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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

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Abstract

Purpose

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.

Methods

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.

Results

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).

Conclusions

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.

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Abbreviations

BMI:

Body mass index

DCIS:

Ductal carcinoma in situ

QoL:

Quality of life

WISC:

Wisconsin In Situ Cohort

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Acknowledgements

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.

Funding

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

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Authors and Affiliations

  1. Vermont Center for Behavior and Health, Office of Health Promotion Research, Department of Surgery, University of Vermont, 1 South Prospect Street, Rm. 4425, Burlington, VT, 05401, USA

    Vicki Hart, Christopher Veal & Brian L. Sprague

  2. Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin, Madison, WI, USA

    Amy Trentham-Dietz & John Hampton

  3. Office of Health Promotion Research and Department of Surgery, University of Vermont, Burlington, VT, USA

    Amy Berkman & Mayo Fujii

  4. Departments of Biostatistics and Medical Informatics and Population Health Sciences, Carbone Cancer Center, University of Wisconsin, Madison, WI, USA

    Ronald E. Gangnon

  5. Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Polly A. Newcomb

  6. Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Susan C. Gilchrist

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  1. Vicki Hart
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Correspondence to Brian L. Sprague.

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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.

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Hart, V., Trentham-Dietz, A., Berkman, A. et al. 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. Qual Life Res 27, 1237–1247 (2018). https://doi.org/10.1007/s11136-018-1807-6

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