What contributes the most to the breast cancer patients’ quality of life during therapy – clinical factors, functional and affective state, or social support?
Abstract
Background/Aim. As significant advances in cancer treatment have occurred over the past decades, the crucial questions in oncology nowadays are not related only to the treatment of the illness but also to the quality of life (QOL) of patients. The aim of our study was to explore which set of determinants (clinical, functional, affective, or social) has the greatest impact on explaining QOL in women who live with the diagnosis of breast cancer. Methods. The research was conducted on 64 women (with a mean age of 58.36 ± 11.30) while undergoing radiation therapy at the Oncology Institute of Vojvodina, Serbia. Quality of Life Instrument – Breast Cancer Patient Version (QOL-BC) questionnaire was used for evaluation of physical, psychological, social, spiritual, and general well-being, the Upper Extremity Functional Index (UEFI) was applied for the assessment of the upper extremity function, the Depression, Anxiety, and Stress Scale-21 Items (DASS-21) was used for measuring symptoms of depression, anxiety, and stress, the Medical Outcomes Survey, Social Support Survey (MOS-SSS) served for evaluation of social support; demographic and clinical data of patients were also collected. Results. Analysis of Variance (ANOVA) with repeated measures [F(2.03, 127.80) = 20.24, p < 0.001] showed that in our sample, physical QOL was significantly better from all other domains, while social QOL was significantly lower from both physical and psychological aspect. A hierarchical regression analysis [F(8, 55) = 7.16, p < 0.001, R2 = 0.51] showed that patients who received adjuvant chemotherapy and experienced high levels of stress and poor social support usually had diminished general QOL. Introduction of affective-related variables [ΔR2 = 0.16, p(ΔF) < 0.01] and social support [ΔR2 = 0.05, p(ΔF) < 0.05] led to a significant increase in proportion of explained variance over and above the clinical and functional variables. Conclusion. Our results indicate that psychological and social resources are more important in predicting QOL compared to clinical and functional factors. At the same time, the social, psychological, and spiritual well-being of patients is significantly worse compared to the physical QOL, meaning that there is still much left to be done regarding the progress from a purely somatic to a holistic approach in the treatment of breast cancer.
References
Vardar Yağlı N, Şener G, Arıkan H, Sağlam M, Inal Ince D, Savcı S, et al. Do Yoga and aerobic exercise training have impact on functional capacity, fatigue, peripheral muscle strength, and quality of life in breast cancer survivors? Integr Cancer Ther 2015; 14(2): 125‒32.
Pinto M, Gimigliano F, Tatangelo F, Megna M, Izzo F, Gimigliano R, et al. Upper limb function and quality of life in breast cancer related lymphedema: a cross-sectional study. Eur J Phys Rehabil Med 2013; 49(5): 665‒73.
Cancer Registry of Central Serbia, Cancer incidence and mortality in central Serbia 2015. Belgrade, Serbia: Institute of Public Health of Serbia „Dr Milan Jovanović Batut“; 2017. Report No. 17. Available from: http://www.batut.org.rs/download/publikacije/Incidencija%20i%20mortalitet%20od%20raka%202015.pdf [cited 2019 March 18]
Irvine D, Brown B, Crooks D, Roberts J, Browne G. Psychosocial adjustment in women with breast cancer. Cancer 1991; 67(4): 1097‒117.
King MT, Kenny P, Shiell A, Hall J, Boyages J. 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 2000; 9(7): 789–800.
Hopwood P, Haviland J, Mills J, Sumo G, Bliss JM. 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 2007; 16(3): 241–51.
Parker PA, Youssef A, Walker S, Basen-Engquist K, Cohen L, Gritz ER, et al. Short-term and long-term psychosocial adjustment and quality of life in women undergoing different surgical procedures for breast cancer. Ann Surg Oncol 2007; 14(11): 3078–89.
Wöckel A, Schwentner L, Krockenberger M, Kreienberg R, Janni W, Wischnewsky M, et al. Predictors of the course of quality of life during therapy in women with primary breast cancer. Qual Life Res 2017; 26(8): 2201‒8.
Repetto L, Ausili-Cefaro G, Gallo C, Rossi A, Manzione L. Quality of life in elderly cancer patients. Ann Oncol 2001; 12(Suppl 3): S49‒S52.
Ahn SH, Park BW, Noh DY, Nam SJ, Lee ES, Lee KM, et al. Health-related quality of life in disease-free survivors of breast cancer with the general population. Ann Oncol 2007; 18(1): 173–82.
Erickson VS, Pearson ML, Ganz PA, Adams J, Kahn KL. Arm edema in breast cancer patients. J Natl Cancer Inst 2001; 93(2): 96–111.
Kwan W, Jackson J, Weir LM, Dingee C, McGregor G, Olivotto IA. Chronic arm morbidity after curative breast cancer treatment: prevalence and impact on quality of life. J Clin Oncol 2002; 20(20): 4242‒8.
