Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina.
Helen Diller Family Comprehensive Cancer Center at University of California, San Francisco, San Francisco, California.
Cancer. 2020 May 15;126(10):2296-2304. doi: 10.1002/cncr.32757. Epub 2020 Feb 27.
The goal of this study was to compare health-related quality of life (HRQL) from diagnosis to 10 years postdiagnosis among breast cancer survivors (BCS) and women without cancer over the same period and to identify BCS subgroups exhibiting different HRQL trajectories.
Our analysis included 141 BCS and 2086 controls from the Study of Women's Health Across the Nation (SWAN), a multiracial/ethnic cohort study of mid-life women assessed approximately annually from 1995 to 2015. Pink SWAN participants reported no cancer at SWAN enrollment and developed (cases) or did not develop (controls) incident breast cancer after enrollment. We assessed HRQL with SF-36 Mental Component Summary and Physical Component Summary scores. We modeled each as a function of case/control status, years since diagnosis, years since diagnosis squared, and the interaction terms between case/control status and the 2 time variables in linear models. We characterized heterogeneity in postdiagnosis HRQL of cases using group-based trajectories.
BCS had significantly lower HRQL compared with controls at diagnosis and 1 year postdiagnosis. By 2 years, BCS and controls no longer differed significantly. Among BCS, 2 trajectory groups were identified for both scores. For the Mental Component Summary, 88.4% of BCS had consistently good and 11.6% had very low scores. For the Physical Component Summary, 73.9% had good scores, and 26.1% had consistently low scores. Prediagnosis perceived stress and current smoking were related to being in the low mental trajectory group, and a higher number of comorbidities was related to being in the low physical trajectory group.
Although the majority of BCS have HRQL similar to non-cancer controls after 2 years, subgroups of BCS continue to have low HRQL. Prediagnosis stress, comorbidities, and smoking are vulnerability factors for long-term, low HRQL in BCS.
本研究旨在比较乳腺癌幸存者（BCS）和同期无癌症女性从诊断到诊断后 10 年的健康相关生活质量（HRQL），并确定表现出不同 HRQL 轨迹的 BCS 亚组。
我们的分析包括来自女性健康全国研究（SWAN）的 141 名 BCS 和 2086 名对照，这是一项从中年女性开始的多种族/族裔队列研究，从 1995 年到 2015 年每年进行大约一次评估。粉红 SWAN 参与者在 SWAN 登记时报告没有癌症，并在登记后发生（病例）或未发生（对照）乳腺癌。我们使用 SF-36 心理健康成分综合评分和生理健康成分综合评分评估 HRQL。我们将每个评分建模为病例/对照状态、诊断后年数、诊断后年数平方以及线性模型中病例/对照状态和 2 个时间变量之间的交互项的函数。我们使用基于组的轨迹来描述病例诊断后 HRQL 的异质性。
BCS 在诊断时和诊断后 1 年的 HRQL 明显低于对照。到 2 年时，BCS 和对照不再有显著差异。在 BCS 中，两个轨迹组都确定了这两个评分。对于心理健康成分综合评分，88.4%的 BCS 一直保持良好评分，11.6%的 BCS 一直保持非常低评分。对于生理健康成分综合评分，73.9%的 BCS 评分良好，26.1%的 BCS 一直保持较低评分。诊断前感知压力和当前吸烟与处于低心理健康轨迹组相关，而合并症数量较多与处于低生理健康轨迹组相关。
尽管大多数 BCS 在 2 年后的 HRQL 与非癌症对照相似，但 BCS 的亚组仍存在 HRQL 较低的情况。诊断前的压力、合并症和吸烟是 BCS 长期低 HRQL 的脆弱因素。
