Background
Methods
Study design
Participants and data collection
Measurements
SF-36v2
FACT-Bv4.0
BISQ-BC
NSQ-BC
Data analyses
Ethics statement
Results
Characteristics | n (%) |
---|---|
Socio-demographics | |
Age (years) (mean ± SD) (range: 22–75) | 49.77 ± 9.57 |
Education level | |
Primary and lower | 84 (20.7) |
Secondary | 234 (57.6) |
Tertiary | 88 (21.7) |
Marital status | |
Married | 387 (95.3) |
Other | 19 (4.7) |
Employment status | |
Employed | 152 (37.4) |
Unemployed | 160 (39.4) |
Retired | 94 (23.2) |
Average monthly income over the past year (Chinese yuan) | |
< 1000 | 100 (24.6) |
1000–3000 | 174 (42.9) |
> 3000 | 132 (32.5) |
Residence | |
Rural | 200 (49.3) |
Urban | 206 (50.7) |
Suffering from chronic disease(s) | |
Yes | 80 (19.7) |
No | 326 (80.3) |
Clinical characteristics | |
Illness stage | |
I | 74 (18.2) |
II | 211 (52.0) |
III | 95 (23.4) |
IV | 26 (6.4) |
Surgery type | |
Modified radical mastectomy | 258 (63.5) |
Total mastectomy | 99 (24.4) |
Lumpectomy and axillary dissection | 37 (9.1) |
Breast conserving surgery | 12 (3.0) |
Chemotherapy | |
Yes | 402 (99.0) |
No | 4 (1.0) |
Radiotherapy | |
Yes | 46 (11.3) |
No | 360 (88.7) |
Endocrinotherapy | |
Yes | 34 (8.4) |
No | 372 (91.6) |
Needs importance (NI) (mean ± SD) | |
Respect/self-esteem needs (RSE) | 76.38 ± 12.44 |
Rehabilitation needs (REH) | 73.61 ± 13.57 |
Information needs (INF) | 71.54 ± 13.74 |
Physical needs (PHY) | 65.83 ± 17.84 |
Psychological needs (PSY) | 58.43 ± 19.58 |
Needs satisfaction (NS) (mean ± SD) | |
Respect/self-esteem needs (RSE) | 69.73 ± 12.49 |
Rehabilitation needs (REH) | 59.30 ± 16.09 |
Physical needs (PHY) | 55.99 ± 17.24 |
Information needs (INF) | 52.66 ± 16.84 |
Psychological needs (PSY) | 51.44 ± 18.22 |
Body image (BI) (mean ± SD) | |
BI-related behavior change (BI-BC) | 62.76 ± 14.83 |
BI-related self-cognition change (BI-SCo) | 59.04 ± 13.33 |
BI-related arm change (BI-AC) | 58.50 ± 11.93 |
BI-related psychological change (BI-PC) | 53.76 ± 16.72 |
BI-related sexual activity change (BI-SAC) | 52.83 ± 16.18 |
BI-related social change (BI-SC) | 52.03 ± 23.66 |
BI-related role change (BI-RC) | 50.03 ± 17.18 |
36-item Short Form Health Survey version 2.0 (SF-36v2) (mean ± SD) | |
Physical component summary (PCS) | 43.72 ± 6.15 |
Mental component summary (MCS) | 42.23 ± 9.09 |
Physical functioning (PF) | 45.54 ± 6.51 |
Role-physical (RP) | 34.85 ± 9.69 |
Bodily pain (BP) | 47.53 ± 9.89 |
General Health (GH) | 42.72 ± 8.89 |
Vitality (VT) | 48.75 ± 8.36 |
Social functioning (SF) | 39.15 ± 10.53 |
