https://doi.org/10.1023/A:1017975609835

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1017975609835

Navigation