Surviving recurrence: psychological and quality-of-life recovery

Abstract

Background: To the authors' knowledge, data characterizing patients' psychosocial experiences after a recurrence diagnosis are limited. This report provides the physical, psychological, and quality-of-life trajectories of patients with recurrent breast cancer. In addition, patients with a well-documented trajectory -- patients with their initial diagnosis of breast cancer -- were included as a referent group, providing a metric against which to gauge the impact and course of cancer recurrence.

Methods: Patients with a newly diagnosed, recurrent (n = 69) or initial (n = 113) breast cancer were accrued. The groups did not differ with regard to age, race, education, family income, or partner status (all P values > .18). All patients were assessed shortly after diagnosis (baseline) and 4 months, 8 months, and 12 months later. Mixed-effects models were used to determine health status, stress, mood, and quality-of-life trajectories.

Results: In the year after a recurrence diagnosis, patients' physical health and functioning showed no improvement, whereas quality of life and mood generally improved, and stress declined. Compared with patients who were coping with their first diagnosis, patients with recurrence had significantly lower anxiety and confusion. In contrast, physical functioning was poorer among recurrence patients, quality-of-life improvement was slower, and cancer-related distress was high as that of the initially diagnosed patient. Slower quality-of-life recovery was most apparent among younger patients (aged <54 years).

Conclusions: Despite the physical burden, patients with recurrent breast cancer exhibit considerable resilience, with steady improvements in psychological adjustment and quality of life during the year after diagnosis. Management of patients' physical symptoms is particularly important, because patients cope with recurrent breast cancer as a chronic illness.

FIGURE 1

The proportions of patients in the recurrence diagnosis group (a) and in the initial diagnosis group (b) that underwent surgery, received chemotherapy, and received radiation therapy at each assessment.

FIGURE 2

Four patterns of change are illustrated. (a) The first pattern was observed in Karnofsky performance status (KPS), in quality of life related to the Physical Functioning and General Health scales, and in the Profile of Mood States (POMS)-Vigor subscale. (b) The second pattern was observed in quality of life related to the Vitality, Social Functioning, and Role Functioning-Physical subscales. (c) The third pattern was observed in the POMS Anxiety and Confusion sub-scales and in global stress on the 10-item Perceived Stress Scale. (d) The fourth pattern was observed in cancer-specific stress on the Impact of Event Scale (IES), on the POMS Depression subscale, and on quality of life related to the Mental Health and Role Functioning-Emotional subscales. SF-36 indicates the Medical Outcomes Study-Short Form.

FIGURE 3

Slower recovery in quality of life was most apparent among younger patients in the recurrence diagnosis group, as illustrated with the Medical Outcomes Study-Short Form (SF-36) Role Functioning-Physical sub-scale.