Breast Cancer Research and Treatment

, Volume 167, Issue 2, pp 537–545 | Cite as

Predictors of the quality of life in Chinese breast cancer survivors




Little is known about the importance of various factors which impair the quality of life (QOL) in survivors of breast cancer 1 year after diagnosis and over 1 year after diagnosis in China. Hence, the goal of this article is to quantitatively evaluate the factors which play an active role in impairing QOL 1 year after diagnosis and over 1 year after diagnosing survivors.


A population-based cross-sectional study was conducted at 34 Cancer Recovery Clubs across China from May 2014 to January 2015. The simplified Chinese version of the Quality of Life Questionnaire-Core 30 items (EORTC QLQ-C30) and the Breast Cancer-specific module QLQ-23 were used to measure QOL in 10794 Chinese women with breast cancer (1 year after diagnosis: 1029, over 1 year after diagnosis: 9765). Forward stepwise multivariable regression analysis was used to identify the most predictive factors for limitations on QOL. Partial R 2 values were calculated to appraise the independent proportion of explained variance within QOL by each factor included in the model.


The participants had higher scores of role functioning, sexual function, sexual enjoyment, and financial difficulties. The uppermost predictors of functional status and QOL were financial difficulties and fatigue for the 1 year after diagnosis, respectively, and fatigue, financial difficulties, and systemic side effects for the long-term survivors. These symptoms explained approximately 28–53% of the variability within the function scores and QOL expect for sexual enjoyment and sexual functioning. Although sociodemographic and clinical factors had a relative importance to sexual function and sexual enjoyment, they were even smaller and had less of an impact on other dimensions.


People who were more active and had an optimistic attitude towards life had relatively higher function scores. For the breast cancer patients 1 year after diagnosis, reducing the burden of fatigue might be a more preferable way to improve their functional status and QOL. Nevertheless, focusing on fatigue symptoms and systemic therapy side effects synchronously may present an especially worthwhile endeavor to enhance the long-term survivors’ functional status and QOL.


Breast cancer 1 year after diagnosis Long-term survivors QOL Impact 



We thank the study participants and the research staff for their contribution to this project.

Compliance with ethical standards

Conflict of interest

The authors declare no potential conflicts of interest.


