Women with history of breast cancer have lower quality of life
Marco DiBonaventura and Ian Dunham
Breast cancer is the most common form of cancer among women in Western Europe, it has the greatest cancer mortality rate in women and ranks third behind lung cancer and colorectal cancer in the total population.
However, the incidence of breast cancer in Western Europe has risen more rapidly than breast cancer mortality over the past decade. This rising prevalence reflects a combination of factors, including increasing age-specific incidence rates, the general aging of the population, improved earlier detection, advances in therapeutic options, and penetration of systemic adjuvant therapy. The incidence rate of breast cancer in Western Europe is expected to continue to increase through at least 2025 as the baby boomers age and their probability of developing breast cancer increases.
“The incidence rate of breast cancer in Western Europe is expected to continue to increase through at least 2025.”
While the prevalence of women with a history of breast cancer is increasing, few international community-based studies have been conducted to examine the health-related quality of life (HRQoL) of women following diagnosis and treatment. How does having a history of breast cancer affect quality of life compared with women who have never been diagnosed with breast cancer?
Using data from the 2010 EU (UK, Germany, France, Italy, and Spain) National Health and Wellness Survey (NHWS), Kantar Health compared women with a history of breast cancer with women without a history of breast cancer on HRQoL. A total of 2.0% of respondents reported a history of breast cancer in the EU. Italy had the highest prevalence at 2.6% and Spain the lowest at 1.5%. Most women who reported a history of breast cancer were currently cancer-free (76.9%), although 33.7% were still receiving drugs (hormonal therapies or others).
However, despite being mostly cancer-free, women with a history of breast cancer reported significantly lower levels of physical quality of life (adjusted means = 45.8 vs. 48.3, p<,.05) and health state utilities (adjusted means = 0.69 vs. 0.71, p<,.05) relative to women without a history of breast cancer, even after adjusting for demographics, comorbidity burden, and health characteristics.
“The diminished health-related quality of life in women with a history of breast cancer in the EU may be related to long-term persistent complications from breast cancer treatments.”
Physical quality of life was measured by the physical component summary (PCS) score from the Short Form-12 (a validated instrument used to assess quality of life). The PCS score varies from 0 to 100 with higher scores indicating greater physical quality of life. A score of 50 represents the population average for the United States. Health state utilities is an index score of a person’s overall health (both physical and mental). It varies from 0 to 1, with higher scores indicating greater overall health.
A closer look at the index shows there were significant differences in the primary predictors of health state utilities. Women with a history of breast cancer were significantly older than women who have not had breast cancer, 60.6 years versus 44.0 years. Much fewer women with a history of breast cancer are employed full-time compared with their counterparts, 36.6% versus 55.8%.
Furthermore, women with a history of breast cancer get regular exercise significantly less often than women without women with a history of breast cancer. They are also less likely to have a normal BMI, 40.4% versus 47.5%, and are more likely to be overweight, 33.8% compared with 25.7%. However, far fewer women with a history of breast cancer are smokers compared with women without a history of breast cancer, 23.1% versus 29.6%. Factors such as these lead to the lower physical quality of life among women with a history of breast cancer when compared with women without a history of breast cancer.
The diminished health-related quality of life in women with a history of breast cancer in the EU may be related to long-term persistent complications from breast cancer treatments. For some patients with breast cancer, the best choice may be “watchful waiting” or observation with no immediate active treatment. The EU differs from both the United States and Japan in physicians’ greater willingness to use “watchful waiting” for Stage 0 patients.
“…prevention initiatives, special support and further attention on improving health-related quality of life among these women with a history of breast cancer should be given…”
Local and locally advanced breast cancers are managed primarily by breast-conserving surgery with or without adjuvant radiotherapy, mastectomy with or without radiotherapy is more common in Stage III disease. A major trend in breast cancer surgery over the past 50 years has been toward the use of less invasive procedures. Breast-conserving surgery followed by radiation provides 10-year overall survival equivalent to mastectomy. In all stages, chemotherapy and / or hormone therapy are commonly used, depending upon the patient’s HER2 and hormone receptor (HR) status.
Respondents to Kantar Health’s NHWS follow these patterns. About 90% of respondents with a history of breast cancer have undergone surgery, almost 70% have received radiation therapy, and about 40% have received chemotherapy and/or hormone therapy.
From a public health perspective, prevention initiatives, special support and further attention on improving health-related quality of life among these women with a history of breast cancer should be given, particularly as the prevalence rates of those with a history of cancer continue to rise.
About the authors:
Marco DiBonaventura, Ph.D. is a Director of Health Economics and Outcomes Research (HEOR) within the Health Sciences Practice at Kantar Health. His role includes overseeing the day-to-day operations of the HEOR group, particularly as it relates to data management, analysis, report writing, and scientific dissemination of research projects. Prior to joining Kantar Health, Dr. DiBonaventura worked at Memorial Sloan-Kettering Cancer Center in the Department of Psychiatry and Behavioral Sciences. His research focused on the effect of patient attitudes on health outcomes and he was responsible for all aspects of study design, questionnaire development, data collection, analysis, interpretation, and dissemination. Dr. DiBonaventura’s research has been grant-funded, he has authored several manuscripts and abstracts, and he has presented his research at numerous medical and psychological conferences. Dr. DiBonaventura received his Ph.D. in social/health psychology from Rutgers University where he also taught statistics courses for the Department of Psychology.
Ian Dunham is Business Development Director within the Health Sciences Practice at Kantar Health. He graduated with a degree in biochemistry and now has over 25 years experience of the healthcare industry encompassing management positions in pharmaceutical manufacturers (Glaxo and Astra) and industry information suppliers (IMS Health, Medical Marketing Research International, Harris Interactive and Kantar Health). Mr. Dunham is a member of the Market Research Society and the Chartered Institute of Marketing. He has been with Kantar Health for over five years.
What can be done to improve the quality of life in those with a history of breast cancer?