Prognostic Value of Post-diagnosis Health-Related Quality of Life for Overall Survival in Breast Cancer: Findings from a 10-Year Prospective Cohort in Korea

Abstract

Purpose: We aimed to evaluate health-related quality of life (HRQOL) at 1-year post-diagnosis in breast cancer (BC) patients and its association with overall survival using data from the National Cancer Center Hospital.

Materials and methods: Data of a BC cohort were first obtained between 2004 and 2006 and followed up. HRQOL was assessed using EORTC QLQ-C30 and BC specific module QLQ-BR23 few days after diagnosis and 1 year after that. We examined and compared the difference in the two HRQOL scores measured for each patient by the patient's current survival status. The Cox proportional hazards model was fitted to evaluate the impact of HRQOL on survival, with adjustment for baseline HRQOL and other factors.

Results: Of 299 enrolled patients, 206 responded at 1-year post-diagnosis (80.6%) and were followed up for 11.6 years on average. At 1-year post-diagnosis, survivors had better HRQOL scores than those who died, although their health status was similar at baseline. Survivors reported significant increase 1 year after diagnosis in global health status and emotional scales. Between the groups, functional scales such as physical, role, and emotional were significantly different. Functional scales, including physical (adjusted hazard ratio [aHR], 0.70), role (aHR, 0.68), emotional (aHR, 0.72), and symptom scales, including fatigue (aHR, 1.34), dyspnea (aHR, 1.29), appetite loss (aHR, 1.24) were significantly associated with overall survival. Patients who were less worried about future health had favorable survival (aHR, 0.83).

Conclusion: Besides treatment-related symptoms, non-medical aspects at 1-year post-diagnosis, including functional well-being and future perspective, are predictive of long-term survival. Intervention to enhance physical, role, and emotional support for women soon after their BC diagnosis might help to improve disease survival outcomes afterwards.

Keywords: Breast neoplasms; Overall survival; Quality of life.

Fig. 1.

Enrollment of cohort, health-related quality of life (QOL) assessments and follow-up period. BC, breast cancer; NCC, National Cancer Center; F/U, follow-up.

Fig. 2.

Health-related quality of life (QOL) measured by QLQ-C30 functional scale after diagnosis (baseline) and at 1-year post-diagnosis (1 year). Blue color indicates the QOL mean scores and 95% confidence intervals for survivors. Red color indicates QOL mean scores and 95% confidence intervals for deaths. p-values were obtained using the Kruskal-Wallis test to compare QOL scores measured at 1-year post-diagnosis between survivors and deaths.

Fig. 3.

Health-related quality of life (QOL) measured by QLQ-C30 symptom scale after diagnosis (baseline) and at 1-year post-diagnosis (1 year). Blue color indicates the quality of life (QOL) mean scores and 95% confidence intervals for survivors. Red color indicates QOL mean scores and 95% confidence intervals for deaths. p-values were obtained using the Kruskal-Wallis test to compare QOL scores measured at 1-year post-diagnosis between survivors and deaths.

Fig. 4.

Health-related quality of life (QOL) measured by QLQ-BR23 after diagnosis (baseline) and at 1-year post-diagnosis (1 year). Blue color indicates the QOL mean scores and 95% confidence intervals for survivors. Red color indicates QOL mean scores and 95% confidence intervals for deaths. p-values were obtained using the Kruskal-Wallis test to compare QOL scores measured at 1-year post-diagnosis between survivors and deaths.