Role-emotional (RE) | 38.59 ± 10.70 |
Mental health (MH) | 44.12 ± 8.25 |
Functional Assessment of Cancer Therapy-Breast version 4.0 (FACT-Bv4.0) (mean ± SD) | |
Physical well-being (PWB) | 17.72 ± 5.07 |
Social/family well-being (SWB) | 18.46 ± 4.75 |
Emotional well-being (EWB) | 17.10 ± 4.34 |
Functional well-being (FWB) | 13.59 ± 5.42 |
Breast cancer specific additional concerns (BCS) | 21.84 ± 5.09 |
Total score | 88.71 ± 17.25 |
NI, NS, BI, and HRQoL
NI, NS, and socio-demographics concerning BI and HRQoL
Needs importance (NI) (≤69 vs. > 69) | Needs satisfaction (NS) (≤55 vs. > 55) | BI (≤56 vs. > 56) | ||||
---|---|---|---|---|---|---|
MD (95%CI) | P | MD (95%CI) | P | MD (95%CI) | P | |
Body image (BI) | ||||||
Self-cognition (SCO) | −2.09 (−4.69, 0.52) | 0.12 | −1.45 (−4.05, 1.15) | 0.28 | – | – |
Behavior change (BC) | −2.48 (−5.37, 0.42) | 0.09 | 3.13 (0.25, 6.01) | 0.03 | – | – |
Arm change (AC) | −0.68 (−3.02, 1.65) | 0.57 | −2.05 (− 4.37, 0.27) | 0.08 | – | – |
Sexual activity change (SAC) | −2.19 (−5.35, 0.98) | 0.18 | 6.84 (3.75, 9.93) | < 0.001 | – | – |
Role change (RC) | −2.54 (−5.90, 0.81) | 0.14 | 3.80 (0.46, 7.13) | 0.026 | – | – |
Psychological change (PC) | −1.44 (−4.71, 1.83) | 0.39 | 9.32 (6.19, 12.46) | < 0.001 | – | – |
Social change (SC) | −2.14 (−6.77, 2.49) | 0.37 | 7.39 (2.82, 11.96) | 0.002 | – | – |
Body image total score | −2.00 (−4.17, 0.17) | 0.07 | 4.25 (2.11, 6.38) | < 0.001 | – | – |
SF-36v2 | ||||||
Physical function (PF) | 0.97 (−0.29, 2.23) | 0.13 | 1.14 (− 0.11, 2.39) | 0.07 | 1.19 (− 0.07, 2.44) | 0.06 |
Role-physical (RP) | 1.30 (−0.54, 3.15) | 0.17 | 0.85 (−0.99, 2.70) | 0.36 | 4.22 (2.42, 6.02) | < 0.001 |
Bodily pain (BP) | 4.18 (2.24, 6.12) | < 0.001 | 1.78 (−0.19, 3.75) | 0.08 | 0.74 (−1.24, 2.72) | 0.46 |
General health (GH) | 0.90 (−0.93, 2.72) | 0.33 | −2.06 (−3.88, − 0.25) | 0.026 | 5.28 (3.53, 7.03) | < 0.001 |
Vitality (VT) | −0.88 (−2.60, 0.85) | 0.32 | −2.75 (−4.45, −1.05) | 0.002 | 4.02 (2.34, 5.70) | < 0.001 |
Social function (SF) | 3.19 (1.08, 5.31) | 0.003 | 1.36 (−0.77, 3.49) | 0.21 | 4.86 (2.78, 6.95) | < 0.001 |
Role-emotional (RE) | 2.88 (0.77, 4.99) | 0.007 | −0.10 (−2.26, 2.02) | 0.92 | 5.90 (3.85, 7.94) | < 0.001 |
Mental health (MH) | 1.44 (− 0.29, 3.17) | 0.10 | −2.80 (−4.51, −1.09) | 0.001 | 5.52 (3.87, 7.17) | < 0.001 |
Physical component summary (PCS) | 1.50 (0.23, 2.77) | 0.021 | −1.38 (−2.65, −0.11) | 0.033 | 1.27 (−0.005, 2.53) | 0.05 |
Mental component summary (MCS) | 1.80 (− 0.09, 3.68) | 0.06 | −2.19 (−4.07, − 0.32) | 0.022 | 6.55 (4.77, 8.33) | < 0.001 |
