Safieddine Batoul, Geyer Siegfried, Sperlich Stefanie, Beller Johannes, Noeres Dorothee
Medical Sociology Unit, Hannover Medical School, Hannover, Germany.
BMC Cancer. 2025 Jan 17;25(1):98. doi: 10.1186/s12885-025-13491-8.
Evidence suggests a deterioration of health-related quality of life (HRQL) after breast cancer diagnosis and therapy. This study examines sociodemographic and health-related factors that could be associated with the HRQL of working women with breast cancer during the first five years after primary surgery. Second, it explores potential vulnerable groups with respect to HRQL using decision tree analyses.
Women diagnosed with breast cancer who had paid work at diagnosis were recruited at 11 breast cancer centers in the Hannover region, Germany, after primary surgery. Assessments took place four times. 455 patients completed mailed questionnaires at 3 weeks after primary surgery. Women were followed up at 6 months, 1 year and on average 5 years after primary surgery. The physical and mental wellbeing dimensions of HRQL were examined through the Short-Form health survey-12. Potential associations between HRQL and health and sociodemographic factors were examined using multiple linear regression. Classification tree analyses were applied to define specific vulnerable groups.
Mastectomy (ß=-2.49; CI:-4.67, -0.30) and chemotherapy (ß=-4.25; CI:-7.04, -1.46) as health related factors were significantly associated with poorer physical wellbeing at 3 weeks and 6 months after primary surgery, respectively. Returning to work (RTW) after having been on sick leave was strongly associated with better HRQL as illustrated by higher sum scores for physical (at 3 weeks: ß=6.21; CI:3.36, 9.05; at 6 months: ß=5.40; CI:3.01, 1.80; at 1 year: ß=8.40; CI:5.31, 11.49) and mental wellbeing (at 6 months: ß=6.03; CI:33.25, 8.81; at 1 year: ß=7.71; CI:4.85, 10.58) until 1 year after primary surgery. However, its significant effect was no more apparent at 5 years after primary surgery. At that stage, income was mostly associated with physical (ß=0.002; CI:0.0002, 0.003) and mental wellbeing (ß=0.002; CI:0.0005, 0.003) with higher summary scores for higher income especially in women aged ≤ 61 years. In addition, living with a partner appeared to be an important positively associated factor with better mental wellbeing in women with breast cancer (at 6 months: ß=3.68; CI: 0.72, 6.63; at 5 years: ß=2.85; CI:0.39, 5.32) and the first splitting node that defined vulnerability at 5 years.
HRQL in breast cancer appears to be a multidimensional phenomenon associated with disease, treatment and social factors. A special focus should be drawn to women with lower income and those not living with a partner when planning rehabilitation programs and strategies that aim to improve the long term HRQL in breast cancer. As RTW appeared to be positively associated with HRQL, future research should examine potential causal relationships between RTW and HRQL in breast cancer in order to provide evidence needed to plan prevention strategies that aim to improve HRQL after breast cancer.
有证据表明，乳腺癌诊断和治疗后，与健康相关的生活质量（HRQL）会下降。本研究调查了可能与乳腺癌职业女性初次手术后头五年的HRQL相关的社会人口学和健康相关因素。其次，使用决策树分析探索HRQL方面的潜在弱势群体。
在德国汉诺威地区的11个乳腺癌中心招募了诊断时从事有酬工作且被诊断为乳腺癌的女性，她们均已接受初次手术。评估共进行了4次。455名患者在初次手术后3周完成了邮寄问卷。在初次手术后6个月、1年和平均5年对女性进行随访。通过简短健康调查-12来检查HRQL的身体和心理健康维度。使用多元线性回归研究HRQL与健康及社会人口学因素之间的潜在关联。应用分类树分析来定义特定的弱势群体。
作为健康相关因素，乳房切除术（β=-2.49；置信区间：-4.67，-0.30）和化疗（β=-4.25；置信区间：-7.04，-1.46）分别与初次手术后3周和6个月时较差的身体健康显著相关。病假后重返工作岗位（RTW）与更好的HRQL密切相关，初次手术后1年内身体（3周时：β=6.21；置信区间：3.36，9.05；6个月时：β=5.40；置信区间：3.01，1.80；1年时：β=8.40；置信区间：5.31，11.49）和心理健康（6个月时：β=6.03；置信区间：33.25，8.81；1年时：β=7.71；置信区间：4.85，10.58）的总分更高。然而，在初次手术后5年，其显著影响不再明显。在那个阶段，收入主要与身体（β=0.002；置信区间：0.0002，0.003）和心理健康（β=0.002；置信区间：0.0005，0.003）相关，收入越高，总分越高，尤其是在年龄≤61岁的女性中。此外，与伴侣同住似乎是乳腺癌女性心理健康状况较好的一个重要正相关因素（6个月时：β=3.68；置信区间：0.72，6.63；5年时：β=2.85；置信区间：0.39，5.32），也是5年时定义脆弱性的第一个分裂节点。
乳腺癌患者的HRQL似乎是一个与疾病、治疗和社会因素相关的多维度现象。在制定旨在改善乳腺癌患者长期HRQL的康复计划和策略时，应特别关注低收入女性和未与伴侣同住的女性。由于RTW似乎与HRQL呈正相关，未来的研究应调查乳腺癌患者中RTW与HRQL之间的潜在因果关系，以便为制定旨在改善乳腺癌后HRQL的预防策略提供所需证据。
