Breast Cancer Survivors In Korea Research Articles

Effects of Endocrine Therapy on Cardiovascular Diseases and Type 2 Diabetes Among Breast Cancer Survivors: The National Health Insurance Service Database of Korea.

Background Although endocrine therapy is an effective treatment for breast cancer, its antiestrogen effects are associated with increased risks of cardiovascular diseases and type 2 diabetes. This study aimed to investigate the association between endocrine therapy and the risk of cardiovascular diseases and type 2 diabetes among breast cancer survivors in Korea, in consideration of various age groups. Methods and Results In the National Health Insurance Service database of Korea, a total of 133 171 patients with breast cancer aged ≥20 years were included in the current study. Endocrine therapy was treated as time-varying exposure, and patients were categorized as nonusers, selective estrogen receptor modulator users, aromatase inhibitor users, and both users. Time-dependent Cox regression models were used to estimate hazard ratios (HRs) and 95% CIs. Age at diagnosis, socioeconomic status, histological type, other treatments, and comorbidities were adjusted in the model. Compared with nonusers, selective estrogen receptor modulator users were associated with higher risks of stroke (HR, 1.20 [95% CI, 1.04-1.40]) and venous thromboembolism (HR, 1.47 [95% CI, 1.13-1.90]), whereas aromatase inhibitor users were associated with a higher risk of coronary heart disease (HR, 1.22 [95% CI, 1.06-1.41]). The risk of type 2 diabetes was associated with selective estrogen receptor modulator users (HR, 1.13 [95% CI, 1.05-1.21]), aromatase inhibitor users (HR, 1.14 [95% CI, 1.05-1.23]), and both users (HR, 1.24 [95% CI, 1.10-1.39]). In particular, the risk of a composite of cardiovascular diseases was higher in younger or premenopausal patients. Conclusions In breast cancer survivors in Korea, endocrine therapy is associated with a higher risk of cardiovascular diseases and type 2 diabetes. Monitoring of cancer comorbidities after endocrine therapy is needed in younger and older patients.

Associations of Circulating Levels of Trimethylamine N-oxide, Choline, Carnitine, and Betaine with Inflammatory Markers Among Breast Cancer Survivors

ObjectivesWe examined the associations of circulating levels of trimethylamine N-oxide (TMAO) and its precursors (choline, carnitine, and betaine) with inflammatory markers in breast cancer survivors in Korea.MethodsA total of 431 women (285 premenopausal breast cancer) aged 30–78 years were included. Least-squares mean (LS-mean)s and 95% confidence interval (CI)s were estimated for plasma levels of high-sensitivity C-reactive protein (hs-CRP), interleukin (IL)-6, IL-8, tumor necrosis factor-α (TNF-α), and adiponectin according to plasma levels of TMAO, choline, carnitine, and betaine, using the generalized linear models.ResultsAmong premenopausal breast cancer survivors, increasing circulating levels of choline were associated with increasing levels of IL-6, IL-8, and TNF-α; LS-means (95% CIs) of the lowest and the highest quartiles were 0.75 (0.56–0.96) and 1.01 (0.80–1.24) pg/mL (p for trend = 0.019) for IL-6, 11.49 (8.19–15.97) and 17.73 (12.96–24.13) pg/mL (p for trend = 0.005) for IL-8, and 9.45 (7.47–11.88) and 11.99 (9.63–14.88) pg/mL (p for trend = 0.021) for TNF-α, respectively. Increasing plasma betaine levels were associated with increasing levels of adiponectin but decreasing levels of hs-CRP and IL-6; LS-means (95% CIs) of the lowest and the highest quartiles were 7.25 (5.65–9.23) and 9.05 (7.10–11.47) μg/mL (p for trend = 0.044) for adiponectin, 0.68 (0.45–0.96) and 0.35 (0.16–0.57) mg/L (p for trend 0.017) for hs-CRP, and 0.98 (0.77–1.21) and 0.75 (0.57–0.97) pg/mL (p for trend = 0.013) for IL-6, respectively. However, plasma levels of TMAO and its precursors were not significantly associated with inflammatory markers in postmenopausal breast cancer survivors.ConclusionsIn this cross-sectional study of breast cancer survivors, increasing plasma levels of choline were associated with increasing levels of inflammatory markers, but plasma levels of betaine were inversely associated with these markers among premenopausal breast cancer survivors.Funding SourcesThis work was supported by the National Research Foundation of Korea (NRF) grants funded by the Korea Government (Ministry of Science and ICT) (No. 2014R1A2A2A01007794, 2019R1F1A1061017, and 2021R1F1A1062476).