  1. 1.
    World Health Organization (2017)
  2. 2.
    Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, Jemal A, Yu XQ, He J (2016) Cancer statistics in China, 2015. CA Cancer J Clin 66:115–132. doi: 10.3322/caac.21338 CrossRefPubMedGoogle Scholar
  3. 3.
    Coyne P, Navidi M, Wuchukwu OI (2011) Survivorship in breast cancer—factors affecting quality of life. Eur J Surg Oncol 37:986–987Google Scholar
  4. 4.
    Conde DM, Pinto-Neto AM, Cabello C, Santos-Sá D, Costa-Paiva L, Martinez EZ (2005) Quality of life in Brazilian breast cancer survivors age 45–65 years: associated factors. Breast J 11(6):425–432CrossRefPubMedGoogle Scholar
  5. 5.
    Hopwood P, Haviland J, Mills J, Sumo G, Bliss JM (2007) The impact of age and clinical factors on quality of life in early breast cancer: an analysis of 2208 women recruited to the UK Start Trial (Standardisation of breast radiotherapy trial). Breast 16(3):241–251CrossRefPubMedGoogle Scholar
  6. 6.
    Ryu YM, Yi M (2013) The factors influencing quality of life in women with breast cancer. Asian Oncol Nurs 13:121CrossRefGoogle Scholar
  7. 7.
    Hwang E, Yi M (2014) Factors influencing quality of life in patients with breast cancer on hormone therapy. J Korean Acad Nurs 44:108CrossRefPubMedGoogle Scholar
  8. 8.
    Ohsumi S, Shimozuma K, Morita S, Hara F, Takabatake D, Takashima S, Taira N, Aogi K, Takashima S (2009) Factors associated with health-related quality-of-life in breast cancer survivors: influence of the type of surgery. Jpn J Clin Oncol 39:491CrossRefPubMedGoogle Scholar
  9. 9.
    Moro-Valdezate D, Buch-Villa E, Peiró S, Morales-Monsalve MD, Caballero-Gárate A, Martínez-Agulló Á, Checa-Ayet F, Ortega-Serrano J (2014) Factors associated with health-related quality of life in a cohort of Spanish breast cancer patients. Breast Cancer 21:442–452CrossRefPubMedGoogle Scholar
  10. 10.
    Ward MA (2013) Factors affecting quality of life in breast cancer survivors. Proceedings: 9th annual symposium: graduate research and scholarly projects. Wichita State University, Wichita, pp 10–11Google Scholar
  11. 11.
    Bernhard J, Hürny C, Coates AS, Peterson HF, Castiglionegertsch M, Gelber RD, Galligioni E, Marini G, Thürlimann B, Forbes JF (1998) Factors affecting baseline quality of life in two international adjuvant breast cancer trials. International Breast Cancer Study Group (IBCSG). Br J Cancer 78:686–693CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Albtoosh LA, Alatiyyat NM (2014) Factor effects quality of life among breast cancer survival patient. SSRN Elect J. doi: 10.2139/ssrn.2378593 Google Scholar
  13. 13.
    Hamer J, Mcdonald R, Zhang L, Verma S, Leahey A, Ecclestone C, Bedard G, Pulenzas N, Bhatia A, Chow R (2017) Quality of life (QOL) and symptom burden (SB) in patients with breast cancer. Support Care Cancer 25:409CrossRefPubMedGoogle Scholar
  14. 14.
    Tiezzi MF, de Andrade JM, Romão AP, Tiezzi DG, Lerri MR, Carrara HA, Lara LA (2017) Quality of Life in women with breast cancer treated with or without chemotherapy. Cancer Nurs 40:108CrossRefPubMedGoogle Scholar
  15. 15.
    Tang F, Wang J, Tang Z, Kang M, Deng Q, Yu J (2016) Quality of life and its association with physical activity among different types of cancer survivors. PloS one 11:e0164971CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Smith AW, Alfano CM, Reeve BB, Irwin ML, Bernstein L, Baumgartner K, Bowen D, Mctiernan A, Ballardbarbash R (2009) Race/Ethnicity, physical activity and quality of life in breast cancer survivors. Cancer Epidemiol Biomark Prev 18:656–663CrossRefGoogle Scholar
  17. 17.
    Irukulla M, Vaghmare R, Joseph D, Ahmed SF, Jonnadula J, Valiyaveettil D (2016) Impact of comorbidities on quality of life in breast cancer patients. Indian J Cardiovasc Dis J women (IJCD) 1:1–5Google Scholar
  18. 18.
    Dodd MJ, Cho MH, Bank KA, Cooper BA, Lee KA, Miaskowski C (2005) Impact of Symptom Clusters on Quality of Life (QOL) Dimensions in Breast Cancer Patients. In: 16 th International Nursing Research CongressGoogle Scholar
  19. 19.
    Ahmed AE, Alharbi AG, Alsadhan MA, Almuzaini AS, Almuzaini HS, Ali YZ, Jazieh AR (2017) The predictors of poor quality of life in a sample of Saudi women with breast cancer. Breast Cancer 9:51–58. doi: 10.2147/BCTT.S125206 PubMedPubMedCentralGoogle Scholar
  20. 20.
    Arndt V, Stegmaier C, Ziegler H, Brenner H (2006) A population-based study of the impact of specific symptoms on quality of life in women with breast cancer 1 year after diagnosis. Cancer 107:2496–2503. doi: 10.1002/cncr.22274 CrossRefPubMedGoogle Scholar
  21. 21.
    Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC (2005) The European Organization for research and treatment of cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. JNCI 85:365–376CrossRefGoogle Scholar
  22. 22.
    Sprangers MA, Groenvold M, Arraras JI, Franklin J, Te VA, Muller M, Franzini L, Williams A, de Haes HC, Hopwood P (1996) The European Organization for research and treatment of cancer breast cancer-specific quality-of-life questionnaire module: first results from a three-country field study. J Clin Oncol 14:2756CrossRefPubMedGoogle Scholar
  23. 23.
