Health-related quality of life among women with breast cancer – a population-based study

Figures & data

Table I. Clinical characteristics among breast cancer patients in Sweden: the study sample vs. non-approached eligible patients (n = 568) and approached eligible patients not included in the analyses (n = 487^a).

	Study sample (n = 1086)	Non-approached eligible patients (n = 568)		Approached non-included eligible patients (n = 487)
	n (%)	n (%)	p	n (%)	p
Age (mean;range;SD)	61.8;25–94;12.6	64.4;24–97;14.4	***	67.9;30–99;14.8	***
Previous breast cancer
Yes	50 (4.6)	31 (5.5)	NS	24 (4.9)	NS
No	1036 (95.4)	537 (94.5)		463 (95.1)
Laterality
Unilateral	1060 (97.6)	555 (97.7)	NS	472 (96.9)	NS
Bilateral	26 (2.4)	13 (2.3)		15 (3.1)
Invasiveness
In situ cancer	101 (9.3)	66 (11.6)	NS	53 (10.1)	NS
Invasive cancer	984 (90.6)	495 (87.1)		430 (88.3)
Tumor size
In situ cancer/invasive cancer ≤ 20mm	710 (65.4)	360 (63.4)	NS	290 (59.5)	NS
Invasive cancer ≥ 21mm	368 (33.9)	167 (29.4)		180 (37.0)
Lymph node involvement
In situ/no axillary surgery/0 metastases	738 (68.0)	404 (71.1)	NS	334 (68.6)	NS
> 1 lymph node metastases	346 (31.9)	156 (27.5)		148 (30.4)
Distant metastases
Yes	15 (1.4)	29 (5.1)	***	13 (2.7)	NS
No/assessment not possible	1068 (98.3)	537 (94.5)		472 (96.9)
Surgery
No surgery	10 (0.9)	74 (13.0)	***	39 (8.0)	***
Partial mastectomy	618 (56.9)	289 (50.9)		229 (47.0)
Mastectomy	458 (42.2)	204 (35.9)		219 (45.0)
Oncological treatment
No treatment	99 (9.1)	92 (16.2)	***	65 (13.3)	*
Radiation therapy	731 (67.3)	321 (56.5)	***	260 (53.4)	***
Chemotherapy	389 (35.8)	157 (27.6)	**	116 (23.8)	***
Endocrine therapy	736 (67.8)	362 (63.7)	NS	316 (64.9)	NS
Antibody therapy	83 (7.6)	42 (7.4)	NS	31 (6.4)	NS

Abbreviation: NS, no significance.

^aOne patient excluded due to misclassification in the register.

*p < 0.05, **p < 0.01, ***p < 0.001

Table II. Comparisons between the study sample of breast cancer patients in Sweden and normative data from the general Swedish female population adjusting for age (EORTC QLQ-C30: ≤ 79 years; HADS: 30–59 years).

