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

Katarina Veličković; Carl A K Borrebaeck; Pär-Ola Bendahl; Cecilia Hegardt; Per Johnsson; Corinna Richter; Lisa Rydén; Ingalill Rahm Hallberg

doi:10.3389/fonc.2022.891850

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

Front Oncol. 2022 Aug 16:12:891850. doi: 10.3389/fonc.2022.891850. eCollection 2022.

Authors

Katarina Veličković¹, Carl A K Borrebaeck², Pär-Ola Bendahl³, Cecilia Hegardt³, Per Johnsson¹, Corinna Richter², Lisa Rydén^{4

5}, Ingalill Rahm Hallberg⁶

Affiliations

¹ Department of Psychology, Lund University, Lund, Sweden.
² Department of Immunotechnology and CREATE Health Translational Cancer Center, Lund University, Lund, Sweden.
³ Department of Clinical Sciences Lund, Division of Oncology, Lund University, Lund, Sweden.
⁴ Department of Clinical Sciences Lund, Division of Surgery, Lund University, Lund, Sweden.
⁵ Department of Surgery, Skåne University Hospital, Lund, Sweden.
⁶ Department of Health Sciences, Lund University, Lund, Sweden.

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.