The impact of a second breast cancer diagnosis on health related quality of life.

A growing of research documents the negative impact of recurrent breast cancer on quality of life (QOL), however few prospective investigations are available that compare QOL outcomes across different types of second cancer events (e.g., local/regional recurrence (LR) versus distant/metastatic recurrence (DR) versus a new primary breast cancer (NP)). In addition, although participant attrition is a major issue in this group of cancer patients, the potential impact of attrition or response bias on QOL outcomes is not typically examined. To address these issues, we prospectively examined QOL data obtained from a sample of women (n=140) participating in the Women's Healthy Eating and Living (WHEL) Study who experienced a second cancer event (LR, DR or NP). Women in our study reported significant worsening in most areas of QOL, except for emotional wellbeing, from pre- to post-second cancer event. Although the patterns of change to QOL differed slightly within each category (LR versus DR versus NP), participants were more similar than different in their QOL ratings. However, the perceived health status of women with DR was significantly lower than women with LR or NP. We also identify important sources of response bias that should be considered when interpreting findings. Specifically, women diagnosed with DR (a) were more likely to decline to complete the post-recurrence QOL questionnaire (27% refusal rate versus 14% LR and 13% NP), and (b) had higher death rates (28% death rate versus 4% LR and 6% NP) after agreeing to but before completing the post-second diagnosis QOL questionnaire.