Validity and reproducibility of a food frequency questionnaire for breast cancer survivors in Korea.

The aim of this study was to examine the validity and reproducibility of a food frequency questionnaire (FFQ) developed in Korea for breast cancer survivors. Ninety-nine breast cancer survivors who completed an FFQ twice and three 3-day dietary records (DRs) between 2016-2017 were included. Energy and 14 nutrient intakes were calculated from FFQs and DRs. To determine the validity of the FFQ, energy-adjusted de-attenuated Pearson correlations between two FFQ assessments and the average of the three 3-day DRs were calculated, and to determine reproducibility, energy-adjusted Pearson correlations and degrees of agreement were calculated between the first and second FFQ assessments. Correlation coefficients of validity ranged from 0.29 (protein) to 0.47 (fat) (median value = 0.36) for the FFQ assessment and from 0.20 (riboflavin) to 0.53 (calcium) (median value = 0.37) for the second. Correlation coefficients of reproducibility ranged from 0.22 (sodium) to 0.62 (carbohydrate) (median value = 0.36). Regarding FFQ reproducibilities, percentage classifications of exact agreements for energy-adjusted nutrients ranged from 27.3% (sodium) and 45.5% (fat). A median 76.8% of participants were classified into the same or adjacent quartiles, while a median of 5.6% of participants were classified in extreme quartiles. Bland-Atman plots for the majority of data points of three macronutrients, calcium and vitamins A and C fell within limits of agreement. These results indicated that the newly developed FFQ for Korean breast cancer survivors has acceptable validity and reproducibility as compared with three 3-day DRs collected over a one-year period.

The development of a lifestyle modification mobile application, "Health for You" for overweight and obese breast cancer survivors in Korea.

PurposeThis study aimed to develop a lifestyle modification (LSM) mobile application based on the Android operating system for overweight and obese breast cancer survivors (BCS) in Korea and evaluate its usability.MethodsThe content analysis, design, development, implementation, and evaluation of the LSM intervention mobile application for overweight and obese BCS was conducted by identifying survivors’ needs, searching the literature, and reviewing existing mobile applications. The survey was conducted from June 1 to December 28, 2020 at Jeonju city, Korea.ResultsThe mobile application for BCS included dietary and exercise information, weight logs, as well as distress and daily achievement check. It also included information and videos on the prevention of breast cancer recurrence and used a communication bulletin board. Expert and user usability evaluation of its content and functions confirmed that it was appropriate and satisfactory for overweight and obese BCS.ConclusionThis LSM mobile application developed for overweight and obese BCS was found to be appropriate for use. It can be applied for further study of effectiveness on improving their health and maintaining a healthy lifestyle, to ultimately improve quality of life.

A scoping review of return to work decision-making and experiences of breast cancer survivors in Korea.

Return to work (RTW) is an important component of cancer survivorship for individual rehabilitation and economic development. The focus of prior research on cancer survivor RTW has generally been on Western and general cancer populations. There is a need to examine the existing research on RTW decisions and experiences in Korean breast cancer survivors (BCS). This scoping review followed the framework of Arksey and O'Malley, which consisted of identifying the research question, discovering and selecting studies, charting data, analyzing results, and incorporating expert consultations. Quality assessments and a thematic map were included. Out of 863 original articles found in the literature search, 8 articles met the inclusion criteria. Majority were published in the past 5years. The scope of the field, socio-demographic and clinical associations, and factors associated with RTW decision-making and experiences were reported. In the thematic analysis, 4 main categories were derived. Future research needs to be conducted on effective RTW interventions targeting various educational backgrounds, socioeconomic levels, and job types. More institutional and social support would encourage more successful RTW through educational awareness, financial assistance, and workplace accommodations. Future studies should focus on interdisciplinary RTW efforts with multiple stakeholders. BCS need programs that include social support, individual coping strategies, reliable RTW information, physical rehabilitation, vocational counseling, workplace allowances, and psychological support. More support should be provided through extending the work law and engaging employers. If they desire to resume working, BCS should be fully supported with RTW specific resources.

