Trajectories of health-related quality of life in breast cancer patients

  • Jin-Hee Park
  • Yong Sik Jung
  • Ji Young Kim
  • Yujung Jo
  • Sun Hyoung BaeEmail author
Original Article



The purpose of this study was to explore the trajectory of health-related quality of life (HRQoL) and its predictors in breast cancer patients.


A total of 126 women with newly diagnosed breast cancer provided baseline sociodemographic and medical characteristics and then completed an HRQoL questionnaire along with self-report measures of anxiety, depression, and cancer-related fatigue prior to their first cycle of chemotherapy (baseline), after chemotherapy completion, and at 6, and 12 months after chemotherapy completion. Group-based trajectory models were constructed to identify HRQoL trajectories over time. Logistic regression analysis was used to evaluate predictors of HRQoL in distinct patient groups.


Group-based trajectory modeling classified two patient groups: participants with consistently medium overall HRQoL trajectories (41.1%) and participants with consistently low overall HRQoL trajectories (58.9%). Older age, perceived severe economic burden, and higher depression predicted consistently low overall HRQoL through 12 months after chemotherapy.


Less than half of the total number of patients maintained a medium level of overall HRQoL after diagnosis and treatment of breast cancer, and nearly 60% continued to have lower overall HRQoL even after the treatment was complete. Older participants with more severe economic burden and higher depression experienced lower and more persistent overall HRQoL; thus, these patients should be monitored and provided supportive care as a part of survivorship care.


Quality of life Depression Fatigue Adjuvant chemotherapy Cost of illness Breast neoplasms 



We would like to thank the study participants for their time and dedication to this study. We also thank the staff at the Breast Cancer Center, Ajou University Medical Center, Suwon, Republic of Korea, for their cooperation.


