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Health-Related Quality of Life and Psychosocial Status in Breast Cancer Prognosis: Analysis of Multiple Variables

From the Departments of Medicine and Surgery, Division of Clinical Epidemiology at the Samuel Lunenfeld Research Institute; Mount Sinai Hospital; Toronto-Sunnybrook Regional Cancer Centre; St Michael's Hospital; and University of Toronto, Toronto, Ontario, Canada

Address reprint requests to Pamela J. Goodwin, MD, Mount Sinai Hospital, 1284-600 University Avenue, Toronto, Ontario M5G 1X4, Canada; e-mail: pgoodwin{at}mtsinai.on.ca

PURPOSE: Evidence that psychosocial status and health-related quality of life (HRQOL) are associated with breast cancer (BC) outcomes is weak and inconsistent. We examined prognostic effects of these factors in a prospective cohort study.

PATIENTS AND METHODS: Three hundred ninety-seven women with surgically resected T1 to T3, N0/N1, M0 BC completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (Core 30 items), Profile of Mood States, Psychosocial Adjustment to Illness Scale, Impact of Events Scale, Mental Adjustment to Cancer Scale, and the Courtauld Emotional Control Scale 2 months after diagnosis and 1 year later. Data on tumor-related factors, treatment, and outcomes were obtained prospectively from medical records, and Cox survival analyses were performed.

RESULTS: Mean age was 52.0 ± 9.9 years. Two hundred twenty-five women had T1, 136 women had T2, 16 women had T3, and 20 women had TX tumors; 127 were N1. One hundred thirteen women received adjuvant chemotherapy, 130 received hormone therapy, 45 received both, and 109 received neither. We investigated 140 prognostic associations; four were found to be statistically significant at a P value of .05 (three fewer than expected by chance). Two were in the hypothesized direction of effect, and two were in the opposite direction. All arose from measurements 1 year after diagnosis, which were most susceptible to confounding by treatment. There was no evidence of consistency of associations across outcomes or questionnaires. These results are in keeping with chance as the explanation for our statistically significant findings.

CONCLUSION: HRQOL and psychosocial status at diagnosis and 1 year later are not associated with medical outcome in women with early-stage BC.

This research was funded by the Canadian Breast Cancer Research Alliance.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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