The impact of a breast cancer diagnosis on health-related quality of life. A prospective comparison among middle-aged to elderly women with and without breast cancer

Figures & data

Figure 1. Flow chart for inclusion.

Table 1. Baseline characteristics of 542 women with breast cancer and 729 women who remained breast cancer-free.

		Women with breast cancer diagnosed between first and second follow-up (n = 542)	Women who remained breast cancer-free (n = 729)	p*
Age (years); mean (range)	Baseline	56.5 (50.3; 65.2)	56.1 (50.2; 65.6)	0.1
	First follow-up	61.8 (54.4; 70.8)	61.5 (54.3; 70.9)	0.1
	Second follow-up	71.2 (63.8; 80.9)	71.4 (64.3; 81.7)	0.5
Length of education at baseline (years), n (%)	≤7	142 (26)	165 (23)
	8–10	282 (52)	401 (55)	0.3
	>10	118 (22)	163 (23))
Partner support at first follow-up, n (%)	No partner	138 (26)	177 (24)
	High	372 (69)	512 (70)	0.5
	Low	32 (6)	40 (5)
Comorbidity at first follow-up (Charlson index), n (%)	0	434 (80)	616 (85)
	1	54 (10)	86 (12)	<0.0001
	≥2	54 (10)	27 (5)
HQoL (SF-36 score) at first follow-up; mean (SD)
Mental component summary		53.8 (8.7)	53.9 (8.5)	0.1
Physical component summary		51.2 (8.4)	52.1 (7.8)	0.04
Physical functioning		85.7 (16.4)	87.5 (15.1)	0.04
Role-physical		85.5 (21.8)	88.0 (19.3)	0.04
Bodily pain		77.9 (23.0)	79.3 (21.9)	0.3
Vitality		69.0 (20.3)	69.6 (18.6)	0.6
Social functioning		92.0 (16.6)	92.4 (16.2)	0.7
Role-emotional		90.7 (17.7)	91.9 (16.0)	0.2
Mental health		81.1 (15.2)	81.3 (15.3)	0.9
General health		74.0 (20.1)	75.8 (18.0)	0.1
Time between diagnosis and second follow-up (years); mean (range)		5.0 (0.6; 10)
Disease stage at diagnosis, n (%)	I	166 (31)
	II	221 (41)
	III	75 (14)
	Unknown	80 (15)
Tumor size (mm), n (%)	≤20	367 (68)
	>20	175 (32)
No. of positive lymph nodes, n (%)	0	291 (54)
	≥1	229 (42)
	Unknown	22 (4)
Type of surgery, n (%)	Mastectomy	206 (38)
	Lumpectomy	310 (57)
	Lumpectomy and	7 (1)
	mastectomy	19 (4)
	Unknown
Radiation therapy, n (%)	Yes	374 (69)
	No	126 (23)
	Unknown	42 (8)
Chemotherapy, n (%)	Yes	62 (11)
	No	480 (89)
Endocrine treatment, n (%)	Yes	309 (57)
	No	233 (43)

SD, standard deviation.

*From t-test for quantitative variables and from χ²-test for categorical variables.

Table 2. Mean changes between first (fu1) and second (fu2) follow-up and differences in changes in health-related quality of life with 95% confidence intervals (CIs) among women with a diagnosis of breast cancer (n = 542) and women who remained breast cancer-free (n = 729) between the first and second follow-up.

Index of health-related quality of life	Women with breast cancer diagnosed between first and second follow-up (n = 542)		Women who remained breast cancer-free (n = 729)		Adjusted mean difference in change score for women with and without breast cancer^a (n = 1271)
	Mean change score (fu2-fu1)	(SD)	Mean Change score (fu2-fu1)	(SD)	Mean difference in change score (fu2-fu1)	(95% CI)
SF-36 physical component summary	−3.1	(8.6)	−1.2	(7.4)	−2.0	(−2.8; -1.2)
SF-36 mental component summary	−0.9	(9.8)	0.7	(8.9)	−1.5	(−2.3; -0.6)
Physical functioning	−7.9	(17.3)	−5.8	(16.4)	−2.2	(−4.0; −0.4)
Role-physical^b	−8.5	(26.0)	−6.0	(21.9)	−3.0	(−5.4; −0.6)
Bodily pain	−4.4	(24.8)	−4.3	(23.8)	−0.6	(−2.9; 1.8)
Vitality	−3.2	(20.3)	0.2	(19.0)	−3.0	(−4.9; −1.1)
Social functioning	−2.5	(20.9)	−0.7	(18.2)	−1.4	(−3.3; 0.5)
Role-emotional^b	−7.0	(23.8)	−4.3	(20.2)	−2.8	(−5.0; −0.6)
Mental health	−1.0	(17.1)	0.4	(17.0)	−1.1	(−2.8; 0.5)
General health	−5.6	(20.5)	−3.6	(16.5)	−2.1	(−4.0; −0.2)

^aAdjusted for age at first follow-up (continuous), score value at first follow-up for the given summary or subscale (continuous), comorbid conditions at first follow-up (0, 1, ≥2), length of education (≤7, 8–10, >10 years) and partner support (no, low, high). Significant differences in changes for women with and without breast cancer are in bold; ^bFurther adjusted for quadratic term of score value at first follow-up to account for non-linearity.

