QOL in Long Term Survivors of Breast Cancer

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Breast Cancer Survivors

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Study characteristics. In total, 16 studies met our search criteria for breast cancer, all published after 1998. The studies are described in Table 1 and include our study,32 which will be discussed in greater detail following the general review. Quality of life was a primary outcome in all studies. Of the 16, five studies compared the QOL between breast cancer survivors and healthy or normal controls.4,41-44 Two of five also compared QOL outcomes between survivors who have experienced a cancer recurrence to those who have not.4,43 Three of the 16 studies compared QOL between breast cancer survivors receiving different types of treatment.2,45,46 Two of the 16 investigated the QOL between breast cancer survivors diagnosed at different ages47,48; another two studies compared QOL at time of diagnosis and follow-up32,49; and two more examined the impact of treatment on QOL.50,51 One study looked specifically at the role of ethnicity in QOL outcomes,52 while the final study examined the impact of length of time since diagnosis on QOL.53

Quality of life. In most studies, breast cancer survivors reported a good overall QOL,32,43,49,51,52 with two of the studies reporting QOL comparable to healthy controls.4,44 Generally, the longer the time since diagnosis, the better the overall QOL reported,32,48,52 although a few studies cited no change46,49 or decreases in QOL53 over time. Studies comparing QOL between survivors with and without recurring cancers found that those with recurring disease reported worse QOL in some, but not all domains.4,43,49 With regard to treatment type, some studies report no differences in long-term QOL by treatment type,45,46,51 while others find significant differences.2,49 Although univariate analyses revealed that African American women reported lower mean QOL scores than Euro-American women, differences disappeared after multivariate analyses.52 Ganz,51 however, reports better QOL outcomes among African American compared to Euro-American women. In the studies reviewed, women reported various concerns in each QOL domain, physical, psychological, social, and spiritual. Findings are reported below according to QOL domains.

Physical quality of life. Eleven of the 16 studies discussed physical domain QOL outcomes for long-term survivors.2,4,32,41,43,46-51 Generally, survivors report lower physical domain QOL than healthy controls and poorer physical functioning.4,41,43,49 Arm pain, including swelling, loss of sensation, weakness, and stiffness, are common.4,32,48,50,51 Survivors also report fatigue,2,46 with one study finding that younger survivors report the lowest levels of vitality.51 Physical problems associated with treatment induced menopause are also common.2,32 One study shows that physical functioning was predicted by age at diagnosis,48 while another found that older age in general is related to worse physical domain QOL.47 Another study found that physical health was most affected among women who were both diagnosed with lymphoma and treated with chemotherapy.2

Psychological quality of life. Eleven of the 16 studies discussed psychological domain QOL outcomes for long-term survivors.4,32,41,44,45,47-51,53 Although survivors and controls tend to report similar QOL in most psychological domains,4 studies report significant psychological concerns among breast cancer survivors including depression and symptoms of Posttraumatic Stress Disorder.32,41,50,53 Survivors report being overly stressed and worried about the future, and having little control over the world.32,44

Table 1. Long-Term Breast Cancer Studies Reviewed

Study

Sample size and type

Time since dx/ tx

Instruments

Methods (C/L)*

Ahels et al?

549 survivors

Mean 10 years

• Quality of Life Cancer Survivors Tool (QOL-CS)

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