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

PurposeWe 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 MethodsData 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.ResultsOf 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).ConclusionBesides 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.

Cancer outcomes research—a European challenge: measures of the cancer burden

“…Hence, we must foster more patient‐centered research that incorporates all stakeholders' perspective [ 33 ]. Quality of life and patient‐reported outcomes have also been reported to predict survival in different types of cancer, although the mechanisms still need to be identified [ 34 , 35 , 36 , 37 ]. The World Health Organization defines quality of life as an individual's perception of their position in life in the context of the culture and value systems in which they live, and also in relation to their goals, expectations, standards, and concerns.…”

Weight Change in Post-Menopausal Women with Breast Cancer during Chemotherapy—Perspectives on Nutrition, Activity and Bone Metabolism: An Interim Analysis of a 5-Year Prospective Cohort

“…Pain and fatigue are subjective phenomena, which is why the assessment must be obtained directly from the individual through patient-reported questionnaires. Patient-reported results are useful and have been shown to have prognostic value [ 11 , 12 ]. Cancer-related fatigue, as well as pain, are multidimensional concepts affecting the physical (less energy and more need for sleep), cognitive (decreased concentration and attention), and affective (decreased motivation) domains.…”

Psychometric Evaluation of the Korean Version of the Functional Assessment of Chronic Illness Therapy-Fatigue

“…The incidence rate in Korea is also high at 243 per 100,000, with cancer ranking as the most prominent cause of death in the country (27.0%; Statistics Korea, 2021).Fatigue is one of the most commonly occurring subjective symptom in patients with cancer (Berger et al, 2020) and may be associated with either the cancer itself or related treatments and often does not improve with rest (Cella et al, 2002). Severe fatigue has been shown to impair physical function, reduce quality of life, delay treatment, and increase mortality (Mai et al, 2019). Thus, accurate and efficient fatigue assessment is essential for the successful completion of cancer treatment and improvement of survival rates in patients with cancer.Fatigue in patients with cancer is often assessed using selfreport questionnaires that employ either a unidimensional scale or a multidimensional scale.…”