Quality of Life Research

, Volume 27, Issue 5, pp 1237–1247 | Cite as

The association between post-diagnosis health behaviors and long-term quality of life in survivors of ductal carcinoma in situ: a population-based longitudinal cohort study

  • Vicki Hart
  • Amy Trentham-Dietz
  • Amy Berkman
  • Mayo Fujii
  • Christopher Veal
  • John Hampton
  • Ronald E. Gangnon
  • Polly A. Newcomb
  • Susan C. Gilchrist
  • Brian L. Sprague



Women diagnosed with ductal carcinoma in situ (DCIS) often experience adverse changes in health-related behaviors following diagnosis. The impact of health behaviors on long-term quality of life (QoL) in DCIS survivors has not been investigated.


We examined the association of post-diagnosis body mass index (BMI), physical activity, alcohol, and smoking with QoL among 1448 DCIS survivors aged 20–74 enrolled in the population-based Wisconsin in situ Cohort from 1997 to 2006. Health behaviors and QoL were self-reported during biennial post-diagnosis interviews. Physical and mental QoL were measured using the validated SF-36 questionnaire. Generalized linear regression was used to determine the association between behaviors and QoL with adjustment for confounders. Lagged behavior variables were used to predict QoL during follow-up and avoid reverse causation.


Women reported 3,536 QoL observations over an average 7.9 years of follow-up. Women maintaining a healthy BMI had on average a significantly higher summary measure score of physical QoL than obese women (normal versus obese: β = 3.02; 2.18, 3.85). Physical QoL scores were also elevated among those who were physically active (5 + h/week vs. none: β = 1.96; 0.72, 3.20), those consuming at least seven drinks/week of alcohol (vs. none; β = 1.40; 0.39, 2.41), and nonsmokers (vs. current smokers: β = 1.80; 0.89, 2.71). Summary measures of mental QoL were significantly higher among women who were moderately physically active (up to 2 h/week vs. none: β = 1.11; 0.30, 1.92) and nonsmokers (vs. current smokers: β = 1.49;0.45, 2.53).


Our results demonstrate that maintaining healthy behaviors following DCIS treatment is associated with modest improvements in long-term QoL. These results inform interventions aimed at promoting healthy behaviors and optimizing QoL in DCIS survivors.


Breast cancer Ductal carcinoma in situ Health-related behaviors Health-related quality of life Epidemiology Exercise Body mass index Alcohol drinking Smoking 



Body mass index


Ductal carcinoma in situ


Quality of life


Wisconsin In Situ Cohort



This Project was supported by Grants from the National Institutes of Health (P20 GM103644, U54 CA163303, R01 CA067264, P30 CA014520). The authors would like to express their gratitude to Julie McGregor and Kathy Peck for their assistance with data collection and project management.


This Project was supported by Grants from the National Institutes of Health (P20 GM103644, U54 CA163303, R01 CA067264, P30 CA014520).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest to report.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Research involving human participants

The study was approved by the University of Wisconsin Health Sciences Institutional Review Board. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

11136_2018_1807_MOESM1_ESM.pdf (75 kb)
Supplementary material 1 (PDF 75 KB)
11136_2018_1807_MOESM2_ESM.pdf (139 kb)
Supplementary material 2 (PDF 139 KB)


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Vicki Hart
    • 1
  • Amy Trentham-Dietz
    • 2
  • Amy Berkman
    • 3
  • Mayo Fujii
    • 3
  • Christopher Veal
    • 1
  • John Hampton
    • 2
  • Ronald E. Gangnon
    • 4
  • Polly A. Newcomb
    • 5
  • Susan C. Gilchrist
    • 6
  • Brian L. Sprague
    • 1
  1. 1.Vermont Center for Behavior and Health, Office of Health Promotion Research, Department of SurgeryUniversity of VermontBurlingtonUSA
  2. 2.Department of Population Health Sciences and Carbone Cancer CenterUniversity of WisconsinMadisonUSA
  3. 3.Office of Health Promotion Research and Department of SurgeryUniversity of VermontBurlingtonUSA
  4. 4.Departments of Biostatistics and Medical Informatics and Population Health Sciences, Carbone Cancer CenterUniversity of WisconsinMadisonUSA
  5. 5.Cancer Prevention ProgramFred Hutchinson Cancer Research CenterSeattleUSA
  6. 6.Department of Clinical Cancer PreventionThe University of Texas MD Anderson Cancer CenterHoustonUSA

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