Introduction
Material and methods
Study design
Study population
Data collection and study measures
Data processing
Statistical analysis
Results
Characteristics of BCSs and CFWs
Characteristics | Breast cancer survivors (n = 722) | Cancer-free women (n = 1359) | p-Value | |
Sociodemographic characteristics | ||||
Mean (SD) | Mean (SD) | |||
Min – Max [Median] | Min – Max [Median] | Student t-test | ||
Age (years) | 52.4 (10.1) | 42.8 (11.9) | < .0001 | |
26–75 [53] | 26–75 [41] | |||
N (%) | N (%) | Chi2 | ||
26 – 39 years | 85 (11.77) | 643 (47.31) | < .0001 | |
40 – 52 years | 259 (35.87) | 391 (28.77) | ||
53 – 75 years | 378 (52.35) | 325 (23.91) | ||
Living alone | Yes | 170 (23.55) | 283 (20.82) | 0.1521 |
Noa | 552 (76.45) | 1076 (79.18) | ||
Dependentsb | Yes | 342 (47.37) | 710 (52.24) | 0.0342 |
No | 380 (52.63) | 649 (47.76) | ||
Financial level | Comfortable or very comfortable | 358 (49.59) | 717 (52.76) | 0.1677 |
Neither comfortable nor in difficulty or lowerc | 364 (50.42) | 642 (47.24) | ||
Education level (years of study) | High school (≤ 12) | 155 (21.47) | 159 (11.70) | < .0001 |
Undergraduate to post-graduate degree (13–17)d | 567 (78.53) | 1200 (88.30) | ||
Currently employed | Yes | 489 (67.73) | 1088 (80.06) | < .0001 |
No | 233 (32.27) | 271 (19.94) | ||
Habitat environment | Rural | 239 (33.10) | 401 (29.51) | 0.0907 |
Urban | 483 (66.90) | 958 (70.49) | ||
Anthropometry | ||||
BMI (kg/m2) | Normal (< 25) | 492 (68.14) | 947 (69.68) | 0.4692 |
Overweight or obese (≥ 25) | 230 (31.86) | 412 (30.32) | ||
Lifestyle habits | ||||
Current smoker | Yes | 62 (8.59) | 130 (9.57) | 0.4628 |
No | 660 (91.41) | 1229 (90.43) | ||
Current alcohol consumption | Yes | 525 (72.71) | 1042 (76.67) | 0.0462 |
No | 197 (27.29) | 317 (23.33) | ||
Increase in physical activity level in the last 10 years | Yes | 354 (49.03) | 472 (34.73) | < .0001 |
No | 368 (50.97) | 887 (65.27) | ||
Fatalistic perception of cancere | Yes | 243 (33.66) | 306 (22.52) | < .0001 |
No | 479 (66.34) | 1053 (77.48) | ||
Health-related characteristics | ||||
Current health status | Good or very good | 413 (57.20) | 1099 (80.87) | < .0001 |
Good enough or lowerf | 309 (42.80) | 260 (19.13) | ||
Number of consultations with a general practitioner in the last 12 monthsg | ≤ 2 | 422 (58.45) | 810 (59.60) | 0.6102 |
> 2 | 300 (41.55) | 549 (40.40) | ||
Current sleep problemsh | Yes | 186 (25.76) | 310 (22.81) | 0.1326 |
No | 536 (74.24) | 1049 (77.19) | ||
Diseases diagnosed in the last 10 years | ||||
Presence of comorbiditiesi | Yes | 158 (21.88) | 149 (10.96) | < .0001 |
No | 564 (78.12) | 1210 (89.04) | ||
Neurological problemsj | Yes | 220 (30.47) | 367 (27.01) | 0.0945 |
No | 502 (69.53) | 992 (72.99) | ||
Cancer-related characteristics | ||||
Treatments received | ||||
Mastectomy | Yes | 269 (37.26) | ||
No | 453 (62.74) | |||
Radiation therapyk | Yes | 655 (90.72) | ||
No | 67 (9.28) | |||
Drugsl | Yes | 514 (71.19) | ||
No | 208 (28.81) | |||
Current cancer therapy | Yes | 241 (33.38) | ||