국내 유방암 생존자의 근로활동 동향에 관한 고찰

국내 유방암 생존자의 근로활동 동향에 관한 고찰

Different Patterns of Conditional Survival of Breast Cancer Patients by Age and Histologic Types: Evidence from the Korean Nationwide Registry.

Conditional relative survival (CRS), which is the survival estimate of patients who have already survived for a certain period of time after diagnosis, could provide more relevant information on the current prognosis of cancer survivors than the standard 5-year relative survival (RS). This study aimed to estimate the 5-year CRS of Korean breast cancer patients. We identified 145,083 breast cancer cases diagnosed between 2002 and 2013 in the Korea Central Cancer Registry. The CRS was estimated for every year after diagnosis, according to sex, age, histologic type, and stage. The 5-year RS at diagnosis was 90.8%, and the 10-year RS was 85.7%. The 5-year CRS was 91.0% and 94.3% at 1 year and 5 years after diagnosis, respectively. Very young and very old patients had worse 5-year CRS after 5 years of survival than those of other age groups (92.2% in the <40-year and 92.6% in the ≥70-year groups vs. 95.4% in 40-49-year, 94.3% in 50-59-year, and 93.7% in 60-69-year groups). The 5-year CRS of metaplastic carcinoma increased from 82.0% at diagnosis to 95.2% at 5 years after diagnosis, compared with that of lobular carcinoma (from 93.1% to 92.5%). Hardly any excess mortality (5-year CRS ≥ 95%) was seen within 7 years after diagnosis. This study shows that the CRS of breast cancer survivors in Korea has increased, but varies by sex, age, stage, and histologic type. These findings provide more detailed information to breast cancer survivors and clinicians.

Abstract P1-08-24: Conditional survival of breast cancer patients: Korean nationwide registry

Abstract Purpose: Conditional relative survival (CRS) could provide more relevant information on the current prognosis of cancer survivors than standard 5-year relative survival (RS). This study aimed to estimate the 5-year CRS of Korean breast cancer patients. Patients and Methods: We identified 145,083 breast cancer cases with diagnosis between 2002 and 2013 in the Korea Central Cancer Registry. The CRS was estimated for every year after diagnosis, according to sex, age, histologic types, stage, and year of diagnosis. Results: The 5-year RS at diagnosis was 90.8% and 10-year RS was 85.7%. Five-year CRS was 91.0% and 94.3% at 1-year and 5-year after diagnosis. Women had better 5-year CRS than men after 5 years of survival (94.3% vs. 79.5%), and very young and very old patients had worse 5-year CRS after 5 years of survival than other age groups (92.2% in &amp;lt;40yr, 92.6% in ≥70yr vs. 95.4% in 40-49, 94.3% in 50-59, and 93.7% in 60-69, relatively). In histologic types, CRS of metaplastic carcinoma has improved from 82.0% to 95.2%, compared to CRS of lobular carcinoma (from 93.1% to 92.5%). Hardly any excess mortality (5-year CRS ≥ 95%) was seen since 7 years after diagnosis. There was hardly any excess mortality at 5 years of survival, for the patients with 40-49 years (95.4%), with localized disease (97.8%), and with metaplastic carcinoma (95.2%). Conclusion: This study showed that CRS of breast cancer survivors in Korea has been improved, which varied by sex, age, stage, and histologic types. These CRS analysis could provide a more detailed information for survival to breast cancer survivors and clinicians. Citation Format: Jung S-Y, Jung K-W, Won Y-J, Kwon Y, Ha J, Kim YA, Kong S-Y, Lee ES. Conditional survival of breast cancer patients: Korean nationwide registry [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-08-24.

Determinants of Plasma 25-Hydroxyvitamin D Concentrations among Breast Cancer Survivors in Korea.

We identified demographic, lifestyle, and clinical factors associated with vitamin D status among breast cancer survivors. The vitamin D prediction model may be a useful surrogate of circulating 25-hydroxvitamin D (25(OH)D) concentrations when this measure was not available. We included a total of 216 Korean breast cancer survivors aged 21–79 years who had been diagnosed with stage I to III primary breast cancer and had breast cancer surgery at least 6 months before enrolment. We used linear and logistic regressions to identify determinants for the plasma 25(OH)D concentrations and vitamin D insufficiency (plasma 25(OH)D concentration < 50 nmol/L). We observed that 48.85% of breast cancer survivors had a plasma 25(OH)D concentration less than 50 nmol/L. We identified the following determinants for plasma 25(OH)D concentrations: time since diagnosis (β = −0.005 for 1 month increment), supplementary vitamin D intake (β = 0.06 for 10 μg/day increment), season of the blood draw (β = 0.35 for summer; β = 0.32 for fall; β = 0.26 for winter vs. spring), smoking status (β = 0.28 for former vs. never), use of any supplement (β = −0.35 for non-use vs. use), and the parity number (β = −0.30 for three or more vs. one) were associated with the plasma 25(OH)D concentrations. In addition to the aforementioned variables, body mass index (BMI) was associated with the prevalence of vitamin D insufficiency. We identified the determinants for the plasma 25(OH)D concentrations among Korean breast cancer survivors. Future studies are needed to investigate the role of vitamin D in the progression of breast cancer among Korean breast cancer survivors.