FACT-Bv4.0 | ||||||
Physical well-being (PWB) | 0.64 (−0.36, 1.64) | 0.21 | −1.05 (−2.04, − 0.06) | 0.038 | 3.17 (2.22, 4.12) | < 0.001 |
Social/family well-being (SWB) | −2.11 (−3.43, − 0.80) | 0.002 | − 2.53 (− 3.84, − 1.23) | < 0.001 | 1.59 (0.26, 2.92) | 0.019 |
Emotional well-being (EWB) | 0.66 (− 0.21, 1.53) | 0.14 | − 2.35 (− 3.19, − 1.51) | < 0.001 | 3.52 (2.71, 4.32) | < 0.001 |
Functional well-being (FWB) | −1.27 (− 2.31, − 0.24) | 0.016 | − 2.36 (− 3.38, − 1.35) | < 0.001 | 2.39 (1.38, 3.40) | < 0.001 |
Additional breast cancer-specific concerns (BCS) | 1.81 (0.83, 2.79) | < 0.001 | − 0.94 (− 1.92, 0.05) | 0.06 | 4.21 (3.30, 5.11) | < 0.001 |
FACT-Bv4.0 total score | −2.10 (− 6.99, 2.78) | 0.40 | −9.90 (− 14.61, −5.20) | < 0.001 | 12.86 (8.32, 17.40) | < 0.001 |
Dependent variable | Independent variables | B (95%CI) | P | VIF† |
---|---|---|---|---|
Body imagea | Needs satisfaction | − 0.34 (− 0.36, − 0.18) | < 0.001 | 1.02 |
Needs importance | 0.30 (0.17, 0.36) | < 0.001 | 1.01 | |
Lumpectomy and axillary dissection (ref. modified radical mastectomy) | −0.11 (− 7.80, − 0.54) | 0.025 | 1.06 | |
PCSb | Body image | −0.12 (− 0.13, − 0.01) | 0.019 | 1.05 |
Needs importance | −0.11 (− 0.10, − 0.007) | 0.026 | 1.03 | |
Chronic disease (ref. yes) | 0.10 (0.03, 3.21) | 0.045 | 1.03 | |
MCSc | Body image | −0.40 (− 0.42, − 0.27) | < 0.001 | 1.02 |
Residence (ref. rural) | 0.14 (1.03, 4.49) | 0.002 | 1.02 | |
Lumpectomy and axillary dissection (ref. modified radical mastectomy) | −0.10 (−6.49, − 0.50) | 0.022 | 1.05 | |
FACT-Bv4.0d | Body image | −0.42 (− 0.80, − 0.44) | < 0.001 | 1.03 |
Unemployed (ref. employed) | −0.21 (−11.68, −3.45) | < 0.001 | 1.05 | |
Needs satisfaction | 0.16 (0.06, 0.37) | 0.008 | 1.02 | |
Radiotherapy (ref. yes) | 0.13 (0.69, 12.06) | 0.028 | 1.05 | |
Marital status (ref. married) | −0.13 (−22.80, −1.02) | 0.032 | 1.05 |
Predictor effects | Body image (BI, mediator) | Physical component summary (PCS) | Mental component summary (MCS) | |||
---|---|---|---|---|---|---|
B (95%CI) | P | B (95%CI) | P | B (95%CI) | P | |
Total effects | ||||||
Body image | – | – | − 0.115 (− 0.202, − 0.003) | 0.047 | − 0.351 (− 0.434, − 0.258) | 0.002 |
Needs importance | 0.297 (0.195, 0.397) | 0.002 | −0.145 (− 0.245, − 0.043) | 0.009 | −0.254 (− 0.363, − 0.136) | 0.003 |
Needs satisfaction | −0.341 (− 0.455, − 0.232) | 0.002 | 0.039 (0.004, 0.076) | 0.034 | 0.261 (0.149, 0.373) | 0.003 |
LAD (ref. MRM) | −0.106 (− 0.214, − 0.004) | 0.043 | 0.012 (0.000, 0.036) | 0.048 | − 0.052 (− 0.155, 0.049) | 0.314 |
