Objective: To examine the extent to which anxiety and depressive symptoms, self-esteem and proinflammatory cytokines interact to significantly predict quality of life in breast cancer survivors.
Methods: Cross-sectional data were collected from 134 breast cancer survivors. Hospital Anxiety and Depression Scale, Rosenberg Self-Esteem Scale and Quality of Life in Adult Cancer Survivors questionnaire, which includes the generic quality of life (QOL) and the quality of life related to cancer (QOLRC) subscales, were administered. Plasma IL-6 and TNF-α levels were measured using ELISA kits. Moderation analyses were performed to study the influence of psychobiological variables on quality of life.
Results: Anxiety and depressive symptoms, TNF-α predicted QOL scores, and both medium and high levels of TNF-α influenced the negative conditional effect of depressive symptoms on QOL. Anxiety symptoms and TNF-α was associated with QOLRC scores, and lower self-esteem predicted poorer QOLRC when women had high levels of TNF-α.
Conclusions: These results highlight the booster effect of TNF-α for poorer quality of life in breast cancer survivors, both alone and in combination with depressive symptoms or low self-esteem. The study provides a framework for assessing subclinical markers, identifying vulnerable survivors and implementing psychological strategies to improve quality of life.
Keywords: Breast cancer survivors; Depression; Quality of life; Self-esteem; TNF-α; anxiety.
Copyright © 2020. Published by Elsevier Inc.