The Influence of Spiritual Well-Being, Self-Esteem, and Perceived Social Support on Post-Traumatic Growth among Breast Cancer Survivors

Purpose: The purpose of this study was to identify the influence of spiritual well-being, self-esteem, and perceived social support on post-traumatic growth in breast cancer survivors in Korea. Methods: Data were collected from March 2 to October 31, 2016 using self-reporting questionnaires from 126 breast cancer survivors who had visited out-patient clinics for follow-up in B city. Data were analyzed using descriptive statistics, independent t-test, one-way ANOVA, Pearson’s correlation coefficient, and stepwise multiple regression. Results: Post-traumatic growth was significantly correlated with spiritual well-being (r=.52, p<.001), self-esteem (r=.54, p<.001), and perceived social support (r=.47, p<.001). In a stepwise multiple regression, spiritual well-being (β=.26, p<.001), self-esteem (β=.23, p<.001), perceived social support (β=.21, p<.001), and presence of spouse (β=.20, p<.001) were associated with posttraumatic growth. These factors attributed to 37.0% of the total variance in post-traumatic growth in breast cancer survivors. Conclusion: Considering the results of this study, it is necessary to develop and implement effective nursing strategies that can improve spiritual well-being, and to develop a holistic nursing intervention that takes into account self-esteem, perceived social support, and spousal help, when applicable, in order to promote post-traumatic growth in breast cancer survivors in Korea.

Distress and Quality of Life for Breast Cancer Survivors during Follow-Up Periods in Korea

Purpose Few studies have reported postdiagnosis differences in distress and quality of life (QOL) for breast cancer (BC) survivors. Here we investigated the differences in distress and QOL for BC survivors in Korea, during follow-up. Methods Completed questionnaires were collected from 179 BC survivors in 2013. Functional Assessment of Cancer Therapy-Breast was administered to measure the distress and Distress Thermometer and Problem List was administered to measure the QOL. Results The mean QOL score was 96.69 (standard deviation, ±20.33). Seventy-nine patients (44.1%) with distress-test scores >4 were assigned to the severe distress group. The patient group with higher family income had high QOL score (p=0.008). In addition, QOL scores were significantly higher in patients who lived longer after diagnosis (p=0.016). Patients at high TNM stage had low QOL scores (p=0.006). Furthermore, older patients tended to have high distress scores (p=0.028). Based on duration of the postdiagnosis period, we divided the patients into two groups. Seventy patients had a postdiagnosis period <2 years; 109 patients, postdiagnosis period ≥2 years. Distress score of the under-2-year group (4.26±2.73) was significantly higher (p=0.044) than that of the longer-than-2-year group (3.47±2.42). Conclusion BC survivors showed improvement in physical well-being, emotional well-being, and functional well-being domain of QOL over time. However, social well-being and BC subscale score were only slightly improved over time. It is possible that cancer patients’ supporting programs are focused on the recently diagnosed patients or those currently undergoing treatment. Therefore, more support should be made available to long-term BC survivors. Keywords: Breast; Neoplasms; Psychological stress; Quality of life; Survivors

Development of a FFQ for breast cancer survivors in Korea.