    Tang Z, Wang JW, Zhang QY, Sun L, Tang FR, Kang M, Yu JM (2015) QLQ-BR23 and EORTC QLQ-C30 for the measurement of the impact of rehabilitation exercise on quality of life in breast cancer patients. Fudan Univ J Med Sci 42:589–595Google Scholar
  24. 24.
    Fayers PM, Aaronson NK, Bjordal K (2001) The EORTC QLQ-C30 scoring manual. EORTC Data Center, BrusselsGoogle Scholar
  25. 25.
    Scott NW, Fayers PM, Aaronson NK, Bottomley A, De Graeff A, Groenvold M, Gundy C, Koller M, Petersen MA, Mirjam AG Sprangers on behalf of the EORTC Quality of Life Group (2008) EORTC QLQ-C30 Reference values. EORTC Quality of Life Study Group. pp 1–427Google Scholar
  26. 26.
    Chie WC, Chang KJ, Huang CS, Kuo WH (2003) Quality of life of breast cancer patients in Taiwan: validation of the Taiwan Chinese version of the EORTC QLQ-C30 and EORTC QLQ-BR23. Psycho 12(7):729–735. doi: 10.1002/pon.727 Google Scholar
  27. 27.
    King PKMT, Shiell A, Hall J, Boyages J (2000) Quality of life three months and one year after first treatment for early stage breast cancer: influence of treatment and patient characteristics. Qual Life Res 9:789–800CrossRefPubMedGoogle Scholar
  28. 28.
    Kim HJ (2007) Symptom prevalence and intensity in breast cancer patients receiving treatment. In: The 18th International Nursing Research Congress Focusing on Evidence-Based PracticeGoogle Scholar
  29. 29.
    Berger AM, Visovsky C, Hertzog M, Holtz S, Jr LF (2012) Usual and worst symptom severity and interference with function in breast cancer survivors. J Support Oncol 10:112CrossRefPubMedGoogle Scholar
  30. 30.
    Zafar SY, Peppercorn JM, Schrag D, Taylor DH, Goetzinger AM, Zhong X, Abernethy AP (2013) The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient’s experience. Oncologist 18:381–390. doi: 10.1634/theoncologist.2012-0279 CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Chino F, Peppercorn J, Jr DHT, Lu Y, Samsa G, Abernethy AP, Zafar SY (2014) Self-reported financial burden and satisfaction with care among patients with cancer. Oncologist 19:414CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Ramsey SD, Bansal A, Fedorenko CR, Blough DK, Overstreet KA, Shankaran V, Newcomb P (2016) Financial insolvency as a risk factor for early mortality among patients with cancer. J Clin Oncol 34:980CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Curt GA (2000) Impact of fatigue on quality of life in oncology patients. Semin Hematol 37:14CrossRefPubMedGoogle Scholar
  34. 34.
    Spiegel D, Sands S, Koopman C (1994) Pain and depression in patients with cancer. Cancer 74:2570–2578CrossRefPubMedGoogle Scholar
  35. 35.
    Blesch KS, Paice JA, Wickham R, Harte N, Schnoor DK, Purl S, Rehwalt M, Kopp PL, Manson S, Coveny SB (1991) Correlates of fatigue in people with breast or lung cancer. Oncol Nurs Forum 18:81PubMedGoogle Scholar
  36. 36.
    Ferrell BR, Grant MM, Funk BM, Otis-Green SA, Garcia NJ (1998) Quality of life in breast cancer survivors: implications for developing support services. Oncol Nurs Forum 25:887–895PubMedGoogle Scholar
  37. 37.
    Maunsell E, Brisson J, Deschênes L (1993) Arm problems and psychological distress after surgery for breast cancer. Can J Surg 36:315PubMedGoogle Scholar
  38. 38.
    Bower JE, Ganz PA, Desmond KA, Rowland JH, Meyerowitz BE, Belin TR (2000) Fatigue in breast cancer survivors: occurrence, correlates, and impact on quality of life. J Clin Oncol 18:743CrossRefPubMedGoogle Scholar
  39. 39.
    Cella D (2004) The longitudinal relationship of hemoglobin, fatigue and quality of life in anemic cancer patients: results from five randomized clinical trials. Ann Oncol 15:979–986. doi: 10.1093/annonc/mdh235 CrossRefPubMedGoogle Scholar
  40. 40.
    Scott JA, Lasch KE, Barsevick AM, Piault-Louis E (2011) Patients’ experiences with cancer-related fatigue: a review and synthesis of qualitative research. Oncol Nurs Forum 38:E191–E203CrossRefPubMedGoogle Scholar
  41. 41.
    Wanchai A, Armer JM, Stewart BR (2011) Nonpharmacologic supportive strategies to promote quality of life in patients experiencing cancer-related fatigue: a systematic review. Clin J Oncol Nurs 15:203–214CrossRefPubMedGoogle Scholar
  42. 42.
    Spence RR, Heesch KC, Brown WJ (2010) Exercise and cancer rehabilitation: a systematic review. Cancer Treat Rev 36:185–194CrossRefPubMedGoogle Scholar
  43. 43.
    Brown JC, Huedo-Medina TB, Pescatello SM, Ferrer RA, Johnson BT, Pescatello LS (2011) the efficacy of exercise interventions on fatigue among cancer survivors: a meta-analysis. Med Sci Sports Exerc 43:277–278CrossRefGoogle Scholar
  44. 44.
    Berger AM, Gerber LH, Mayer DK (2012) Cancer-related fatigue: implications for breast cancer survivors. Cancer 118:2261CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  1. 1.Institute of Clinical Epidemiology, Key Laboratory of Public Health Safety, Ministry of Education, Key Lab of Health Technology Assessment of Ministry of Health, School of Public HealthFudan UniversityShanghaiChina
  2. 2.Key Laboratory of Carcinogenesis and Cancer Invasion of Ministry of Education, Department of Liver Surgery, Liver Cancer Institute, Zhongshan HospitalFudan UniversityShanghaiChina

Personalised recommendations