	Normative data (expected mean)	Observed mean	Mean difference	95% CI
EORTC QLQ-C30^a
Global health status/QoL^b
Total (n = 974)	75.7	65.0	−10.7	−12.1—9.2
<50 yrs (n = 190)	75.3	59.6	−15.7	−18.9—12.5
≥50 yrs (n = 784)	75.8	66.3	− 9.5	−11.1—7.9
Physical functioning^b
Total (n = 982)	86.1	82.3	−3.8	−5.0—2.6
<50 yrs (n = 194)	92.5	83.6	−9.0	−11.4—6.5
≥50 yrs (n = 788)	84.5	82.0	−2.5	−3.8—1.2
Role functioning^b
Total (n = 982)	85.4	67.7	−17.7	−19.7—15.7
<50 yrs (n = 194)	87.4	59.2	−28.2	−32.9—23.5
≥50 yrs (n = 788)	84.9	69.8	−15.1	−17.3—12.9
Emotional functioning^b
Total (n = 975)	80.6	72.3	−8.3	−9.7—6.8
<50 yrs (n = 190)	75.6	65.0	−10.6	−14.0—7.1
≥50 yrs (n = 785)	81.8	74.1	−7.7	−9.3—6.1
Cognitive functioning^b
Total (n = 975)	88.7	80.6	−8.1	−9.5—6.6
<50 yrs (n = 190)	88.6	73.0	−15.6	−19.4—11.9
≥50 yrs (n = 785)	88.8	82.5	−6.2	−7.7—4.7
Social functioning^b
Total (n = 973)	90.2	75.2	−15.1	−16.8—13.4
<50 yrs (n = 190)	88.5	64.8	−23.7	−27.7—19.7
≥50 yrs (n = 783)	90.7	77.7	−13.0	−14.8—11.2
Fatigue^c
Total (n = 985)	22.2	36.4	14.1	12.5–15.7
<50 yrs (n = 194)	22.9	44.7	21.7	17.8–25.6
≥50 yrs (n = 791)	22.1	34.3	12.2	10.5–14.0
Nausea and vomiting^c
Total (n = 986)	3.2	9.5	6.2	5.2–7.3
<50 yrs (n = 194)	3.7	13.3	9.7	7.0–12.3
≥50 yrs (n = 792)	3.1	8.5	5.4	4.3–6.5
Pain^c
Total (n = 985)	21.7	20.9	−0.8	−2.3–0.8
<50 yrs (n = 194)	20.2	21.6	1.4	−2.1–5.0
≥50 yrs (n = 791)	22.0	20.7	−1.3	−3.0–0.4
Dyspnoea^c
Total (n = 978)	15.6	22.9	7.3	5.6–9.1
<50 yrs (n = 192)	14.5	26.0	11.5	7.5–15.5
≥50 yrs (n = 786)	15.9	22.2	6.3	4.4–8.2
Insomnia^c
Total (n = 982)	21.4	33.3	11.9	9.9–13.9
<50 yrs (n = 194)	18.5	38.1	19.6	14.8–24.4
≥50 yrs (n = 788)	22.1	32.1	10.0	7.8–12.2
Appetite loss^c
Total (n = 984)	4.5	14.5	10.0	8.5–11.6
<50 yrs (n = 194)	4.5	19.4	14.9	11.0–18.8
≥50 yrs (n = 790)	4.4	13.3	8.9	7.1–10.6
Constipation^c
Total (n = 984)	7.5	13.1	5.6	4.1–7.1
<50 yrs (n = 194)	6.4	14.4	8.0	4.4–11.6
≥50 yrs (n = 790)	7.7	12.7	5.0	3.4–6.7
Diarrhoea^c
Total (n = 971)	4.8	10.8	6.0	4.7–7.4
<50 yrs (n = 189)	5.6	13.6	8.0	4.5–11.5
≥50 yrs (n = 782)	4.6	10.1	5.6	4.1–7.0
Financial difficulties^c
Total (n = 969)	8.0	16.4	8.4	6.7–10.1
<50 yrs (n = 189)	7.3	30.5	23.2	18.6–27.8
≥50 yrs (n = 780)	8.2	12.9	4.8	3.1–6.5
HADS ^d
Anxiety^e
Total (n = 449)	4.76	6.17	1.41	0.99–1.83
<50 yrs (n = 191)	4.81	6.57	1.76	1.12–2.40
≥50 yrs (n = 258)	4.72	5.87	1.15	0.59–1.72
Depression ^f
Total (n = 449)	4.09	4.30	0.21	−0.14–0.56
<50 yrs (n = 191)	3.60	4.63	1.03	0.49–1.58
≥50 yrs (n = 258)	4.45	4.06	−0.39	−0.85–0.06

Abbreviations: CI, confidence interval.

^aOnly clinically meaningful mean group differences are in bold.

^bScores 0–100. Higher scores indicate better function.

^cScores 0–100. Higher scores indicate more symptoms/problems.

^dScores 0–21. Higher scores indicate more symptoms.

^eClinically meaningful mean group differences ≥ 1.23 are in bold.

^fClinically meaningful mean group differences ≥ 0.86 are in bold.

Table III. Clinically meaningful mean group differences based on fully adjusted^a regression models of EORTC functioning scales (study sample: breast cancer patients in Sweden).

