Abstract
The development and validation of guidelines for breast cancer survivors are of importance due to the increased survival rate for breast cancer. In this cross-sectional study, we aimed to examine the association between adherence to the American Cancer Society (ACS) guidelines for cancer survivors and health-related quality of life (HRQoL). A total of 618 breast cancer survivors aged 30 to 81 years who had been diagnosed with stage I to III primary breast cancer and had surgery at least a year before enrollment were included. The participants completed the 36 Item Short-Form Health Survey (SF-36) to evaluate HRQoL, and adherence scores were calculated based on the Nutrition and Physical Activity Guidelines for Cancer Survivors, which were released by the ACS. Increasing adherence scores were associated with increasing scores on the physical component summary (PCS) and the physical functioning (PF), bodily pain (BP), and vitality (VT) domains (p for trend <0.001 for PCS and PF, 0.01 for BP, and 0.02 for VT); these scores were mainly driven by the associations among survivors with stage II–III cancer. Further prospective studies are needed to evaluate whether adherence to these guidelines improves HRQoL scores among breast cancer survivors.
Highlights
Breast cancer is the most common cancer (24.2% of the total cases in 2018) and the leading cause of cancer deaths (15.0% of the total cancer deaths in 2018) in women worldwide [1]
We observed that increasing adherence scores were associated with increasing levels of physical component summary, physical functioning, bodily pain, and vitality scores in all breast cancer survivors in this study (Table 3); LS-means of the lowest and the highest quintiles of adherence scores were 46.29 (44.76–47.83) and 48.99 (47.34–50.63; p for trend < 0.001), respectively, for physical component summary, 44.08 (42.47–45.69) and 47.30 (45.58–49.03; p for trend < 0.001), respectively, for the physical functioning, 47.27 (45.25–49.29) and 49.91 (47.74–52.08; p for trend = 0.01), respectively, for bodily pain, and 45.37 (43.05–47.68) and 48.56 (46.07–51.04; p for trend = 0.02), respectively, for vitality
When we examined whether the association between physical activity levels and health-related quality of life (HRQoL) was modified by menopausal status at diagnosis, we found that increasing physical activity levels were associated with increasing scores for the physical component summary (p for trend = 0.01) and the physical functioning (p for trend = 0.01), general health (p for trend = 0.03) and vitality (p for trend = 0.01) domains among premenopausal survivors and general health (p for trend = 0.005) among postmenopausal survivors after adjustment for multiple comparisons using the false discovery rate (FDR) method (Table S2)
Summary
Breast cancer is the most common cancer (24.2% of the total cases in 2018) and the leading cause of cancer deaths (15.0% of the total cancer deaths in 2018) in women worldwide [1]. It is Nutrients 2019, 11, 2924; doi:10.3390/nu11122924 www.mdpi.com/journal/nutrients. Due to advances in the early detection and treatment of breast cancer, the survival rate of patients has continuously increased in Korea. Especially nutrition and physical activity, may be associated with a better prognosis and health-related quality of life (HRQoL) for breast cancer survivors. Among breast cancer survivors in the U.S Health, Eating, Activity, and Lifestyle (HEAL) Registry (KCCR) data, the 5 year relative survival for Korean women with breast cancer between 2012 and 2016 was 92.7%, which was 14.8% higher than that of those diagnosed between 1993 and 1995 [2].
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