Mullen divided the stages of cancer survival into three major classifications [32, 33]. First is the acute stage, which marks the period after the cancer diagnosis. Second is the extended stage, in which the active treatment of cancer has ended and the patient is placed under tracking observation or engages in intermittent treatment. During this period, the majority of cancer survivors experience uncertainty toward their cancer treatment and fear recurrence, and they may experience physical and psychological issues. Lastly, the permanent stage marks a period in which the cancer is thought to be fully cured, or the patient is expected to survive long term, with a low risk of recurrence.
The participants in this study averaged a score of 66.90 for quality of life. As it is difficult to draw a direct comparison given the lack of research utilizing this measure, in converting quality of life into a scale of 100 points, this study’s results were similar to those found previously regarding post-hoc management following breast cancer treatment for 200 women [8, 10]. However, a study covering regionally based, adult female breast cancer survivors between 6 months and 2 years after anti-cancer treatment completion reported lower scores (e.g., 60.13 points) compared to this study . Likewise, a study of breast cancer survivors with completed surgeries and assistive treatments, breast cancer survivors whose treatment had ended had scores of 53.4 and 56.66 points, respectively for breast cancer survivors with completed surgeries and assistive treatments [25, 26].
On the other hand, a report of 110 adult females with breast cancer or OB/GYN cancers  indicated that quality of life according to cancer survival stage was 58.7, 62.3, and 66.8 points during the acute, extended, and permanent stages, respectively. Quality of life in this study was similar to the level experienced by survivors during the permanent stage. Considering that the average time since treatment was 17.64 months, these results indicate a relatively high quality of life. While these differences cannot be accurately compared and discussed because of the lack of research covering the same variables, the majority of survivors had thyroid cancer (70.9%), and it is known that thyroid cancer has higher rates of survival. Going forward, it is important to develop interventions to improve quality of life by assessing survivors’ specific stages.
There were no significant relationships between quality of life and length of time since completing treatment. Existing research has suggested that quality of life was significantly higher for those surviving more than 5 years after cancer treatment completion [8, 33], indicating that quality of life improves as duration of survival increases. The quality of life of these cancer survivors has been reported to improve with the passage of time [8, 33]. Therefore, cross-sectional and longitudinal studies are required in the future to identify quality of life by survival stage and changes in quality of life over time.
On the other hand, qualitative studies of Korean female cancer survivors have indicated that the significant others and families of female cancer survivors wanted them to return to their pre-cancer lives to take care of their spouses and children, indicated the demands on female cancer survivors in Korea to fulfill their roles as wives and mothers before fully recovering from cancer . Thus, customized interventions by survival stage for female cancer survivors are needed along with further research on the relationships between cultural specificity, role conflicts imposed on survivors because they are women, and their quality of life.
The uncertainty toward illness of the participants in this study was similar to existing research in breast cancer patients undergoing chemotherapy averaged 83.08  and female thyroid cancer patients . On the other hand, the level of uncertainty faced by cancer patients prior to surgery averaged 81.43 in a study of cancer patients hospitalized for breast, thyroid, and bladder cancer , which was slightly lower than the value found in this study. This appears to be because female cancer survivors in this study were mostly in the extended stage, which comes after the active treatment of their cancer [32, 33]. Most cancer survivors face uncertainty toward cancer treatment and fear of recurrence [8, 32, 33]; thus, they experience a diverse range of physical and psychological problems [6, 7]. On the other hand, a qualitative study of 25 breast cancer survivors aged over 30 who had undergone surgery and chemotherapy as their primary treatment for breast cancer  indicated that quality of life following treatment for breast cancer survivors saw a coexistence of anxiety and uncertainty about recurrence. A shorter duration of time since treatment led to higher confusion in their own health management efforts and health management in general.
These results indicate that there are limitations to comparing uncertainty results given the lack of domestic studies on cancer survivors; therefore, future studies are needed to fill this gap. Moreover, it is necessary to confirm uncertainty by cancer survival stage and develop interventions to reduce the uncertainty accompanying each stage.
Uncertainty in illness was higher for those with less than a high school education, compared to those with a university education or higher, when they were dissatisfied with their financial status, and for those who were smokers. These results were similar to previous research , which indicated high uncertainty for participants over 60 who had a low monthly income and low level of education. Therefore, it is necessary to consider these socioeconomic factors when developing uncertainty reducing strategies such as customized information delivery and communication.
