Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Dec;9(4):620-9.
doi: 10.1007/s11764-015-0438-y. Epub 2015 Feb 24.

Depression and quality of life before and after breast cancer diagnosis in older women from the Women's Health Initiative

Salene M W Jones  1 , Andrea Z LaCroix  2 , Wenjun Li  3 , Oleg Zaslavsky  4 , Sylvia Wassertheil-Smoller  5 , Julie Weitlauf  6   7 , Gretchen A Brenes  8 , Rami Nassir  9 , Judith K Ockene  3 , Graciela Caire-Juvera  10 , Suzanne C Danhauer  8
Affiliations

Depression and quality of life before and after breast cancer diagnosis in older women from the Women's Health Initiative

Salene M W Jones et al. J Cancer Surviv. 2015 Dec.

Abstract

Purpose: Distress and reduced quality of life (QOL) are common among people with cancer. No study has compared these variables after breast cancer diagnosis to pre-cancer diagnosis levels.

Methods: Data on women with breast cancer 50 years of age or older (n = 6949) were analyzed from the Women's Health Initiative (1993-2013). Health-related QOL (physical function, mental health) was measured using Rand-36. Depressive symptoms were measured with the six-item Center for Epidemiologic Studies Depression scale. Assessments occurred before and after the cancer diagnosis. Hierarchical linear modeling compared pre-cancer QOL and depressive symptoms to levels post-diagnosis and tested whether pre-cancer physical activity, stressful life events, sleep disturbance, and pain predicted post-diagnosis outcomes.

Results: Compared with pre-cancer levels, depressive symptoms increased (20.0% increase at 0-6 months, 12.9% increase at 6-12 months), while physical function (-3.882 points at 0-6 months, -3.545 at 6-12 months) and mental health decreased (-2.899 points at 0-6 months, -1.672 at 6-12 months) in the first year after diagnosis (all p < .01). Depressive symptoms returned to pre-cancer levels after 10 years, but QOL remained significantly lower. At more than 10 years post-diagnosis, physical function was 2.379 points lower than pre-cancer levels (p < 0.01) while mental health was 1.922 points lower (p < 0.01). All pre-cancer predictors were associated with all outcomes. Pain predicted uniquely greater decreases in physical function post-diagnosis.

Conclusions: Depressive symptoms increased and QOL decreased following breast cancer diagnosis compared with pre-cancer levels, particularly in the first year.

Implications for cancer survivors: QOL may remain lower for years after breast cancer diagnosis, although decreases are small.

Keywords: Breast cancer; Depression; Distress; Health-related quality of life; Neoplasm; Women’s health.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Flow diagram of participants included in the analyses from the Women's Health Initiative.
Figure 2
Figure 2
Results for depressive symptoms (CESD-SF), physical function and emotional function. Values are predicted levels from the hierarchical linear models, adjusted for age, ethnicity, education, income, cancer stage, ER/PR status, HER2neu status, study arm and body mass index. Error bars indicate a 95% confidence interval around the mean. When compared with pre-diagnosis levels, *=p<0.05, and †=p<0.01. a) Natural log (ln) of Depressive Symptoms (higher values indicate more symptoms). On this scale, 1.61 corresponds to the 5 point cutoff of this version of the CESD-SF. N=6948 b) Rand-36 Physical Function subscale (higher values indicate better function). N=6943 c) Rand-36 Mental Health subscale (higher values indicate better mental health). N=6944
Figure 2
Figure 2
Results for depressive symptoms (CESD-SF), physical function and emotional function. Values are predicted levels from the hierarchical linear models, adjusted for age, ethnicity, education, income, cancer stage, ER/PR status, HER2neu status, study arm and body mass index. Error bars indicate a 95% confidence interval around the mean. When compared with pre-diagnosis levels, *=p<0.05, and †=p<0.01. a) Natural log (ln) of Depressive Symptoms (higher values indicate more symptoms). On this scale, 1.61 corresponds to the 5 point cutoff of this version of the CESD-SF. N=6948 b) Rand-36 Physical Function subscale (higher values indicate better function). N=6943 c) Rand-36 Mental Health subscale (higher values indicate better mental health). N=6944
Figure 2
Figure 2
Results for depressive symptoms (CESD-SF), physical function and emotional function. Values are predicted levels from the hierarchical linear models, adjusted for age, ethnicity, education, income, cancer stage, ER/PR status, HER2neu status, study arm and body mass index. Error bars indicate a 95% confidence interval around the mean. When compared with pre-diagnosis levels, *=p<0.05, and †=p<0.01. a) Natural log (ln) of Depressive Symptoms (higher values indicate more symptoms). On this scale, 1.61 corresponds to the 5 point cutoff of this version of the CESD-SF. N=6948 b) Rand-36 Physical Function subscale (higher values indicate better function). N=6943 c) Rand-36 Mental Health subscale (higher values indicate better mental health). N=6944
See this image and copyright information in PMC

References

    1. Andersen BL, Kiecolt-Glaser JK, Glaser R. A biobehavioral model of cancer stress and disease course. American Psychologist. 1994;49(5):389–404. - PMC - PubMed
    1. Shapiro SL, et al. Quality of life and breast cancer: Relationship to psychosocial variables. Journal of Clinical Psychology. 2001;57(4):501–519. - PubMed
    1. Mitchell AJ, et al. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncology. 2011;12(2):160–174. - PubMed
    1. van't Spijker AD, Trijsburg RW, Duivenvoorden HJ. Psychological sequelae of cancer diagnosis: A meta-analytical review of 58 studies after 1980. Psychosomatic Medicine. 1997;59:280–293. - PubMed
    1. Trask PC. Assessment of depression in cancer patients. J Natl Cancer Inst Monogr. 2004;(32):80–92. - PubMed

Publication types

LinkOut - more resources