No | 481 (66.62) | |||
Time since diagnosis (years) | 1–3 years | 259 (35.87) | ||
4–6 years | 255 (35.32) | |||
7–10 years | 208 (28.81) | |||
Persistent sequelae due to cancer and its treatments | Yes | 531 (73.55) | ||
No | 191 (26.45) |
Breast cancer survivors (n = 722) | Cancer-free women (n = 1359) | p-Value | |
---|---|---|---|
Adjusted meana [CI 95%] | Adjusted meana [CI 95%] | ||
WHOQOL-BREF | |||
WHOQOL: physical health [PHYSH] | 59.45 [57.95; 60.96] | 63.24 [61.68; 64.80] | < .0001 |
WHOQOL: psychological health [PSYCH] | 57.96 [56.28; 59.63] | 58.14 [56.40; 59.88] | 0.8026 |
WHOQOL: social relationships [SOCREL] | 54.59 [52.53; 56.66] | 55.12 [52.98; 57.27] | 0.5552 |
WHOQOL: environment [ENVIR] | 67.55 [66.22; 68.88] | 67.20 [65.82; 68.58] | 0.5445 |
MHLCS – Form A | |||
MHLCS: internal | 21.58 [21.19; 21.97] | 22.20 [21.79; 22.61] | 0.0003 |
MHLCS: powerful others | 19.73 [19.24; 20.23] | 18.90 [18.38; 19.42] | 0.0001 |
MHLCS: chance | 18.55 [18.04; 19.05] | 18.28 [17.76; 18.81] | 0.2261 |
Brief-COPE | |||
BCOPE: positive thinking | 14.78 [14.41; 15.16] | 13.58 [13.19; 13.96] | < .0001 |
BCOPE: problem solving | 10.76 [10.46; 11.07] | 10.41 [10.09; 10.73] | 0.0087 |
BCOPE: seeking social support | 17.05 [16.56; 17.53] | 17.24 [16.74; 17.74] | 0.3651 |
BCOPE: avoidance | 17.71 [17.34; 18.09] | 18.59 [18.20; 18.98] | < .0001 |
HLS-EU-Q16b | 12.16 [11.79; 12.52] | 11.92 [11.54; 12.31] | 0.1426 |
Psychometric scales scores of BCSs and CFWs
Characteristics | Breast cancer survivors (n = 722) | Cancer-free women (n = 1359) | Chi2 p-Value | Adjusted p-Valuea |
---|---|---|---|---|
N (%) | N (%) | |||
WHOQOL-BREF: Global QoL | ||||
Poor or very poorb | 28 (3.88) | 58 (4.27) | 0.0014 | 0.3307 |
Neither poor nor good | 131 (18.14) | 167 (12.29) | ||
Good or very goodc | 563 (77.98) | 1134 (83.44) | ||
WHOQOL-BREF: Health satisfaction | ||||
Dissatisfied or very dissatisfiedd | 113 (15.65) | 140 (10.30) | < .0001 | 0.0019 |
Neither satisfied nor satisfied | 201 (27.84) | 197 (14.50) | ||
Satisfied or very satisfiede | 408 (56.51) | 1022 (75.20) | ||
Health literacy (HLS-EU-Q16) | ||||
Inadequate (0–8) | 73 (10.77) | 158 (13.87) | < .0001 | < .0001 |
Problematic (9–12) | 239 (35.25) | 470 (41.26) | ||
Sufficient (13–16) | 366 (53.98) | 511 (44.86) | ||
Don’t know/ Not applicable | 220 (16.19) | 44 (6.09) |
Factors associated with scores of HRQoL in BCSs
WHOQOL-BREF scores (Table 4; Additional file 4)
Variable | Breast cancer survivors (n = 722) | Cancer-free women (n = 1359) | ||||||
---|---|---|---|---|---|---|---|---|
WHOQOL-BREF | WHOQOL-BREF | |||||||
Physical health | Psychological health | Social relationships | Environment | Physical health | Psychological health | Social relationships | Environment | |
β coefficienta | β coefficienta | β coefficienta | β coefficienta | β coefficientb | β coefficientb | β coefficientb | β coefficientb | |
Intercept | 63.433 | 61.816 | 56.943 | 62.412 | 58.455 | 48.593 | 46.085 | 57.333 |
