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Table 3 Quality of life studies in long-term breast cancer survivors.

From: A systematic review of quality of life instruments in long-term breast cancer survivors

Study Study objective Patient population Inclusion/exclusion criteria Instruments used/
Administration
Results Ferrell's QoL domains *
Dow et al. (1996) [28] Evaluation of QoL in long-term BCS. N = 294; mean post-cancer survivorship = 68.5 months; mean age = 50.9 years. Not reported QOL-CS, FACT-G
Self-administered
Concerns included psychological/family distress, fear of recurrence, uncertainty, fatigue, chest pain, sleep problems, and sexuality. Ph.
Ps.
So.
Sp.
Weitzner et al. (1997) [29] Comparison of mood and QoL of BCS with those observed in low-risk breast cancer screening patients. Long-term stage I-III BCS (N = 60); mean age = 53.8 years. Low-risk breast cancer screening patients (N = 93); mean age = 45.3 years. Mean post-cancer survivorship ≥ 5 years. Inclusion (BCS): disease-free ≥ 5 years; stage I, II, or III; age < 70 years. Inclusion (comparison group): no personal/family history of breast cancer. Exclusion (both groups): DSM-III-R psychiatric diagnosis; brain carcinoma; using steroids/narcotic analgesics. QLI-CV; other instruments (BDI, STAI)
Self-administered
Stage III breast cancer resulted in significantly poorer functioning compared to other groups. Ps.
So.
Ashing-Giwa et al. (1998) [30] Evaluation of QoL of long- term BCS and to examine the role of ethnicity. African-American: N = 117; mean post-cancer survivorship = 6.5 years; White respondents: N = 161); mean post-cancer survivorship = 7.4 years. Inclusion: breast carcinoma diagnosis between 1989 and 1990; previously participated in a study of first-degree relatives of BCS by Bastani et al. CARES-SF; other instruments (SF-36, Ladder of Life Scale, Life Distress Scale). Self-administered Overall, BCS reported favorable health-related QoL. Differences in QoL outcomes were attributable to socioeconomic and life-burden factors and not to ethnicity. Ph.
So.
Holzner et al. (2001) [31] Evaluation of effect of time elapsed since initial diagnosis on QoL. N = 87; mean post-cancer survivorship = 5.1 years; mean current age = 53.9 years. Inclusion: Relapse-free patients.
Exclusion: presence of other severe diseases.
EORTC QLQ-C30, EORTC QLQ-BR23, FACT-B. Self-administered Emotional, social, and sexual functioning areas showed reduced QoL after initial treatment (1-2 years) and > 5 years survival. Ps.
So.
Beaulac et al. (2002) [32] Evaluation of effect of surgical treatment related lymphedema on QoL. Women with lymphedema, (N = 42), without lymphedema (N = 109); mean post-cancer survivorship = 5.0 years; mean age = 62.4 years. Inclusion: mastectomy or breast-conserving surgery with radiation; level I, II axillary lymph node dissection. Exclusion: other breast surgery; chemotherapy; rheumatologic condition. FACT-B. Self-administered Women with lymphedema reported lower breast, functional, and physical wellbeing, irrespective of type of surgery. Ph.
Ps.
So.
Cimprich et al. (2002) [33] Evaluate relationship between life-stage variables on QoL in BCS. Diagnosis age: young (< 45 years, N = 42), middle (45-65 years, N = 35), old (> 65 years, N = 28); mean post-cancer survivorship = 11.5 years. Inclusion: at least 5 years past the diagnosis; no recurrent disease or other cancer diagnosis. QOL-CS
Self-administered
Long-term BCS diagnosed at an older age had worse QoL in physical domain and women diagnosed at a younger age had worse QoL in social domain. Ph.
Ps.
So.
Kornblith et al. (2003) [34] Assessing the long-term impact of breast carcinoma in BCS. Phase III randomized trial CALGB 7581] group; N = 153; mean post-cancer survivorship = 18 years; age (range) = 41-87 years. Inclusion: no evidence of breast carcinoma; completion of all cancer treatment at least1 year interview; no major psychiatric/cognitive deficit. EORTC QLQ-C30; other instruments (BSI, LES, OARS, PCL-C). nterviewer-administered Persistent psychological effects were observed in BCS long after treatment completion. Ph.
Ps.
So.
