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Quality of life over time in women diagnosed with ductal carcinoma in situ, early-stage invasive breast cancer, and age-matched controls

  • Epidemiology
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Abstract

Little is known about quality-of-life (QOL) differences over time between incident ductal carcinoma in situ (DCIS) and early-stage invasive breast cancer (EIBC) cases as compared with same-aged women without breast cancer (controls). We prospectively recruited and interviewed 1,096 women [16.8 % DCIS, 33.3 % EIBC (25.7 % Stage I; and 7.6 % Stage IIA), 49.9 % controls; mean age 58; 23.7 % non-white] at mean 6.7 weeks (T1), and 6.2 (T2), 12.3 (T3), and 24.4 months (T4) after surgery (patients) or screening mammogram (controls). We tested two hypotheses: (1) DCIS patients would report lower levels of QOL compared with controls but would report similar QOL compared with EIBC patients at baseline; and (2) DCIS patients’ QOL would improve during 2-year follow-up and approach levels similar to that of controls faster than EIBC patients. We tested hypothesis 1 using separate general linear regression models for each of the eight subscales on the RAND 36-item Health Survey, controlling for variables associated with at least one subscale at T1. Both DCIS and EIBC patients reported lower QOL at T1 than controls on all subscales (each P < 0.05). We tested hypothesis 2 using generalized estimating equations to examine change in each QOL subscale over time across the three diagnostic groups adjusting for covariates. By T3, physical functioning, role limitations due to physical problems, energy/fatigue, and general health each differed significantly by diagnostic group at P < 0.05, because of larger differences between EIBC patients and controls; but DCIS patients no longer differed significantly from controls on any of the QOL subscales. At T4, EIBC patients still reported worse physical functioning (P = 0.0001) and general health (P = 0.0017) than controls, possibly because of lingering treatment effects. DCIS patients’ QOL was similar to that of controls two years after diagnosis, but some aspects of EIBC patients’ QOL remained lower.

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Acknowledgments

This study was supported by grants from the National Cancer Institute (NCI) and Breast Cancer Stamp Fund (R01 CA102777; PI: Jeffe, DB), and the NCI Cancer Center Support Grant (P30 CA091842; PI: Eberlein, T) to the Alvin J. Siteman Cancer Center at Washington University School of Medicine and Barnes-Jewish Hospital in St. Louis, Missouri. The authors thank the participants, the interviewers, and the Siteman Cancer Center’s Health Behavior, Communication, and Outreach Core for data management services (Irene Fisher and Jim Struthers). The authors also thank all the physicians who helped in recruiting their patients for this study, including Drs. Barbara Monsees, Jill Dietz, Julie Margenthaler, Virginia Herrmann, Timothy Eberlein, Matthew Ellis, Imran Zoberi, Marie Taylor, Michael Naughton, Antonella Rastelli, Donald Lombardi, Cynthia Ma, Loren Michel, and Rama Suresh at Washington University School of Medicine; and Dr. Eddie Hsueh and Pam Hunborg, RN, at Saint Louis University School of Medicine.

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The authors declare that they have no conflicts of interest.

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Authors and Affiliations

  1. Division of Health Behavior Research, Department of Medicine, Washington University School of Medicine, 4444 Forest Park, Suite 6700, St. Louis, MO, 63108, USA

    D. B. Jeffe, M. Pérez, K. K. Collins & M. Schootman

  2. Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA

    D. B. Jeffe, K. K. Collins, R. L. Aft & M. Schootman

  3. Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Y. Liu & R. L. Aft

  4. John Cochran Veterans Administration Hospital, St. Louis, MO, USA

    R. L. Aft

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  1. D. B. Jeffe
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  3. Y. Liu
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Correspondence to D. B. Jeffe.

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Jeffe, D.B., Pérez, M., Liu, Y. et al. Quality of life over time in women diagnosed with ductal carcinoma in situ, early-stage invasive breast cancer, and age-matched controls. Breast Cancer Res Treat 134, 379–391 (2012). https://doi.org/10.1007/s10549-012-2048-y

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