Living status (not living alone)c | -0.306 | 2.129 | 3.727* | 1.634 | -0.744 | 2.786** | 5.211*** | 2.299** |
Dependents (yes) | 0.037 | -1.050 | -0.141 | -1.392 | -1.409 | 1.324 | -2.030 | -1.257 |
Financial level (high) | 3.964*** | 4.065** | 1.862 | 7.204*** | 1.587* | 1.944* | 0.003 | 6.267*** |
Education level (13–17 years) | -3.107* | -1.464 | -1.012 | 0.414 | -1.472 | 0.861 | -2.023 | 1.467 |
Professionally active (yes) | 3.116** | 0.299 | 0.032 | 0.792 | 4.426*** | 4.168*** | 2.554* | 1.267 |
Habitat environment (urban) | 0.182 | -0.837 | -0.099 | -1.345 | -0.281 | 0.209 | 1.030 | -0.171 |
Age (40–52 years) | -3.011 | -4.529** | -3.394 | -2.010 | -0.333 | -1.392 | -0.592 | -0.452 |
Age (53–75 years) | -2.805 | -3.545 | -4.223 | -1.044 | -0.270 | 2.894** | 0.511 | 1.589 |
BMI (normal) | 2.875** | 0.195 | -1.297 | -1.250 | 1.626* | 2.344** | 0.159 | 0.324 |
Current health status (good) | 10.828*** | 7.602*** | 5.211** | 3.697*** | 12.814*** | 6.537*** | 5.985*** | 5.052*** |
Neurological problemsd, e (yes) | -3.776** | -3.406** | -3.131* | -1.568 | -5.248*** | -3.220*** | -1.113 | -1.320 |
Presence of comorbiditiese, f (yes) | -2.126 | -1.593 | -0.169 | -0.235 | -3.542** | 0.036 | 0.291 | 0.623 |
Consultations with a general practitionerg (> 2) | -3.604** | -2.124* | -3.060* | 0.230 | -3.715*** | -1.546* | -0.716 | -0.438 |
Currently smoking (yes) | 1.183 | 0.655 | -1.400 | -0.705 | 1.929 | -0.060 | 0.415 | -1.348 |
Current alcohol consumption (yes) | 2.693* | 0.896 | 1.570 | 2.027* | 2.615** | -0.744 | 1.241 | 1.162 |
Increased physical activity level (yes) | 1.358 | 1.561 | -0.083 | 0.894 | 2.813*** | 1.364 | 0.708 | 1.226 |
Sleep problems (yes) | -2.258* | -1.837 | -5.421** | -3.059** | -5.219*** | -4.333*** | -3.268** | -2.464** |
Fatalistic opinion about cancerh (yes) | 0.921 | 1.898 | 2.263 | 0.576 | 0.642 | 0.426 | 0.592 | 0.890 |
Brief-COPE: positive thinkingi (> 14) | 1.022 | 4.507*** | 3.689** | 3.930*** | 2.280** | 6.005*** | 6.322*** | 1.986** |
Brief-COPE: problem solvingi (> 11) | 2.933** | 5.168*** | 2.166 | 2.481** | 1.022 | 4.320*** | 0.142 | 0.921 |
Brief-COPE: seeking social supporti (> 18) | 1.859 | 2.056* | 4.412** | 1.569 | 0.119 | 2.125** | 4.337*** | 2.200** |
Brief-COPE: avoidancei (> 18) | -1.242 | -5.943*** | -2.985* | -1.873* | -2.686** | -5.397*** | -3.062** | -1.143 |
MHLCS: internali (> 22) | 2.399* | 0.318 | 0.343 | 1.613 | 1.471* | 0.343 | 0.554 | 1.185 |
MHLCS: powerful othersi (> 19) | -0.629 | 1.336 | -0.129 | -0.254 | 0.979 | 0.779 | 2.273* | 0.694 |
MHLCS: chancei (> 18) | -1.799 | -4.463*** | -0.904 | -0.975 | -0.475 | -1.218 | -0.082 | -0.802 |
Health literacy (HLS-EU-Q16) (sufficient > 12) | 0.649 | 0.763 | -0.084 | 2.160** | 0.720 | 0.810 | 3.002** | 1.386* |
Current sequelae of cancer (yes) | -3.628** | -1.464 | -0.656 | -0.263 | ||||
Current cancer treatment (yes) | -4.192** | 1.999 | 1.968 | 1.146 | ||||
Response time since diagnosis (1–3 years) | -3.494** | -3.195* | -3.483* | -2.065 | ||||
