Quality of Life Improves Over Time and Is Similar in Long-Term Breast Cancer Survivors and Women With No History of Breast Cancer
In a study reported in Journal of Clinical Oncology, Pamela J. Goodwin, MD, and Tina Hsu of University of Toronto and colleagues assessed changes in quality of life from time of breast cancer diagnosis to long-term survivorship and compared quality of life in long-term survivors to that of age-matched women with no history of breast cancer. Quality of life improved over time in survivors and was similar to that in controls with the exception of small but clinically important deficits in cognition and finances.
Study Details
In the study, women with localized breast cancer (T1-3, N0-1, M0) were recruited from 1989 to 1996 and followed prospectively, completing quality-of-life questionnaires at diagnosis and 1 year postdiagnosis. Between 2005 and 2007, those alive without distant recurrence were recontacted to participate in a long-term follow-up study. An age-matched control group was recruited from women presenting for screening mammograms, and both groups completed long-term follow-up quality-of-life questionnaires.
Patients with breast cancer completed the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-30), Profile of Mood States (POMS), Psychological Adjustment to Illness Scale (PAIS), and Impact of Event Scale (IES) at diagnosis, 1 year postdiagnosis, and at long-term follow-up. They also completed the Fatigue Symptom Inventory (FSI) and Short Form (36) Health Survey (SF-36) at long-term follow-up. Controls completed the EORTC, POMS, FSI, and SF-36 questionnaires.
Longitudinal changes in survivors and differences between survivors and controls were assessed by quality-of-life scales grouped into eight broad categories: overall quality of life; physical functioning, fatigue, and vitality; other physical symptoms; social functioning; role functioning and limitations; cognition, intrusion and avoidance; emotional functioning and symptoms; and other. Clinically significant differences were set at 5% and 10% of the breadth of each quality-of-life scale.
Of the 285 breast cancer survivors enrolled, 260 completed the long-term follow-up quality-of-life questionnaires and 166 completed quality-of-life profiles at all time points (diagnosis, 1 year postdiagnosis, and long-term follow-up). Survivors participated in long-term follow-up at a mean of 12.5 years (range, 9.4–17.6 years) after diagnosis. Of 167 controls enrolled, 161 completed quality-of-life questionnaires.
Controls were slightly but significantly younger than survivors at long-term follow-up (59 vs 62 years), less likely to be menopausal (86% vs 94%), and older at menopause (50 vs 48 years) There were no major differences in comorbid conditions at long-term follow-up. Controls had lower blood pressure, higher education and family income, were less likely to be retired, and were more likely to consume alcohol than survivors.
Longitudinal Changes in Survivors
Survivors exhibited > 5% improvement over time on many scales. Overall quality of life improved over time with clinically important differences at 1 year and long-term follow-up, including improvements of 5.6% and 5.3% at 1 year and 13.3% and 12.2% at long-term follow-up for EORTC global health and EORTC overall quality of life.
Clinically important improvements were observed in four of the five subscales in the physical functioning, fatigue, and vitality category. Improvements at 1 year were followed by continued major improvement by long-term follow-up in EORTC overall physical condition (1 year 5.9%, long-term follow-up 14.4%) and POMS vigor-activity (1 year 5.7%, long-term follow-up 11.4%). Between diagnosis and long-term follow-up, clinically important improvements in fatigue were observed (POMS fatigue-inertia 5.8%, EORTC fatigue 16.2%), with the greatest improvement observed between 1 year and long-term follow-up. No change was seen in EORTC physical functioning. In the other physical symptoms category, modest improvements were seen in the EORTC appetite subscale between diagnosis and 1 year (5.4%, maintained at long-term follow-up) and the EORTC sleep disturbance subscale between diagnosis and long-term follow-up (5.3%).
Improvements in social functioning were seen by 1 year and sustained at long-term follow-up, including improvements in PAIS domestic environment (5.2%), PAIS social environment (11.8%), and EORTC social functioning (13.3%). No changes were seen in the PAIS extended family or sexual relationships subscales. Improvements in role functioning and limitations at 1 year (PAIS vocational environment 14.7%, EORTC role functioning 12.1%) were sustained at long-term follow-up.
In the cognition, intrusion, and avoidance category, improvement in the IES intrusion (8.8%), avoidance (6.1%), and total scales (7.4%) were seen by 1 year, with major improvements between diagnosis and long-term follow-up (18.9%, 14.2%, and 16.4%, respectively). No clinically significant changes were seen on POMS confusion/bewilderment or EORTC cognitive functioning scales. Of the six scales in the emotional functioning and symptoms category, only the PAIS psychological distress subscale showed a modest improvement (5.5%) at 1 year, which was sustained at long-term follow-up.
The EORTC financial impact and PAIS health-care orientation subscales were grouped into the ‘other’ category. An improvement was seen at long-term follow-up in the financial impact subscale (5.5%).
Comparisons With Controls
There were few clinically important differences between breast cancer survivors at long-term follow-up and controls after adjusting for age and income. No clinically important differences were seen in the categories of overall quality of life, physical functioning, fatigue, and vitality, social functioning, role functioning and limitations, or emotional functioning and symptoms. Survivors reported less pain at long-term follow-up than controls on the EORTC pain subscale (difference, 5.4%). Survivors had clinically important deficits compared with controls on the EORTC cognitive functioning subscale (difference, 5.3%) and on the EORTC financial impact subscale (difference, 6.3%), even after adjustment for income was omitted.
The investigators concluded, “Long-term breast cancer survivors show improvement in many domains of [quality of life] over time, and they appear to have similar [quality of life] in most respects to age-matched non-cancer controls, although small deficits in cognition and finances were identified”
The study was supported by the Breast Cancer Research Foundation, Canadian Breast Cancer Research Alliance, and the Medical Research Council.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