Engel J, Kerr J, Schlesinger-Raab A, Eckel R, Sauer H, Hölzel D. Predictors of quality of life of breast cancer patients. Acta Oncol 2003; 42(7): 710‒8.
Hormes JM, Bryan C, Lytle LA, Gross CR, Ahmed RL, Troxel AB, et al. Impact of lymphedema and arm symptoms on quality of life in breast cancer survivors. Lymphology 2010; 43(1): 1–13.
Collins LG, Nash R, Round T, Newman B. Perceptions of upper-body problems during recovery from breast cancer treatment. Support Care Cancer 2004; 12(2): 106–13.
Härtl K, Engel J, Herschbach P, Reinecker H, Sommer H, Friese K. Personality traits and psychosocial stress: quality of life over 2 years following breast cancer diagnosis and psychological impact factors. Psychooncology 2010; 19(2): 160–9.
Brunault P, Toledano A, Aguerre C, Suzanne I, Garaud P, Trzepidur-Edom M, et al. Impact of late treatment-related radiotherapy toxicity, depression, and anxiety on quality of life in long-term breast cancer survivors. Bull Cancer 2012; 99(5): 589–98.
Burgess C, Cornelius V, Love S, Graham J, Richards M, Ramirez A. Depression and anxiety in women with early breast cancer: five year observational cohort study. BMJ 2005; 330(7493): 702–5.
Reich M, Lesur A, Perdrizet-Chevallier C. Depression, quality of life and breast cancer: a review of the literature. Breast Cancer Res Treat 2008; 110(1): 9–17.
Avis NE, Crawford S, Manuel J. Quality of life among younger women with breast cancer. J Clin Oncol 2005; 23(15): 3322–30.
Tsaras K, Papathanasiou IV, Mitsi D, Veneti A, Kelesi M, Zyga S, et al. Assessment of depression and anxiety in breast cancer patients: prevalence and associated factors. Asian Pac J Cancer Prev 2018; 19(6): 1661‒9.
Hegel MT, Moore CP, Collins ED, Kearing S, Gillock KL, Riggs RL, et al. Distress, psychiatric syndromes, and impairment of function in women with newly diagnosed breast cancer. Cancer 2006; 107(12): 2924–31.
Huang CY, Hsu MC. Social support as a moderator between depressive symptoms and quality of life outcomes of breast cancer survivors. Eur J Oncol Nurs 2013; 17(6): 767–74.
Fong AJ, Scarapicchia TMF, McDonough MH, Wrosch C, Sabiston CM. Changes in social support predict emotional well-being in breast cancer survivors. Psychooncology 2017; 26(5): 664–71.
Cohen S, Underwood L, Gottlieb B. Social support measurement and intervention: a guide for health and social scientists. New York: Oxford University Press; 2000.
McDonough MH, Sabiston CM, Wrosch C. Predicting changes in posttraumatic growth and subjective well-being among breast cancer survivors: the role of social support and stress. Psychooncology 2014; 23(1): 114–20.
Sabiston CM, McDonough MH, Crocker PR. Psychosocial experiences of breast cancer survivors involved in a dragon boat program: exploring links to positive psychological growth. J Sport Exerc Psychol 2007; 29(4): 419–38.
Ferrell BR, Dow KH, Grant M. Quality of Life Instrument - Breast Cancer Patient Version (QOL-BC). Measurement Instrument Database for the Social Sciences; 2012. [cited 2019 March 12] Available from: http://www.midss.org/sites/default/files/qol-bc.pdf
Ferrell BR, Grant M, Funk B, Garcia N, Otis-Green S, Schaffner MLJ. Quality of life in breast cancer. Cancer Practice 1996; 4(6): 331-40.
Dow KH, Ferrell BR, Leigh S, Ly J, Gulasekaram P. An evaluation of the quality of life among long-term survivors of breast cancer. Breast Cancer Res Treat 1996; 39(3): 261‒73.
Ferrell BR, Grant M, Funk B, Otis-Green S, Garcia N. Quality of life in breast cancer. Part I: physical and social well-being. Cancer Nurs 1997; 20(6): 398‒408.
Ferrell BR, Grant M, Funk B, Otis-Green S, Garcia N. Quality of life in breast cancer. Part II: psychological and spiritual well being. Cancer Nurs 1998; 21(1): 1‒9.
Ferrell BR, Grant M, Funk B, Otis-Green S, Garcia N. Quality of life in breast cancer survivors: implications for developing support services. Oncol Nurs Forum 1998; 25(5): 887‒95.
Stratford PW, Binkley JM, Stratford DM. Development and initial validation of the Upper Extremity Functional Index. Physioter Can 2001; 52(281): 259‒67.
Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther 1995; 33(3): 335‒43.