Response time since diagnosis (4–6 years) | -1.265 | -2.446 | -3.765* | -0.331 | ||||
Mastectomy (yes) | -3.383** | -1.848 | 0.950 | -1.155 | ||||
Radiation therapyj (yes) | -4.209* | -0.773 | 0.483 | 0.996 | ||||
Medical treatmentk (yes) | 3.478** | -0.627 | -0.058 | -1.058 |
Variable | Breast cancer survivors (n = 722) | Cancer-free women (n = 1359) | ||
---|---|---|---|---|
WHOQOL-BREF | WHOQOL-BREF | |||
Global Quality of life | Health’ satisfaction | Global Quality of life | Health’ satisfaction | |
Good (n = 563) vs. Low (n = 159) | Yes (n = 408) vs. No (n = 314) | Good (n = 1134) vs. Low (n = 225) | Yes (n = 1022) vs. No (n = 337) | |
OR [CI 95%]a | OR [CI 95%]a | OR [CI 95%]b | OR [CI 95%]b | |
Living alone | ||||
Yes | 0.63 [0.39; 1.03] | 1.49 [0.95; 2.32] | 0.43 [0.30; 0.62]*** | 0.93 [0.63; 1.37] |
Noc | Reference | Reference | Reference | Reference |
Dependents | ||||
Yes | 1.12 [0.68; 1.84] | 0.89 [0.59; 1.35] | 1.12 [0.78; 1.60] | 1.06 [0.75; 1.50] |
No | Reference | Reference | Reference | Reference |
Financial level | ||||
Lowd | 0.34 [0.22; 0.55]*** | 0.79 [0.55; 1.15] | 0.51 [0.36; 0.72]** | 0.67 [0.48; 0.93]* |
Highe | Reference | Reference | Reference | Reference |
Education level (study years) | ||||
High school (≤ 12) | 1.49 [0.87; 2.55] | 1.29 [0.81; 2.05] | 0.78 [0.48; 1.26] | 1.14 [0.70; 1.86] |
Undergraduate to post-graduate degree (> 12) | Reference | Reference | Reference | Reference |
Professionally active | ||||
Yes | Reference | Reference | Reference | Reference |
No | 0.62 [0.39; 1.01] | 1.46 [0.95; 2.23] | 0.56 [0.38; 0.83]** | 1.02 [0.68; 1.52] |
Habitat environment | ||||
Rural | 1.92 [1.19; 3.10]** | 1.00 [0.68; 1.47] | 1.10 [0.77; 1.58] | 1.25 [0.89; 1.76] |
Urban | Reference | Reference | Reference | Reference |
Age (years) | ||||
26 – 39 | Reference | Reference | Reference | Reference |
40 – 52 | 0.54 [0.25; 1.16] | 0.70 [0.38; 1.27] | 0.92 [0.62; 1.37] | 0.70 [0.48; 1.02] |
53 – 75 | 0.52 [0.23; 1.15] | 0.54 [0.29; 1.03] | 1.20 [0.76; 1.88] | 0.93 [0.61; 1.44] |
Ptrend | 0.161 | 0.063 | 0.549 | 0.434 |
Body mass index (BMI) | ||||
Normal | Reference | Reference | Reference | Reference |
Overweight or obese | 1.44 [0.90; 2.28] | 0.71 [0.48; 1.04] | 1.05 [0.74; 1.48] | 0.81 [0.58; 1.12] |
Current health status | ||||
Good enough or lower | 0.35 [0.22; 0.56]*** | 0.22 [0.15; 0.32]*** | 0.43 [0.30; 0.62]*** | 0.09 [0.07; 0.13]*** |
Good or very good | Reference | Reference | Reference | Reference |
Neurological problemsf, g | ||||
Yes | 0.68 [0.44; 1.06] | 0.83 [0.56; 1.22] | 0.78 [0.55; 1.11] | 0.61 [0.44; 0.85]** |
No | Reference | Reference | Reference | Reference |
Presence of comorbiditiesg, h | ||||
Yes | 0.75 [0.44; 1.25] | 0.50 [0.32; 0.79]** | 1.23 [0.73; 2.05] | 0.69 [0.43; 1.10] |
No | Reference | Reference | Reference | Reference |
Consultations with a general practitioneri | ||||
≤ 2 | Reference | Reference | Reference | Reference |
> 2 | 0.94 [0.61; 1.46] | 0.97 [0.67; 1.40] | 0.76 [0.54; 1.07] | 0.68 [0.50; 0.93]* |
Currently smoking | ||||