Diet may play an important role in breast cancer recurrence or survival, and therefore assessment of long-term diet among breast cancer survivors is important in breast cancer survivorship research. Given that the diet of breast cancer survivors may differ from that of the general population, the use of a FFQ specific to this group may be needed. The objective of this study was to develop a FFQ for breast cancer survivors, the most commonly used tool to measure long-term dietary patterns in nutritional epidemiological studies. We collected information on the foods and amounts of foods consumed using 3-d dietary records from a total of 192 women who had been diagnosed with stage I-III breast cancers and had undergone breast cancer surgery at least 6 months before the baseline study. A total of 1254 foods and dishes consumed were re-grouped by the similarity of the main ingredients and/or serving units, and several dishes commonly consumed among the Korean population were added. After we performed contribution analyses and variability analyses to detect between-person variation for selected nutrients, we listed a total of 123 foods and dishes for the FFQ specific to breast cancer survivors. Our breast cancer survivor-specific FFQ can be used to estimate long-term dietary intake and to examine its association with breast cancer prognosis in epidemiological studies of breast cancer in Korea.

Management of long-term breast cancer survivors in Korea

Management of long-term breast cancer survivors in Korea Jung Ah Lee, Md · Jong han Yu, Md · Yun-Mi song, Md Department of Family Medicine and Cancer Prevention Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul; Division of Breast and Endocrine Surgery, Department of Surgery and Samsung Comprehensive Cancer Center, Department of Family Medicine and Samsung Comprehensive Cancer Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

유방암 수술을 받은 여성의 의복추구혜택에 관한 탐색적 연구

Abstract The objective of this study was to take a closer look at the clothing benefits sought by breast cancer survivors in Korea. A qualitative descriptive study was conducted, using the focus group interview. Data was collected from members of online breast cancer forum. 18 participants were breast cancer survivors who had mastectomy or lumpectomy in their 30s~50s. The data was analyzed using content analysis in order to identify significant themes. The analysis indicated that benefits were sought after functional/comfort, health, feminity, and compensation were found. First, breast cancer survivors considered functional/comfort to be most important benefit so as to keep the body comfortable from the weather. Second, participants put the healthy body as the first priority and chose a well-being lifestyle and were likely to wear clothes made in healthy fabric, such as organic, bamboo or charcoal. Also, they preferred to look active by wearing sport brands or outdoorwear brands. Third, after the surgery, they experienced the sense of femininity loss and the sense of crisis as a woman. Single women and married women in early 30s recognized more seriously, and they tried to recover feminity by wearing clothes with feminine details. Forth, breast cancer survivor consumers tended to shop for the psychological compensation. In summary, consumers with breast cancer surgery, unlike general healthy women, did not sought to be economic, fashion, self-expression benefits, rather they sought health, femininity, and compensation benefits. Therefore, it seems necessary to develop proper products and marketing strategy to meet the said consumer's special needs. Keywords: breast cancer survivors(유방암 생존자), clothing benefits sought(의복추구혜택), focus group interview (초점집단면접법)

Low bone density in breast cancer survivors in Korea: Prevalence, risk factors and associations with health-related quality of life

PurposeTo examine the prevalence and risk factors of low bone density and identify associations with health-related quality of life (HRQOL) in breast cancer survivors in Korea. MethodsThis study was a cross-sectional descriptive study design. A total of 136 women with breast cancer who had completed their therapy were recruited at one university-based cancer center in Korea. Bone mineral density (BMD), health behaviors (physical activity, diet/nutrition behaviors, smoking, alcohol consumption, sunlight exposure), and HRQOL were measured. ResultsAmong the 136 breast cancer survivors, 49 women (36.0%) had osteopenia and six women (4.4%) had osteoporosis. Univariate analyses revealed that older age, low education level, low monthly income, tamoxifen therapy, aromatase inhibitor therapy, calcium supplement intake, and past or current smoking were associated with low bone density (BMD T-score < −1.0). In multivariate analyses, low economic status (OR = 2.22, p = 0.050) and past or current smoking (OR = 3.77, p = 0.039) were final risk factors of low bone density. In addition, women who had low bone density reported worse role function (p = 0.022) than women who did not. ConclusionsWomen of lower economic status or who are past or current smokers warrant monitoring and treatment strategies to reduce bone loss risk. Nurses may play a crucial role in screening this high-risk group for low bone density and in educating patients on the importance of healthy lifestyle changes.