Jovanović V, Gavrilov-Jerković V. Validity of a Serbian translation of the Medical Outcomes Study Social Support Survey (MOS-SSS). Primenjena Psihologija 2015; 8(3): 245‒64. (Serbian)
Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med 1991; 32(6): 705–14.
Tarlov AR, Ware JE, Greenfield S, Nelson EC, Perrin E, Zubkoff M. The Medical Outcomes Study. An application of methods for monitoring the results of medical care. JAMA 1989; 262(7): 925–30.
George D, Mallery M. SPSS for Windows step by step: a simple guide and reference, 17.0 update. 10th ed. Boston: Allyn & Bacon; 2010.
Lorusso D, Bria E, Costantini A, Di Maio M, Rosti G, Mancuso A. Patients’ perception of chemotherapy side effects: expectations, doctor–patient communication and impact on quality of life – an Italian survey. Eur J Cancer Care (Engl) 2017; 26(2): doi: 10.1111/ecc.12618.
Sommariva S, Pongiglione B, Tarricone R. Impact of chemotherapy-induced nausea and vomiting on health-related quality of life and resource utilization: a systematic review. Crit Rev Oncol Hematol 2016; 99: 13‒36.
Dawes DJ, Meterissian S, Goldberg M, Mayo NE. Impact of lymphoedema on arm function and health-related quality of life in women following breast cancer surgery. J Rehabil Med 2008; 40(8): 651‒8.
Chachaj A, Małyszczak K, Pyszel K, Lukas J, Tarkowski R, Pudełko M, et al. Physical and psychological impairments of women with upper limb lymphedema following breast cancer treatment. Psychooncology 2010; 19(3): 299‒305.
Gold M, Dunn LB, Phoenix B, Paul SM, Hamolsky D, Levine JD, et al. Co-occurrence of anxiety and depressive symptoms following breast cancer surgery and its impact n quality of life. Eur J Oncol Nurs 2016; 20: 97–105.
Fasoi-Barka GG, Kelesi-Stauropoulou MN, Koutsopoulou-Sofikiti VE. Study for the change of health related quality of life in women with early stage breast cancer, one year after the diagnosis. Rostrum of Asclepius 2010; 9: 76–99.
Montazeri A, Vahdaninia M, Harirchi I, Ebrahimi M, Khaleghi F, Jarvandi S. Quality of life in patients with breast cancer before and after diagnosis: an eighteen months follow-up study. BMC Cancer 2008; 8: 330.
Andritsch E, Dietmaier G, Hofmann G, Zloklikovits S, Samonigg H. Global quality of life and its potential predictors in breast cancer patients: an exploratory study. Support Care Cancer 2007; 15(1): 21–30.
Charalambous A, Kaite CP, Charalambous M, Tistsi T, Kouta C. The effects on anxiety and quality of life of breast cancer patients following completion of the first cycle of chemotherapy. SAGE Open Med 2017; 5: 2050312117717507.
Plaisier I, Beekman AT, de Graaf R, Smit JH, van Dyck R, Penninx BW. Work functioning in persons with depressive and anxiety disorders: the role of specific psychopathological characteristics. J Affect Disord 2010; 125(1‒3): 198–206.
Lou Z, Li Y, Yang Y, Wang L, Yang J. Affects of anxiety and depression on health-related quality of life among patients with benign breast lumps diagnosed via ultrasonography in China. Int J Environ Res Public Health 2015; 12(9): 10587–601.
Leung J, Pachana NA, McLaughlin D. Social support and health-related quality of life in women with breast cancer: a longitudinal study. Psychooncology 2014; 23(9): 1014‒20.
Matthews DA, Larson DB, Barry CP. The faith factor: an annotated bibliography of clinical research on spiritual subjects, volume 1. Rockville, MD: National Institute for Healthcare Research; 1993.
Matthews DA, Larson DB. The faith factor: an annotated bibliography of clinical research on spiritual subject, volume 3: enhancing life satisfaction. Washington, DC: National Institute for Healthcare Research; 1995.
Weaver AJ, Flannelly KJ. The role of religion/spirituality for cancer patients and their caregivers. South Med J 2004; 97(12): 1210–4.
Rippentrop AE, Altmaier EM, Burns CP. The relationship of religiosity and spirituality to quality of life among cancer patients. J Clin Psychol Med Settings 2006; 13(1): 29.
Visser A, Grassen B, Vingerhoets A. Spirituality and well-being in cancer patients: a review. Psychooncology 2010; 19(6): 565‒72.
Cotton SP, Levine EG, Fitzpatrick CM, Dold KH, Targ E. Exploring the relationships among spiritual well-being, quality of life, and psychological adjustment in women with breast cancer. Psychooncology 1999; 8(5): 429‒38.
Brunault P, Champagne AL, Huguet G, Suzanne I, Senon JL, Body G, et al. Major depressive disorder, personality disorders, and coping strategies are independent risk factors for lower quality of life in non-metastatic breast cancer patients. Psychooncology 2016; 25(5): 513‒20.