One-year recovery from breast cancer: Importance of tumor and treatment-related factors, resilience, and sociodemographic factors for health-related quality of life

Abstract

Aim: This study investigated the changes in health-related quality of life from diagnosis to 1 year after diagnosis in breast cancer (BC) patients and the influence of clinical, psychological, and sociodemographic variables. An additional aim was to explore the mediating and moderating effects of resilience on changes in health-related quality of life.

Methods: A longitudinal population-based study was conducted in southern Sweden. Newly diagnosed BC patients filled in measures of health-related quality of life, resilience, and sociodemographic variables at diagnosis (N = 980) and 1 year post-diagnosis (N = 780). Clinical variables were extracted from the Swedish national breast cancer quality registry. Mixed-model analyses were performed.

Results: Most health-related quality of life outcomes declined from diagnosis to 1 year post-diagnosis. Role limitations due to emotional problems remained the same, whereas mental health improved. Lower health-related quality of life outcomes were associated with symptomatic detection and axillary dissection. Patients with a higher TNM stage and histologic grade and estrogen receptor (ER)-negative and human epidermal growth factor 2 (HER2)-positive status, who received chemotherapy, antibody therapy, or bisphosphonate therapy, had a steeper decline in outcomes. Changes in resilience were positively associated with all outcomes but did not mediate or moderate changes in any. Resilience at baseline moderated changes in bodily pain, vitality, and mental health, with higher baseline resilience being associated with a steeper decline, possibly due to floor or ceiling effects. Patients with lower socioeconomic status, educational level, and older age had a lower health-related quality of life.

Conclusion: Physical health-related quality of life among breast cancer patients declined 1 year post-diagnosis, whereas mental health-related quality of life improved. Low resilient patients may be especially vulnerable at diagnosis. Biopsychosocial assessment at diagnosis can help identify patients who may require additional support. A multidimensional treatment plan should be started early to help overcome the problems in everyday activities.

Keywords: biopsychosocial (BPS) model; breast cancer; breast cancer treatment; health-related quality of life (HRQL); longitudinal study; multidisciplinary; psychological resilience; tumor characteristics.

Figure 1

Flow diagram of the study cohort.

Figure 2

Simple slopes of the moderating effect of menstrual status on changes in bodily pain (A) and PCS (B); TNM stage on changes in bodily pain (C); histologic grade on changes in physical role limitations (D) and PCS (E). Higher scores on outcome variables indicate better functioning. Error bars show standard errors. Simple slopes for TNM stage and histologic grade are adjusted for age, radiotherapy, and systemic therapy. PCS, physical health component score.

Figure 3

Simple slopes of the moderating effect of ER status on changes in role limitations—physical (A) and PCS (B); HER2 status on changes in social functioning (C), role limitations—emotional (D), and MCS (E). Higher scores on outcome variables indicate better functioning. Error bars show standard errors. Simple slopes are adjusted for age, radiotherapy, and systemic therapy. PCS, physical health component score; MCS, mental health component score; HER2, human epidermal growth factor 2.

Figure 4

Simple slopes of the moderating effect of type of surgery on changes in bodily pain (A), social functioning (B), and PCS (C). Higher scores on outcome variables indicate better functioning. Error bars show standard errors. Simple slopes are adjusted for age. PCS, physical health component score.

Figure 5

Simple slopes of the moderating effect of chemotherapy on changes in physical functioning (A), Role limitations due to physical problems (B), bodily pain (C), vitality (D), and PCS (E). Higher scores on outcome variables indicate better functioning. Error bars show standard errors. Simple slopes are adjusted for age. PCS, physical health component score.

Figure 6

Simple slopes of the moderating effect of antibody therapy on changes in vitality (A), role limitations—emotional (B), and MCS (C). Higher scores on outcome variables indicate better functioning. Error bars show standard errors. Simple slopes are adjusted for age. MCS, mental health component score.

Figure 7

Simple slopes of the moderating effect of bisphosphonate therapy on changes in physical functioning (A), role limitations—physical (B), bodily pain (C), and PCS (D). Higher scores on outcome variables indicate better functioning. Error bars show standard errors. Simple slopes are adjusted for age. PCS, physical health component score.

Figure 8

Simple slopes of the moderating effect of baseline resilience on changes in bodily pain (A), vitality (B), mental health (C), and MCS (D). Higher scores on outcome variables indicate better functioning. Error bars show standard errors. MCS, mental health component score.