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Prospective Changes in Quality of Life After Ductal Carcinoma-in-Situ: Results From the Nurses' Health Study

Larissa Nekhlyudov, Candyce H. Kroenke, Inkyung Jung, Michelle D. Holmes, Graham A. Colditz

From the Department of Ambulatory Care and Prevention, Harvard Medical School/Harvard Pilgrim Health Care; Department of Epidemiology, Harvard School of Public Health; and the Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA

Address reprint requests to Larissa Nekhlyudov, MD, MPH, Department of Ambulatory Care and Prevention, Harvard Medical School/Harvard Pilgrim Health Care, 133 Brookline Avenue, 6th Floor, Boston, MA 02215; e-mail: larissa_nekhlyudov{at}harvardpilgrim.org

PURPOSE: The incidence of ductal carcinoma-in-situ (DCIS) of the breast has been increasing. However, uncertainties exist about its prognosis, optimal treatment, and effect on women's health-related quality-of-life (HRQoL). Our study assessed the prospective changes in HRQoL in women diagnosed with DCIS.

PATIENTS AND METHODS: Between 1992 and 2000, HRQoL was assessed at three 4-year intervals among women enrolled in two Nurses' Health Study cohorts using the Medical Outcomes Survey Short-Form 36 health survey. Using mixed effects and logistic regression modeling, we compared the prospective changes in HRQoL scores among women with and without DCIS.

RESULTS: The study included 114,728 women; 510 were diagnosed with DCIS during the study period. During 4 years, women with DCIS had small, but statistically significantly greater declines in the domains of role limitations due to physical problems (–6.74; SE, 1.69), vitality (–2.06; SE, 0.78), and social functioning (–2.40; SE, 0.93) than women without DCIS. Among those with DCIS, clinically significant declines were more often observed within 6 months of the diagnosis in the domains of social functioning (odds ratio, 1.78; 95% CI, 1.03 to 3.07) and mental health (odds ratio, 2.03; 95% CI, 1.09 to 3.79) than after 6 months after diagnosis.

CONCLUSION: Women with DCIS experienced small long-term declines in HRQoL, although these declines did not seem to be clinically important. Short-term clinically significant declines in the psychosocial domains were noted. In counseling women with DCIS, clinicians should provide reassurance but prepare them to deal with the short-term sequelae.

Supported by the National Cancer Institute Grant No. RO1-CA87969 to the Nurses' Health Study; in part by an American Cancer Society Clinical Research Professorship (G.A.C.); and by the Institutional Training Grant in the Epidemiology and Prevention of Breast Cancer (Grant No. DAMD17-00-1-0165), Department of Defense, US Army Medical Research and Material Command (L.N.).

Presented in part at the national meeting of the Society of General Internal Medicine, Chicago, IL, May 13, 2004.

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

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