Table 3. Differences in changes in health-related quality of life for 542 women with breast cancer and 729 who remained free of breast cancer, stratified by age, comorbidity, partner support and time since diagnosis (n = 1271).

	≤60 years n = 545	>60 years n = 726	Comorbidity 0 n = 1050	Comorbidity ≥1 n = 221	No or low partner support n = 387	High partner support n = 884	Time since diagnosis ≤ 5 years^b n = 1023Breast cancer (n = 294)	Time since diagnosis > 5 years n = 977Breast cancer (n = 248)
	Mean difference (95% CI)	Mean difference (95% CI)	Mean difference (95% CI)	Mean difference (95% CI)	Mean difference (95% CI)	Mean difference (95% CI)	Mean difference (95% CI)	Mean difference (95% CI)
Physical component summary	−1.5 (−2.7; −0.3)	−2.4 (−3.4; −1.4)	−1.6 (−2.4; −0.7)^a	−4.1 (−6.0; −2.2)^a	−1.7 (−3.1; −0.2)	−2.2 (−3.1; −1.2)	−2.7 (−3.6; −1.7)^a	−1.3 (−2.3; −0.2)^a
Mental component summary	−2.5 (−3.8; −1.1)	−0.8 (−2.0; 0.3)	−1.4 (−2.4; −0.4)	−2.2 (−4.3; −0.1)	−0.9 (−2.6; 0.7)	−1.8 (−2.9; −0.7)	−2.4 (−3.4; −1.3)^a	−0.5 (−1.7; 0.6)^a
Physical functioning	−1.2 (−3.9; 1.4)	−2.6 (−4.9; −0.3)	−1.4 (−3.3; 0.6)	−5.0 (−9.2; −0.9)	−1.3 (−4.4; 1.9)	−2.4 (−4.4, -0.3)	−3.6 (−5.7; −1.5)^a	−0.1 (−2.4; 2.1)^a
Role-physical^c	−3.1 (−6.8; 0.5)	−3.0 (−6.1; 0.1)	−2.1 (−4.7; 0.5)	−7.2 (−13.0; −1.6)	−3.0 (−7.3; 1.3)	−3.1 (−5.9; −0.2)	−5.2 (−8.1; −2.4)^a	−0.4 (−3.4; 2.7)^a
Bodily pain	−0.1 (−3.8; 3.5)	−0.7 (−3.8; 2.5)	0.3 (−2.3; 3.0)	−4.0 (−9.6; 1.6)	0.9 (−3.4; 5.2)	−1.0 (−3.8; 1.9)	−2.6 (−5.5; 0.2)^a	2.2 (−0.8; 5.3)^a
Vitality	−4.4 (−7.4; −1.5)	−2.2 (−4.7; 0.3)	−2.8 (−5.0; −0.7)	−4.6 (−9.1; −0.1)	−1.5 (−4.9, 2.0)	−3.9 (−6.2; −1.6)	−4.9 (−7.2; −2.6)^a	−1.1 (−3.5; 1.4)^a
Social functioning	−3.3 (−6.2; −0.4)	−0.4 (−2.9; 2.1)	−1.3 (−3.4; 0.8)	−2.9 (−7.4; 1.6)	−0.1 (−3.6; 3.3)	−2.3 (−4.6; −0.0)	−3.3 (−5.6; −1.0)^a	0.4 (−2.1; 2.8)^a
Role-emotional^c	−3.6 (−7.0; −0.3)	−2.2 (−5.1, 0.7)	−2.2 (−4.6; 0.2)	−5.3 (−10.0;- 0.1)	−2.0 (−6.0; 1.9)	−3.1 (−5.7; −0.5)	−4.3 (−7.0; −1.7)^a	−0.9 (−3.7; 1.9)^a
Mental health	−3.0 (−5.5; −0.5)	0.1 (−2.1; 2.2)	−0.7 (−2.5; 1.1)	−3.4 (−7.3; 0.5)	−0.5 (−3.5, 2.5)	−1.5 (−3.5, 0.4)	−3.0 (−5.0; −1.0)^a	1.0 (−1.2; 3.1)^a
General health	−3.2 (−6.0; −0.4)	−1.6 (−4.1; 0.8)	−1.1 (−3.1; 1.0)^a	−7.9 (−12.0; −3.5)^a	−0.1 (−3.4; 3.3)	−3.3 (−5.5; −1.1)	−3.0 (−5.3; −0.8)	−1.4 (−3.8; 1.0)

Mean difference in change score for women with and without breast cancer, adjusted for age at first follow-up (continuous), length of education (≤7, 8–10, >10 years), score value at first follow-up for the given summary or subscale (continuous), comorbid conditions at first follow-up (0, 1, ≥2) and partner support (no, low, high). Differences are reported with 95% confidence intervals (CIs). Significant differences in changes are in bold.

^aSignificant effect modification; ^bTime since diagnosis, time between diagnosis and second follow-up. These analyses included 729 breast cancer-free women and 294 with breast cancer ≤5 years from diagnosis and 248 women with breast cancer >5 years from diagnosis; ^cFurther adjusted for quadratic term of score value at first follow-up to account for non-linearity.