	Global health status/QoL (n = 910)^b		Role functioning (n = 915)^b		Social functioning (n = 909)^b		Sexual functioning (n = 889)^b
	B (95% CI)	Mean diff.^cd	B (95% CI)	Mean diff.^cd	B (95% CI)	Mean diff.^cd	B (95% CI)	Mean diff.^cd
Age and clinical factors
Age^e	NS		NS		0.3 (0.9–0.5)**	−13.5	−0.5 (−0.7—0.3)***	10.8
Time since diagnosis^f	−1.1 (−2.0—0.3)**	4.2	NS		−1.1 (−2.1—0.1)*	5.1	NS
Invasiveness
In situ cancer (ref.)	–		–		–		–
Invasive cancer	−6.8 (−12.1—1.4)*	−13.4	−11.4 (−18.9—3.9)**	−18.1	NS		NS
Chemotherapy
No (ref.)	–		–		–		–
Yes	−9.3 (−13.1—5.5)***	−14.7	−13.2 (−18.6—7.8)***	−23.0	−13.2 (−17.7—8.6)***	−18.9	NS
Comorbidity
No comorbidity (ref.)	–		–		–		–
1 comorbidity	−5.8 (−9.1—2.5)**	−0.2	NS		NS		−3.8 (−7.2—0.3)*	−3.1
> 2 comorbidities	−11.3 (−14.6—8.0)***	−9.3	−9.5 (−14.2—4.9)***	−8.1	−7.3 (−11.3—3.4)***	−4.6	−4.3 (−7.8—0.8)*	−6.5
Demographic factors and social support
Support within the family
Yes (ref.)	–		–		–		–
No	−7.4 (−12.0—2.7)**	−12.9	−7.8 (−14.4—1.3)*	−11.7	−13.4 (−18.9—7.8)***	16.9	−6.8 (−11.8—1.9)**	−9.6
Support outside the family
Yes (ref.)	–		–		–		–
No	−7.3 (−12.1—2.6)**	−11.4	NS		−6.2 (−11.9—0.4)*	−9.1	NS
Socio-economic factors
Education
University level (ref.)	–		–		–		–
Other	NS		NS		NS		−5.7 (−8.7—2.7)***	−9.3
Occupation
Retirement pension (ref.)	–		–		–		–
Employed/student	NS		NS		NS		NS
Sick leave	−12.1 (−17.1—7.2)***	−12.8	−25.3 (−32.3—18.4)**‘	−25.8	−6.8 (−12.6—0.9)*	−14.8	NS
Other occupation	−9.1 (−14.1—4.2)***	−8.8	−14.2 (−21.1—7.3)***	−7.8	−7.5 (−13.4—1.7)*	−9.6	NS
Financial situation^g	2.2 (1.6–2.8)***	−15.0	2.2 (1.4–3.0)***	−15.0	2.0 (1.3–2.7)***	−11.7	0.8 (0.2–1.4)**	−7.1

Abbreviations: B, unstandardized coefficient; CI, confidence interval; Mean diff., mean difference between explanatory variables; NS, no significance.

^aAdjusted for previous breast cancer diagnosis, laterality, tumor size, lymph node involvement, type of surgery and oncological treatment, marital status and children.

^bScores 0–100. Higher scores indicate better function.

^cMean differences were only calculated for associations with statistical significance.

^dAssociations with clinically meaningful mean group differences are in bold.

^eCategorized when assessing clinically meaningful mean group differences (<50, ≥50 (ref.) years).

^fCategorized when assessing clinically meaningful mean group differences (1–4 months, 5–8 months (ref.)).

^gCategorized when assessing clinically meaningful mean group differences (0–4 = poor, 5–10 = good (ref.)).

*p < 0.05, **p < 0.01, ***p < 0.001

Table IV. Clinically meaningful mean group differences based on fully adjusted^a regression models of EORTC symptom scales (study sample: breast cancer patients in Sweden).

	Fatigue (n = 916)^b		Insomnia (n = 914)^b		Systemic therapy side effects (n = 911)^b
	B (95% CI)	Mean diff.^cd	B (95% CI)	Mean diff.^cd	B (95% CI)	Mean diff.^cd
Age and clinical factors
Age^e	NS		−0.4 (−0.6—0.1)**	7.3	NS
Time since diagnosis^f	1.3 (0.3–2.2)*	−5.7	NS		1.2 (0.5–1.8)***	−5.8
Previous breast cancer diagnosis
No (ref.)	–		–		–
Yes	NS		12.1 (3.1–21.0)**	9.0	NS
Invasiveness
Insitu cancer (ref.)	–		–		–
Invasive cancer	11.1 (4.9–17.2)***	16.7	NS		6.7 (2.6–10.8)**	15.7
Lymph node involvement (N)
In situ, invasive no surgery/N (ref.)	–		–		–
≥ 1 lymph node metastases	5.4 (1.4–9.4)**	13.1	NS		NS
Chemotherapy
No (ref.)	–		–		–
Yes	8.8 (4.4–13.2)***	17.0	6.1 (0.4–11.9)*	12.0	22.1 (19.1–25.0)***	24.7
Endocrine therapy
No (ref.)	–		–		–
Yes	−4.4 (−8.0—0.8)*	0.3	NS		NS
Comorbidity
No comorbidity (ref.)	–		–		–
1 comorbidity	NS		NS		3.5 (1.0–6.0)**	0.7
> 2 comorbidities	10.7 (6.9–14.5)***	9.7	6.7 (1.7–11.7)**	6.7	6.7 (4.2–9.2)***	3.8
Demographic factors and social support
Support within the family
Yes (ref.)	–		–		–
No	7.9 (2.6–13.2)**	12.6	9.9 (2.9–16.9)**	15.8	6.1 (2.5–9.6)**	7.4
Support outside the family
Yes (ref.)	–		–		–
No	NS		11.5 (4.3–18.6)**	14.4	NS
Socio-economic factors
Occupation
Retirement pension (ref.)	–		–		–
Employed/student	NS		NS		NS
Sick leave	10.3 (4.6–16.0)***	15.0	7.8 (0.3–15.2)*	12.4	4.5 (0.7–8.3)*	13.1
Other occupation	7.8 (2.2–13.5)**	9.7	11.8 (4.4–19.3)**	14.3	6.8 (3.0–10.5)***	7.5
Financial situation^g	−2.0 (−2.7—1.3)***	13.9	−1.3 (−2.1—0.4)**	12.1	−1.3 (−1.8—0.9)***	8.8