Yes | 0.86 [0.44; 1.69] | 0.96 [0.51; 1.80] | 1.27 [0.74; 2.15] | 1.74 [1.01; 3.00]* |
No | Reference | Reference | Reference | Reference |
Current alcohol consumption | ||||
Yes | 1.90 [1.22; 2.96]** | 1.36 [0.92; 2.02] | 0.83 [0.57; 1.22] | 1.22 [0.85; 1.74] |
No | Reference | Reference | Reference | Reference |
Increased physical activity level | ||||
Yes | Reference | Reference | Reference | Reference |
No | 0.82 [0.54; 1.25] | 0.85 [0.59; 1.20] | 0.74 [0.52; 1.05] | 0.60 [0.43; 0.84]** |
Sleep problems | ||||
Yes | 0.64 [0.40; 1.00] | 1.16 [0.77; 1.75] | 0.54 [0.38; 0.77]** | 0.56 [0.40; 0.79]** |
No | Reference | Reference | Reference | Reference |
Fatalistic opinion about cancerj | ||||
Yes | 1.27 [0.80; 2.00] | 0.87 [0.59; 1.27] | 1.19 [0.82; 1.75] | 1.09 [0.75; 1.57] |
No | Reference | Reference | Reference | Reference |
Brief-COPE: positive thinkingk | ||||
≤ 14 | 0.48 [0.31; 0.75]** | 0.54 [0.38; 0.77]** | 0.41 [0.28; 0.61]*** | 0.72 [0.51; 1.01] |
> 14 | Reference | Reference | Reference | Reference |
Brief-COPE: problem solvingk | ||||
≤ 11 | 0.96 [0.62; 1.49] | 0.93 [0.64; 1.34] | 1.01 [0.71; 1.44] | 1.16 [0.83; 1.62] |
> 11 | Reference | Reference | Reference | Reference |
Brief-COPE: seeking social supportk | ||||
≤ 18 | 0.59 [0.37; 0.92]* | 0.62 [0.43; 0.90]* | 0.88 [0.64; 1.21] | 0.81 [0.60; 1.10] |
> 18 | Reference | Reference | Reference | Reference |
Brief-COPE: avoidancek | ||||
≤ 18 | Reference | Reference | Reference | Reference |
> 18 | 0.86 [0.55; 1.34] | 1.18 [0.80; 1.74] | 0.65 [0.46; 0.90]** | 0.79 [0.58; 1.09] |
MHLCS: internalk | ||||
≤ 22 | 1.17 [0.75; 1.83] | 0.75 [0.52; 1.09] | 1.07 [0.77; 1.48] | 0.69 [0.51; 0.95]* |
> 22 | Reference | Reference | Reference | Reference |
MHLCS: powerful othersk | ||||
≤ 19 | Reference | Reference | Reference | Reference |
> 19 | 0.98 [0.64; 1.50] | 1.02 [0.71; 1.45] | 1.38 [0.97; 1.96] | 1.00 [0.72; 1.39] |
MHLCS: chancek | ||||
≤ 18 | Reference | Reference | Reference | Reference |
> 18 | 0.64 [0.41; 0.99]* | 0.86 [0.60; 1.25] | 0.72 [0.52; 1.00] | 0.95 [0.70; 1.30] |
Health literacy (HLS-EU-Q16) | ||||
Limited (≤ 12) | 0.81 [0.53; 1.24] | 0.87 [0.61; 1.24] | 0.82 [0.59; 1.15] | 0.89 [0.65; 1.22] |
Sufficient (> 12) | Reference | Reference | Reference | Reference |
Current cancer sequelae | ||||
Yes | 0.83 [0.47; 1.46] | 0.78 [0.50; 1.22] | ||
No | Reference | Reference | ||
Current cancer treatment | ||||
Yes | 1.23 [0.73; 2.07] | 0.89 [0.57; 1.39] | ||
No | Reference | Reference | ||
Response time since diagnosis | ||||
1 – 3 years | 0.92 [0.52; 1.62] | 0.75 [0.46; 1.23] | ||
4 – 6 years | 1.05 [0.60; 1.84] | 1.07 [0.67; 1.70] | ||
7 – 10 years | Reference | Reference | ||
Ptrend | 0.737 | 0.207 | ||
Mastectomy | ||||
Yes | 0.55 [0.35; 0.87]* | 0.81 [0.55; 1.20] | ||
No | Reference | Reference | ||
Radiation therapyl | ||||
Yes | 0.72 [0.33; 1.57] | 0.80 [0.41; 1.56] | ||
No | Reference | Reference | ||
Medical treatmentm | ||||
Yes | 1.11 [0.66; 1.88] | 1.41 [0.90; 2.21] | ||
No | Reference | Reference |