The social support of female cancer survivors in this study was rather high, at 62.62 out of 84 points; family support was the highest, followed by support from significant others, and finally friends. Social support is known to play an important role in helping individuals reduce their levels of uncertainty . Particularly, in Korea, family and healthcare professional support have been the most important support resources among all social support types . The results of this study indicated that family support was the highest, which was in line with the results of existing studies. On the other hand, a qualitative study of 25 breast cancer survivors aged over 30 who had undergone surgery and chemotherapy as their primary breast cancer treatments  indicated that positive support and responses from family, patients with similar illnesses, and those surrounding them helped to strengthen positive self-suggestion, which also helped them to overcome their illnesses. Other studies have reported that patients undergoing treatment receive active support from healthcare professionals and their family, but they receive less support and interest from healthcare professionals, their family, and those surrounding them after the treatment ends [22, 23, 27]. Therefore, it is necessary to take a continuous interest in and facilitate social support for cancer survivors.
Social support was higher for participants with average satisfaction toward their financial status, and for those for whom less than a year, or between 1 and 5 years, had passed since the completion of their cancer treatment, compared to those for whom 5 years or more had passed since treatment. These results were similar to those of studies on cancer patients hospitalized for breast, thyroid, and bladder cancer surgery , which indicated social support differed according to the time that had passed since diagnosis. Moreover, these results are similar to those reporting that breast cancer survivors are required by their spouses or family to fulfill roles they had filled prior to their cancer diagnosis, and this was associated with decreasing support from family . These results indicate that female cancer survivors require ongoing psychosocial support as well as education and access to information as they live out their lives.
According to Baik and Lim , who studied social support according to different stages of breast and gynecological cancer survival, the social support of patients in the acute stage was comparatively higher, but there were no significant differences in social support across the different stages, which was different from the findings of this study. While there were no significant differences, Baik and Lim  reported that the social support perceived by survivors decreased as they proceeded through the acute to the extended stage. The social support perceived by respondents decreased in the 2 years following the diagnosis but maintained the reduced rate through the permanent stage . Long-term survivors had a greater need to meet other cancer patients and self-help groups . Kwon and Yi  asserted that interest and support from family and the society in general are very important in raising breast cancer survivors’ quality of life and survival rates. Moreover, self-help groups were reported to be effective in providing emotional support for long- and short-term cancer survivors , which indicates the need for developing stage-specific social support interventions and various methods of facilitating social support groups. Moreover, further research is required concerning cancer survival stage-dependent social support and quality of life.
The results of this study showed that higher uncertainty in illness among female cancer survivors led to reduced social support and quality of life, while higher social support led to better quality of life. Support from others was found to be the most relevant aspect of the relationship between quality of life and uncertainty. These results were similar to those of studies on early-stage breast cancer patients  and on cancer patients hospitalized for breast, thyroid, and bladder cancer surgery , which indicated that perceived social support was lower as uncertainty increased.
Uncertainty was very influential on female cancer survivors’ quality of life. Higher uncertainty in illness among female cancer survivors led to lower social support and reduce quality of life; higher social support led to improved quality of life. The explanatory power of these variables on quality of life was 12.1%; uncertainty in illness and social support influenced the quality of life of female cancer survivors. Moreover, in the process of uncertainty in illness influencing subjects’ quality of life, social support was confirmed to play a significant, partially mediating, role in the relationship between uncertainty and quality of life. Higher uncertainty toward illness led to lower quality of life, higher social support led to higher quality of life, and social support influenced female cancer survivors’ quality of life by partially mediating its relationship with uncertainty. Social support plays an important role in directly and indirectly reducing uncertainty [18, 19]. Social support is closely related to the prognosis of breast cancer survivors . Uncertainty among breast cancer survivors has been found to lower their quality of life; however, social support has been found to improve quality of life . Thus, the need for a diverse range of attempts, including developing and applying social support programs, to increase cancer survivors’ quality of life exists. On the other hand, the partially mediating effects of social support indicate that there are other mediating factors in uncertainty in illness’s influence on quality of life. Therefore, it is important for future studies to include other mediating factors in their examinations of what influences quality of life among female cancer survivors.
In Korea, studies on cancer survivors have been conducted since 2010, and the majority of these focused on breast cancer survivors. Particularly, as there has been no overall research into the healthy behaviors of cancer survivors, it is necessary to develop practical guidelines that befit Korea through studies concerning the development and application of health improvement programs based on the study of healthy behaviors, as per the assertion of Kim . Moreover, attempts are needed to practically apply a diverse range of intervention studies to improve cancer survivors’ quality of life.
Moreover, future studies should include mediator variables other than social support that might influence quality of life. Additionally, both cross-sectional and longitudinal studies are needed to further investigate the quality of life and uncertainty according to the stages of survival.