Chronic disease (ref. yes) | – | – | 0.100 (0.004, 0.206) | 0.040 | – | – |
Residence (ref. rural) | – | – | – | – | 0.150 (0.050, 0.236) | 0.002 |
Direct effects | ||||||
Body image | – | – | − 0.115 (− 0.202, − 0.003) | 0.047 | − 0.351 (− 0.434, − 0.258) | 0.002 |
Needs importance | 0.297 (0.195, 0.397) | 0.002 | − 0.111 (− 0.211, − 0.009) | 0.035 | −0.150 (− 0.249, − 0.037) | 0.004 |
Needs satisfaction | − 0.341 (− 0.455, − 0.232) | 0.002 | – | – | 0.142 (0.039, 0.244) | 0.007 |
LAD (ref. MRM) | − 0.106 (− 0.214, − 0.004) | 0.043 | – | – | − 0.089 (− 0.184, − 0.002) | 0.043 |
Chronic disease (ref. yes) | – | – | 0.100 (0.004, 0.206) | 0.040 | – | – |
Residence (ref. rural) | – | – | – | – | 0.150 (0.050, 0.236) | 0.002 |
Indirect effects | ||||||
Body image | – | – | – | – | – | – |
Needs importance | – | – | −0.034 (− 0.066, − 0.004) | 0.032 | − 0.104 (− 0.150, − 0.065) | 0.001 |
Needs satisfaction | – | – | 0.039 (0.004, 0.076) | 0.034 | 0.120 (0.077, 0.173) | 0.001 |
LAD (ref. MRM) | – | – | 0.012 (0.000, 0.036) | 0.048 | 0.037 (0.003, 0.080) | 0.036 |
Chronic disease (ref. yes) | – | – | – | – | – | – |
Residence (ref. rural) | – | – | – | – | – | – |
Predictor effects | Body image (mediator) | FACT-Bv4.0 | ||
---|---|---|---|---|
B (95%CI) | P | B (95%CI) | P | |
Total effects | ||||
Body image | - | - | -0.432 (-0.536, -0.324) | 0.001 |
Needs importance | 0.192 (0.044, 0.315) | 0.013 | -0.083 (-0.143, -0.022) | 0.008 |
Needs satisfaction | -0.316 (-0.470, -0.146) | 0.002 | 0.312 (0.171, 0.436) | 0.002 |
Marital status (ref. married) | - | - | -0.132 (-0.155, -0.009) | 0.032 |
Unemployed (ref. employed) | - | - | -0.223 (-0.371, -0.126) | 0.020 |
Radiotherapy (ref. yes) | - | - | 0.130 (0.098, 0.257) | 0.041 |
Direct effects | ||||
Body image | - | - | -0.432 (-0.536, -0.324) | 0.001 |
Needs importance | 0.192 (0.044, 0.315) | 0.013 | - | - |
Needs satisfaction | -0.316 (-0.470, -0.146) | 0.002 | 0.176 (0.055, 0.300) | 0.005 |
Marital status (ref. married) | - | - | -0.132 (-0.155, -0.009) | 0.032 |
Unemployed (ref. employed) | - | - | -0.223 (-0.371, -0.126) | 0.020 |
Radiotherapy (ref. yes) | - | - | 0.130 (0.098, 0.257) | 0.041 |
Indirect effects | ||||
Body image | - | - | - | - |
Needs importance | - | - | -0.083 (-0.143, -0.022) | 0.008 |
Needs satisfaction | - | - | 0.136 (0.060, 0.220) | 0.001 |
Marital status (ref. married) | - | - | - | - |
Unemployed (ref. employed) | - | - | - | - |
Radiotherapy (ref. yes) | - | - | - | - |