Capturing Elusive Quality of Life in Breast Cancer Survivors
Capturing Elusive Quality of Life in Breast Cancer Survivors
Tessier P, Lelorain S, Bonnaud-Antignac A
Eur J Cancer Care (Engl). 2012 April 4 [Epub ahead of print]
The growing number of breast cancer survivors worldwide has prompted researchers to examine the psychosocial and health-related consequences of diagnosis and treatment. Women who are alive 5 years or more after a diagnosis of breast cancer are, by convention, considered long-term survivors. In France alone, the number of long-term survivors of breast cancer is more than 200,000.
Evidence on the long-range impact of diagnosis and treatment is conflicting. Several studies reported no significant correlations with health-related quality-of-life (HRQoL),whereas others found that chemotherapy, hormone therapy, and more radical surgery (mastectomy) impair health.
Most studies that have evaluated cancer survivors have used validated instruments such as the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) or the Quality-of-Life Questionnaire (QLQ)-C30, both of which assess symptoms and level of functioning across several health parameters. Tessier and colleagues hypothesized that these surveys could miss important and meaningful dimensions of a patient's experience. These investigators looked at subjective well-being (SWB), which measures happiness and satisfaction with life and is responsive to psychological reactions to illness.
The study enrolled 321 French breast cancer survivors diagnosed 5-15 years ago and used a mailed survey to compare, in a cross-sectional sample, the treatment covariates of HRQoL and SWB measures that can be interpreted as personal opinions. Happiness, for instance, was measured using a visual horizontal with a scale from 0 to 10.
With a mean respondent age of 62 years, three fourths of the women were married or lived with a partner and only 6% reported financial difficulties. On average, breast cancer was diagnosed 10 years earlier. Almost all women were treated with surgery; one third underwent a mastectomy. Two thirds received adjuvant systemic treatment with chemotherapy or endocrine therapy and 84% received radiation therapy. Mental and physical SF-36 scores were related to financial situation and physical health. Treatment type was not significantly associated with physical health.
In analyzing data from the SWB measures, the investigators found a different picture. Women who had received systemic adjuvant therapy combining chemotherapy and hormone therapy were significantly happier and experienced fewer negative effects than those who did not receive adjuvant therapy. Hormonal therapy increased positive affect and radiation therapy was associated with negative affect. Women who had received mastectomies were less likely to be satisfied with their lives. Higher tumor stage also led to a reduction in happiness scores. Thus, medical factors significantly influenced all measures of SWB that were not captured by routine HRQoL assessments.
This study supports the notion that HRQoL and SWB are not interchangeable. Physical treatments, tumor stage, and type of treatment received influence a patient's experience and memory of illness and are not routinely captured by the instruments designed to detect symptoms and function that are commonly used in breast cancer research. The central message of the study is that measures of SWB could provide a useful complement to HRQoL in both research and practice. Another is that socioeconomic factors play a fundamental role in recovery from illness and should be a focus of survivorship research.
Abstract
A Comparison of the Clinical Determinants of Health-Related Quality of Life and Subjective Well-being in Long-term Breast Cancer Survivors
Tessier P, Lelorain S, Bonnaud-Antignac A
Eur J Cancer Care (Engl). 2012 April 4 [Epub ahead of print]
Background
The growing number of breast cancer survivors worldwide has prompted researchers to examine the psychosocial and health-related consequences of diagnosis and treatment. Women who are alive 5 years or more after a diagnosis of breast cancer are, by convention, considered long-term survivors. In France alone, the number of long-term survivors of breast cancer is more than 200,000.
Evidence on the long-range impact of diagnosis and treatment is conflicting. Several studies reported no significant correlations with health-related quality-of-life (HRQoL),whereas others found that chemotherapy, hormone therapy, and more radical surgery (mastectomy) impair health.
Study Summary
Most studies that have evaluated cancer survivors have used validated instruments such as the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) or the Quality-of-Life Questionnaire (QLQ)-C30, both of which assess symptoms and level of functioning across several health parameters. Tessier and colleagues hypothesized that these surveys could miss important and meaningful dimensions of a patient's experience. These investigators looked at subjective well-being (SWB), which measures happiness and satisfaction with life and is responsive to psychological reactions to illness.
The study enrolled 321 French breast cancer survivors diagnosed 5-15 years ago and used a mailed survey to compare, in a cross-sectional sample, the treatment covariates of HRQoL and SWB measures that can be interpreted as personal opinions. Happiness, for instance, was measured using a visual horizontal with a scale from 0 to 10.
With a mean respondent age of 62 years, three fourths of the women were married or lived with a partner and only 6% reported financial difficulties. On average, breast cancer was diagnosed 10 years earlier. Almost all women were treated with surgery; one third underwent a mastectomy. Two thirds received adjuvant systemic treatment with chemotherapy or endocrine therapy and 84% received radiation therapy. Mental and physical SF-36 scores were related to financial situation and physical health. Treatment type was not significantly associated with physical health.
In analyzing data from the SWB measures, the investigators found a different picture. Women who had received systemic adjuvant therapy combining chemotherapy and hormone therapy were significantly happier and experienced fewer negative effects than those who did not receive adjuvant therapy. Hormonal therapy increased positive affect and radiation therapy was associated with negative affect. Women who had received mastectomies were less likely to be satisfied with their lives. Higher tumor stage also led to a reduction in happiness scores. Thus, medical factors significantly influenced all measures of SWB that were not captured by routine HRQoL assessments.
Viewpoint
This study supports the notion that HRQoL and SWB are not interchangeable. Physical treatments, tumor stage, and type of treatment received influence a patient's experience and memory of illness and are not routinely captured by the instruments designed to detect symptoms and function that are commonly used in breast cancer research. The central message of the study is that measures of SWB could provide a useful complement to HRQoL in both research and practice. Another is that socioeconomic factors play a fundamental role in recovery from illness and should be a focus of survivorship research.
Abstract