This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education (NRF-2015R1D1A1A01061101).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Jung KW, Won YJ, Kong HJ, Lee ES (2018) Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2015. Cancer Res Treat 50(2):303–316. CrossRefGoogle Scholar
  2. 2.
    Korean Breast Cancer Society (2018) 2018 Breast cancer facts & figures. Korean Breast Cancer SocietyWeb. Accessed 31 April 2019
  3. 3.
    Ho PJ, Gernaat SAM, Hartman M, Verkooijen HM (2018) Health-related quality of life in Asian patients with breast cancer: a systematic review. BMJ Open 8(4):e020512. CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Lemieux J, Goodwin PJ, Bordeleau LJ, Lauzier S, Théberge V (2011) Quality-of-life measurement in randomized clinical trials in breast cancer: an updated systematic review (2001-2009). J Natl Cancer Inst 103(3):178–231. CrossRefGoogle Scholar
  5. 5.
    Goyal NG, Levine BJ, Van Zee KJ, Naftalis E, Avis NE (2018) Trajectories of quality of life following breast cancer diagnosis. Breast Cancer Res Treat 169(1):163–173. CrossRefGoogle Scholar
  6. 6.
    Ai Z, Gao X, Zheng S, Lu C (2018) Variability and influencing factors of QOL in breast cancer patients having chemotherapy. Clin Nurs Res.
  7. 7.
    Dura-Ferrandis E, Mandelblatt JS, Clapp J et al (2017) Personality, coping, and social support as predictors of long-term quality-of-life trajectories in older breast cancer survivors: CALGB protocol 369901 (Alliance). Psychooncology 26(11):1914–1921. CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Ganz PA, Kwan L, Stanton AL, Bower JE, Belin TR (2011) Physical and psychosocial recovery in the year after primary treatment of breast cancer. J Clin Oncol 29(9):1101–1109. CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Oh PJ, Cho JR (2018) Changes in fatigue, psychological distress, and quality of life after chemotherapy in women with breast cancer: a prospective study. Cancer Nurs.
  10. 10.
    Chu WO, Dialla PO, Roignot P et al (2016) Determinants of quality of life among long-term breast cancer survivors. Qual Life Res 25(8):1981–1990. CrossRefGoogle Scholar
  11. 11.
    Klein D, Mercier M, Abeilard E et al (2011) Long-term quality of life after breast cancer: a French registry-based controlled study. Breast Cancer Res Treat 129(1):125–134. CrossRefPubMedGoogle Scholar
  12. 12.
    Meneses K, Azuero A, Hassey L (2012) Does economic burden influence quality of life in breast cancer survivors? Gynecol Oncol 124(3):437–443. CrossRefPubMedGoogle Scholar
  13. 13.
    Ho PJ, Hartman M, Gernaat SAM et al (2018) Associations between workability and patient-reported physical, psychological and social outcomes in breast cancer survivors: a cross-sectional study. Support Care Cancer 26(8):2815–2824. CrossRefPubMedGoogle Scholar
  14. 14.
    Hsiao FH, Kuo WH, Jow GM et al (2019) The changes of quality of life and their correlations with psychosocial factors following surgery among women with breast cancer from the post-surgery to post-treatment survivorship. Breast 44:59–65. CrossRefPubMedGoogle Scholar
  15. 15.
    Dodd MJ, Cho MH, Cooper BA, Miaskowski C (2010) The effect of symptom clusters on functional status and quality of life in women with breast cancer. Eur J Oncol Nurs 14(2):101–110. CrossRefPubMedGoogle Scholar
  16. 16.
    Kelly DL, Yang GS, Starkweather AR et al (2018) Relationships among fatigue, anxiety, depression, and pain and health-promoting lifestyle behaviors in women with early-stage breast cancer. Cancer Nurs.
  17. 17.
    Nagin DS, Odgers CL (2010) Group-based trajectory modeling in clinical research. Annu Rev Clin Psychol 6:109–138. CrossRefPubMedGoogle Scholar
  18. 18.
    Muthén B (2004) Latent variable analysis: growth mixture modeling and related techniques for longitudinal data. In: Kaplan D (ed) Handbook of quantitative methodology for the social sciences. The Sage, Newbury Park, California, pp 346–369Google Scholar
  19. 19.
    Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6):361–370. CrossRefPubMedGoogle Scholar
  20. 20.
    Vodermaier A, Millman RD (2011) Accuracy of the hospital anxiety and depression scale as a screening tool in cancer patients: a systematic review and meta-analysis. Support Care Cancer 19(12):1899–1908. CrossRefPubMedGoogle Scholar
  21. 21.
    Cella DF (1997) Manual of the functional assessment of chronic illness therapy measurement system (version 4). Evanston Northwestern Healthcare and Northwestern University. Evanston, IllinoisGoogle Scholar
  22. 22.
    Cella DF, Tulsky DS, Gray G et al (1993) The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol 11(3):570–579. CrossRefPubMedGoogle Scholar
  23. 23.
    Jones BL, Nagin DS, Roeder K (2001) A SAS procedure based on mixture models for estimating developmental trajectories. Sociol Methods Res 29(3):374–393. CrossRefGoogle Scholar
  24. 24.
    Nagin DS (2005) Group-based modeling of development. Harvard University Press, Cambridge, MACrossRefGoogle Scholar
  25. 25.
    Kass RE, Wasserman L (1995) A reference Bayesian test for nested hypotheses and its relationship to the Schwarz criterion. J Am Stat Assoc 90(431):928–934. CrossRefGoogle Scholar
  26. 26.
    Brady MJ, Cella DF, Mo F et al (1997) Reliability and validity of the functional assessment of cancer therapy-breast quality-of-life instrument. J Clin Oncol 15(3):974–986. CrossRefPubMedGoogle Scholar
  27. 27.
    Ou HT, Chung WP, Su PF et al (2019) Health-related quality of life associated with different cancer treatments in Chinese breast cancer survivors in Taiwan. Eur J Cancer Care.
  28. 28.
    Lam WW, Soong I, Yau TK et al (2013) The evolution of psychological distress trajectories in women diagnosed with advanced breast cancer: a longitudinal study. Psychooncology 22(12):2831–2839. CrossRefPubMedGoogle Scholar
  29. 29.
    Paraskevi T (2012) Quality of life outcomes in patients with breast cancer. Oncol Rev 6(1):e2. CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Janz NK, Friese CR, Li Y et al (2014) Emotional well-being years post-treatment for breast cancer: prospective, multi-ethnic, and population-based analysis. J Cancer Surviv 8(1):131–142. CrossRefPubMedGoogle Scholar
  31. 31.
    Runowicz CD, Leach CR, Henry NL et al (2016) American Cancer Society/American Society of Clinical Oncology Breast Cancer survivorship care guideline. J Clin Oncol 34(6):611–635. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.College of Nursing·Research Institute of Nursing ScienceAjou UniversitySuwonRepublic of Korea
  2. 2.Department of Surgery, School of MedicineAjou UniversitySuwonRepublic of Korea
  3. 3.College of NursingAjou UniversitySuwonRepublic of Korea

Personalised recommendations