Factors influencing health-promoting behaviors in Korean breast cancer survivors

PurposeThe purpose of this study was to examine the relationships among internal health locus of control, depression, social support, and health-promoting behaviors in Korean breast cancer survivors and to identify factors influencing health-promoting behaviors. MethodA predictive design was used. The data were collected by questionnaires from a convenience sample of 258 breast cancer survivors in Korea during 2007. The data were analyzed using descriptive statistics, t-tests, one-way ANOVA, Pearson's correlation coefficients, and stepwise multiple regression. ResultsWhen differences of health-promoting lifestyle based on demographic and illness-related characteristics were examined, no significant differences were found except for undergoing chemotherapy. Internal health locus of control, depression, and social support were correlated significantly with the health-promoting lifestyle. As a result of stepwise multiple regression analysis, social support, depression, and chemotherapy were discovered to account for 34.98% of the variance in health-promoting lifestyle. The variable that most affected a health-promoting lifestyle was social support, followed by chemotherapy and depression. ConclusionsThe results of the study clearly demonstrate the importance of social support and depression in explaining the occurrence of a health-promoting lifestyle among Korean breast cancer survivors.

Experiences of the Use of External Breast Prosthesis among Breast Cancer Survivors in Korea.

The purpose of this study was to examine the experiences of the use of external breast prostheses among breast cancer survivors in Korea. A qualitative descriptive study was conducted, using focus groups. Data were collected from breast cancer survivors who were patients of C women's hospital in Seoul, Korea. Data were analyzed using content analysis in order to identify significant themes. Participants included forty breast cancer survivors who had mastectomy as a surgical treatment. Four themes emerged from the collected data were: 1) concern over the high price of external breast prosthesis, 2) irregular use of external breast prosthesis, 3) unsatisfied with mastectomy bra, and 4) wanting to hide or not to talk about using breast prosthesis openly. Since most participants reported irregular use and negative experiences related to external breast prosthesis or mastectomy bra use, healthcare workers should allow more time for proper fitting and counseling and consulting with breast cancer survivors. In addition, health care providers as well as family and friends should keep in mind that cancer survivors need support that can help them cope by using positive reframing. Furthermore, improvements in the coverage of costs and services are needed for these women. This would be helpful for breast prosthesis users.

Distress and Quality of Life in Breast Cancer Survivors in Korea

Purpose: The purposes of this study were to find the levels of distress and quality of life of breast cancer survivors in Korea and to identify relationship between distress and quality of life. Methods: The data were collected from 122 breast cancer survivors in 2009. To measure the distress and quality of life, the ‘Distress Thermometer and Problem List’and the ‘Functional Assessment Cancer Therapy-Breast’were used respectively. Results: The mean score of distress was 4.77 (±2.35) and 63.1% of the subjects reported a distress score of 4 or more, indicating a clinically significant level of distress. Among these, the most frequently reported problem area was emotion, followed by family. The mean score of the quality of life was 88.22 (±18.41), signifying 6.13 out of 10. The levels of distress and the quality of life were negatively correlated (r=-.38, p<.001). Conclusion: The results of the study indicate that distress is prevalent in Korean breast cancer survivors and the distress is related negatively with their quality of life. Thus oncology professionals continuously need to assess distress of breast cancer survivors and to provide appropriate psychosocial interventions to improve their quality of life.

Symptoms and uncertainty in breast cancer survivors in Korea: differences by treatment trajectory

The study compared the levels of symptoms and uncertainty, their associated factors, relationships between them and predictors of uncertainty by treatment trajectory among breast cancer survivors. Little is known with regard to how uncertainty and symptoms are related to treatment trajectory among breast cancer survivors. A cross-sectional descriptive design was used. A total of 252 women with breast cancer, receiving cancer therapy, or having completed their therapy were recruited from the National Cancer Center in Korea. Measurements used included symptom subscales of the European Organization of Research and Therapy for Cancer QLQ-C30 and Breast Cancer Module BR23 and the Mishel Uncertainty in Illness Scale. Women in treatment reported more severe symptoms and higher levels of uncertainty than women having completed treatment. During treatment, most symptoms were positively correlated with the level of uncertainty, whereas, in women who had completed treatment, only dyspnoea, insomnia, systemic therapy side effects and arm symptoms positively correlated with uncertainty. There were also differences in predictors of uncertainty by treatment trajectory. Age, marital status and pain were significant predictors of uncertainty during treatment, while monthly income, dyspnoea and insomnia were predictors of uncertainty after treatment. Among breast cancer survivors, levels of symptoms and uncertainty, associated factors, relationships between them and predictors of uncertainty differed depending on treatment trajectory. To provide trajectory-sensitive nursing intervention for uncertainty among breast cancer survivors, age, marital status and pain should be considered during treatment, while factors such as economic status, dyspnoea and insomnia should be taken into account after treatment.