Long-term health-related quality of life of breast cancer survivors remains impaired compared to the age-matched general population especially in young women. Results from the prospective controlled BREX exercise study

Abstract

Objective: To investigate long-term health-related quality of life (HRQoL) changes over time in younger compared to older disease-free breast cancer survivors who participated in a prospective randomized exercise trial.

Methods: Survivors (aged 35-68 years) were randomized to a 12-month exercise trial after adjuvant treatment and followed up for ten years. HRQoL was assessed with the generic 15D instrument during follow-up and the younger (baseline age ≤ 50) and older (age >50) survivors' HRQoL was compared to that of the age-matched general female population (n = 892). The analysis included 342 survivors.

Results: The decline of HRQoL compared to the population was steeper and recovery slower in the younger survivors (p for interaction < 0.001). The impairment was also larger among the younger survivors (p = 0.027) whose mean HRQoL deteriorated for three years after treatment and started to slowly improve thereafter but still remained below the population level after ten years (difference -0.017, 95% CI: -0.031 to -0.004). The older survivors' mean HRQoL gradually approached the population level during the first five years but also remained below it at ten years (difference -0.019, 95% CI: -0.031 to -0.007). The largest differences were on the dimensions of sleeping and sexual activity, on which both age groups remained below the population level throughout the follow-up.

Conclusions: HRQoL developed differently in younger and older survivors both regarding the most affected dimensions of HRQoL and the timing of the changes during follow-up. HRQoL of both age groups remained below the population level even ten years after treatment.

Keywords: Breast neoplasms; Cancer survivors; Exercise; Follow-up studies; Health-related quality of life; Utility.

Fig. 1

a. Mean HRQoL and 95% confidence intervals of the younger and older breast cancer survivors during the ten-year follow-up. A difference of ±0.015 in the HRQoL score is considered clinically important. 1b. The difference in mean HRQoL between the breast cancer survivors (BCS) and the age-matched general female population during the ten-year follow-up. The mean values of the general population are presented with a dashed line. A difference of ±0.015 in the HRQoL score is considered clinically important.

Fig. 2

Difference in mean 15D dimension scores between the breast cancer survivors (BCS) and the general population during follow-up. The black squares represent the older survivors and the white ones the younger survivors. Bonferroni corrected 95% confidence intervals are presented with whiskers. The mean values of the general population are presented with a dashed line.