Abstract
PurposeThere is limited high-quality evidence on quality of life, anxiety, and depressive symptoms in breast cancer survivors and women with no history of cancer. We aimed to address this by comparing patient-reported outcomes between breast cancer survivors and women with no history of breast cancer.MethodsBreast cancer survivors and women with no prior cancer were selected from the UK Clinical Practice Research Datalink GOLD primary care database, which includes population-based primary care electronic health record data. Breast cancer survivors and controls were frequency matched by age and primary care practice. Outcomes were assessed with validated instruments via postal questionnaire. Linear and logistic regression models were fitted to estimate adjusted associations between breast cancer survivorship and outcomes.ResultsA total of 356 breast cancer survivors (8.1 years post diagnosis) and 252 women with no prior cancer participated in the study. Compared with non-cancer controls, breast cancer survivors had poorer QoL in the domains of cognitive problems (adjusted β (aβ) = 1.4, p = 0.01), sexual function (aβ = 1.7, p = 0.02) and fatigue (aβ = 1.3, p = 0.01), but no difference in negative feelings, positive feelings, pain, or social avoidance. Breast cancer survivors had higher odds of borderline-probable anxiety (score ≥ 8) (adjusted OR = 1.47, 95%CI:1.15–1.87), but no differences in depression. Advanced stage at diagnosis and chemotherapy treatment were associated with poorer QoL.ConclusionsCompared with women with no history of cancer, breast cancer survivors report more problems with cognition, sexual function, fatigue, and anxiety, particularly where their cancer was advanced and/or treated with chemotherapy.Implications for Cancer SurvivorsBreast cancer survivors with more advanced disease and/or treated with chemotherapy should be closely monitored and, when possible, offered evidence-based intervention for fatigue, cognitive dysfunction, and sexual problems.
Highlights
Millions of women worldwide are living beyond breast cancer, including over 2.7 million in the USA and 500,000 in the United Kingdom (UK) [1, 2]
Longitudinal studies have shown that mental health symptoms and quality of life (QoL) scores tend to improve over time, with many breast cancer survivors reaching similar levels to those of the general population
Factors that have been associated with poorer mental health and quality of life include younger age at diagnosis [10, 11], lower socio-economic status [12], persistent fatigue [13], lymphedema or arm symptoms [14, 15], and having had chemotherapy [16, 17]
Summary
Millions of women worldwide are living beyond breast cancer, including over 2.7 million in the USA and 500,000 in the United Kingdom (UK) [1, 2]. Many women undergoing treatment for recently diagnosed breast cancer report clinically relevant symptoms of anxiety and/or depression [3, 4], and impairments for virtually all domains of quality of life (QoL) [5, 6]. Specific groups of breast cancer survivors appear to continue to have poorer QoL, anxiety, and depression in the long-term [9]. Factors that have been associated with poorer mental health and quality of life include younger age at diagnosis [10, 11], lower socio-economic status [12], persistent fatigue [13], lymphedema or arm symptoms [14, 15], and having had chemotherapy [16, 17]
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