Sammarco et al. (2003) [35] Evaluation of relation among social support, uncertainty, and QoL in older BCS. Older women (> 50 years); N = 103; mean post-cancer survivorship = 5.0 years; mean age = 68 years. Inclusion: > 50 years; able to read and respond in English. QLI-CV; other instruments (SSQ, MUIS-C). Self-administered There was significant association between perceived social support and QoL. Uncertainty resulted in poorer QoL. Ph.
Ps.
So.
Sp.
Casso et al. (2004) [36] Assessing QoL of long-term BCS diagnosed at age of 40-49 years. N = 216; mean post-cancer survivorship = 7.3 years; age (range) = 45-60 years. Inclusion: women with an initial diagnosis of ductal carcinoma in situ (DCIS) or invasive breast cancer; diagnosis age of 40-49 years. CARES-SF; other instruments (SF-36, CES-D). Self-administered Long-term QoL affected by surgery/chemotherapy/hormonal therapy. Negative impact of breast related symptoms/pain on QoL. Ph.
So.
Ahles et al.
(2005) [37]
Comparison of local therapy and standard-dose systemic chemotherapy on BCS's QoL. Women treated with standard-dose systemic chemotherapy (N = 141, mean age = 57 years) or local therapy (N = 294, mean age = 65.8 years); mean post-cancer survivorship = 10.0 years. Inclusion: > 5 years after diagnosis; currently disease free; currently receiving no cancer treatments. QOL-CS.
Interviewer-administered
Survivors treated with systemic chemotherapy exhibited lower overall QoL compared with survivors treated with local therapy only. Ph.
Ps.
So.
Burckhardt et al. (2005) [38] Evaluation of effect of chronic pain on health status and overall QoL resulting from surgical treatment. Women with regional pain: N = 11; mean post-cancer survivorship = 5.9 years; mean age = 58.7 years and with widespread pain: N = 12; mean post-cancer survivorship = 5.4 years; mean age = 56.8 years. Inclusion: post-mastectomy ≥ 6 months/≥ 3 months post-radiation/cytotoxic chemotherapy; cancer-free; simple mastectomy/lumpectomy/modified radical mastectomy. Exclusion: breast surgery for cosmetic reasons or prophylactic mastectomy; arthritis. FACT-B, QOLS; other instruments (BPI, MPQ-SF, FIQ, SF-36). Self-administered Women who experienced widespread pain after breast cancer surgery had significantly more severity of pain and lower physical health status than those with regional pain. Ph.
Ps.
So.
Helgeson et al. (2005) [39] Examining the impact of breast cancer on long-term QoL. Survivors, N = 267, mean age = 54.4 years. Controls, N = 187, mean age = 53.2 years; mean post-cancer survivorship = 5.5 years. Inclusion: Women with Stage I, II, or III breast cancer who underwent surgery followed by adjuvant chemotherapy between 1993 and 1996. FACIT-SP, MFSI; other instruments (SF-36, PANAS, BSI, DAS, IES). Interviewer-administered Survivors reported more difficulties with physical functioning and more physical symptoms. Ph.
So.
Carver et al. (2006) [40] Assessing the effect of medical, demographic, and personal variables on BCS's QoL. N = 163; mean post-cancer survivorship = 10.0 years; mean age at diagnosis = 54.2 years. Inclusion: Women who participated in the past projects (1988-1995, 1994-1996). QLACS; other instruments (LOT, ISEL). Self-administered Initial chemotherapy and higher stage predicted more financial problems and worry about appearance. More distress and social avoidance in Hispanic BCS. Ph.
Ps.
So.
Dirksen et al. (2007) [41] Evaluation of efficacy of cognitive behavioral therapy on fatigue, mood, and QoL in BCS. N = 86; mean post-cancer survivorship, CBT group = 85.3 months & control = 63.8 months; mean age = 58 years. Inclusion: stage I, II or III, ≥ 3 months post-treatment; disease-free; sleep problem ≥ 3 months. Exclusion: cognitive impairment or other sleep disorders (restless leg syndrome). FACT-B; other instruments (STAI, CES-D, POMS). Self-administered Women receiving cognitive behavioral therapy for insomnia had significant improvements in fatigue, trait anxiety, depression and QOL. Ph.
Ps.
So.
Perkins et al. (2007) [42] Evaluation of individual differences in well-being in older BCS. N = 127; mean post-cancer survivorship = 5.1 years; mean age = 78.2 years. Inclusion: BCS survivors with a current age of 70 or older. FACIT-SP, FSI; other instruments (SF-36, LOT-R). Self-administered Higher age predicted increased depression. Poorer health status was associated with poorer well-being. Ph.
Ps.
So.
Sp.