Abbreviations: B, unstandardized coefficient; CI, confidence interval; Mean diff., mean difference between explanatory variables; NS, no significance.

^aAdjusted for laterality, tumor size, type of surgery and oncological treatment, marital status, children and education.

^bScores 0–100. Higher scores indicate more symptoms/problems.

^cMean differences were only calculated for associations with statistical significance.

^dAssociations with clinically meaningful mean group differences are in bold.

^eCategorized when assessing clinically meaningful mean group differences (< 50, ≥ 50 (ref.) years).

^fCategorized when assessing clinically meaningful mean group differences (1–4 months, 5–8 months (ref.)).

^gCategorized when assessing clinically meaningful mean group differences (0–4 = poor, 5–10 = good (ref.)).

*p < 0.05, ** p < 0.01, ***p < 0.001

Table V. Clinically meaningful mean group differences based on fully adjusted^a regression models of the HADS (study sample: breast cancer patients in Sweden).

	Anxiety (n = 914)^b		Depression (n = 914)^b
	B (95% CI)	Mean diff.^cd	B (95% CI)	Mean diff.^cd
Age and clinical factors
Age^e	−0.1 (−0.1––0.0)**	1.4	NS
Previous breast cancer diagnosis
No (ref.)	–		–
Yes	1.8 (0.6–3.0)**	1.1	NS
Chemotherapy
No (ref.)	–		–
Yes	NS		0.8 (0.2–1.4)*	1.5
Comorbidity
No comorbidity (ref.)	–		–
1 comorbidity	0.7 (0.0–1.3)*	−0.4	0.7 (0.2–1.3)**	0.1
≥2 comorbidities	1.6 (0.9–2.3)***	1.4	1.2 (0.6–1.7)***	1.1
Demographic factors and social support
Support within the family
Yes (ref.)	–		–
No	2.1 (1.1–3.0)***	3.2	2.1 (1.3–2.8)***	3.0
Support outside the family Yes (ref.)
No	1.4 (0.5–2.4)**	2.2	1.5 (0.7–2.2)***	2.3
Socio-economic factors
Occupation
Retirement pension (ref.)	–		–
Employed/student	NS		NS
Sick leave	NS		NS
Other occupation	NS		1.2 (0.4–1.9)**	1.6
Financial situation^f	−0.4 (−0.5––0.3)***	2.8	−0.3 (−0.4––0.2)***	2.3

Abbreviations: B, unstandardized coefficient; CI, confidence interval; Mean diff., mean difference between explanatory variables; NS, no significance.

^aAdjusted for time since diagnosis, laterality, invasiveness, tumor size, lymph node involvement, type of surgery and oncological treatment, marital status, children and education.

^bScores 0–21. Higher scores indicate higher levels of symptoms.

^cMean differences were only calculated for associations with statistical significance.

^dAssociations with clinically meaningful mean group differences of ≥ 1.1 for anxiety and ≥ 0.8 for depression are in bold.

^eCategorized when assessing clinically meaningful mean group differences (< 50, ≥ 50 (ref.) years).

^fCategorized when assessing clinically meaningful mean group differences (0–4 = poor, 5–10 = good (ref.)).

*p < 0.05, **p < 0.01, ***p < 0.001