Leak et al. (2008) [43] Examining relation among symptom distress, spirituality, and QoL of African- American BCS. N = 30; mean post-cancer survivorship = 5.6 years; mean age 55.5 years. Inclusion: speak and read English; had diagnosis of breast cancer; treatment completion (Jan 1, 1980 - June 1, 2004). Exclusion: recurrent breast cancer/another cancer in the past 12 months. QLI-CV; other instruments (SDS, SPS). Interviewer -administered Sleep disturbance, fatigue, and pain were the most commonly reported symptoms in African- American BCS. Ph.
Ps.
So.
Sp.
Sammarco et al. (2008) [44] Examining relation among perceived social support and uncertainty on Hispanic BCS's QoL. N = 89; mean post-cancer survivorship = 5.0 years; age (range) = 30-86 years. Inclusion: at least one year after treatment. QLI-CV; other instruments (SSQ, MUIS-C). Self-administered Perceived social support and uncertainty play a pivotal role in managing or maintaining QoL in Hispanic BCS. Ph.
Ps.
So.
Sp.
Skrzypulec et al. (2008) [45] Evaluate problems related to total and partial mastectomy affecting QoL. Treatment with total mastectomy (N = 403, mean age = 57.8 years); partial mastectomy (N = 91, mean age = 47.3 years); post-cancer survivorship = 6-10 years. Inclusion: total mastectomy due to breast cancer (research group); partial mastectomy (control group). Exclusion: using drugs impeding sexual function. EORTC QLQ-BR23; other instruments (IES, LSI, HADS). Self-administered The level of depression and anxiety in women after mastectomy results in worse bio-psychosocial functioning. Ph.
So.
Speck et al. (2010) [46] Evaluation of impact of Physical Activity and Lymphedema (PAL) trial on perceptions of body image in BCS. BCS with lymphedema (N = 112); without lymphedema (N = 122). Post-cancer survivorship > 5 years. Inclusion: unilateral non-metastatic breast cancer; BMI < 50 kg/m2; cancer-free; no medical conditions limiting participation in exercise program; no weight lifting in year prior to study entry, not currently pregnant/lactating. BIRS
Self-administered
Twice-weekly strength training positively impacted self-perceptions of appearance, health, physical strength, sexuality, relationships, and social functioning. Ph.
So.
  1. * Ph. = Physical; Ps. = Psychological; So. = Social; Sp. = Spiritual
  2. Other instruments: instruments validated in general population and used in the included studies.
  3. BDI = Beck Depression Inventory; BIRS = Body Image and Relationships Scale; BPI = Brief Pain Inventory; BSI = Brief Symptom Inventory; CALGB = Cancer and Leukemia Group B; CARES-SF = Cancer Rehabilitation Evaluation System Cancer-Short Form; CBT = Cognitive Behavioral Therapy; CES-D = Center for Epidemiologic Studies Depression Scale; DAS = Dyadic Adjustment Scale; EORTC QLQ-C30 = European Organization for Research and Treatment of Cancer; EORTC QLQ-BR23 = European Organization for Research and Treatment of Cancer-Breast Module; FACT-B = Functional Assessment of Cancer Therapy-Breast; FACT-G = Functional Assessment of Cancer Therapy-General; FACIT-SP = Functional Assessment of Chronic Illness Therapy-Spiritual Well Bring Scale; FIQ = Fibromyalgia Impact Questionnaire; FSI = Fatigue Symptom Inventory; HADS = Hospital Anxiety and Depression Scale; IES = Impact of Events Scale; LES = Life Experience Survey; LSI = Life Satisfaction Index; ISEL = Interpersonal Support Evaluation List; LOT = Life Orientation Test; LOT-R = Life Orientation Test Revised; MFSI = Multidimensional Fatigue Symptom Inventory; MPQ-SF = Short Form McGill Pain Questionnaire; MUIS-C = Mishel Uncertainty in Illness Scale-Community; OARS = Older American Services and Resources Questionnaire; PANAS = Positive and Negative Affect Scale; PCL-C = Posttraumatic Stress Disorder Checklist-Civilian; POMS = Profile of Mood States; QLACS = Quality of Life in Adult Cancer Survivor Scale; QLI-CV = Quality of Life Index-Cancer Version; QOL-CS = Quality of Life-Cancer Survivor SF-36 = Medical Outcomes Study 36-item Short Form Health Survey; SDS = Symptom Distress Scale; SPS = Spiritual Perspective Scale; SSQ = Social Support Questionnaire; STAI = State-Trait Anxiety Inventory