BREAST-CANCER SURVIVORS - PSYCHOSOCIAL CONCERNS AND QUALITY-OF-LIFE

Purpose: To describe the psychosocial concerns and quality of life of breast cancer survivors evaluated 2 and 3 years after primary treatmen t. Methods: A sample of 139 breast cancer survivors who had been inter viewed during the first year after primary treatment participated in a mailed survey at 2 years (N = 69) and 3 years (N = 70) after initial surgery. A random sample of these survivors were also interviewed in p erson. The mailed questionnaire included standardized instruments to a ssess quality of life (QL), rehabilitation needs, and psychological di stress. Additional survey questions were developed to examine post-sur gical recovery, employment and insurance problems, social support, and existential concerns. The in-person interviews expanded on these ques tions and systematically compared these patients' rehabilitation needs to those which existed at the time of an interview 1 year after surge ry. Results: The 2 and 3 year participants in this follow-up study did not differ from each other on their prior assessments with standardiz ed QL instruments during the first year after surgery, nor did they di ffer from the full study sample of 227 women. The scores on the Profil e of Mood States and the Functional Living Index-Cancer were the same for the 2 and 3 year survivor groups and did not differ from the previ ous assessments at 1 year after initial treatment. The scores on the C ancer Rehabilitation Evaluation System showed a significant decline in Global Quality of Life, Sexual Functioning and Marital Functioning be tween the 1 year and 3 year evaluations. For the 2 year sample only Se xual Functioning showed a deterioration between the 1 and 2 year evalu ations. Using the RAND 36-Item Health Survey 1.0, the breast cancer su rvivors were compared with patients from the Medical Outcomes Study. T he breast cancer survivors demonstrated higher levels of functioning i n many dimensions (role functioning, social functioning, pain, and gen eral health) than the patients with chronic medical conditions. In spi te of relatively good physical and emotional functioning on this gener ic measure of health status and quality of life, these breast cancer s urvivors reported a number of important and severe rehabilitation prob lems that persisted beyond one year after primary treatment. Especiall y frequent were problems associated with physical and recreational act ivities, body image, sexual interest, sexual function, and problems wi th dating for those who were single. Conclusions: Breast cancer surviv ors appear to attain maximum recovery from the physical and psychologi cal trauma of cancer treatment by one year after surgery. A number of aspects of QL and rehabilitation problems worsen after that time. Neve rtheless, breast cancer survivors rate their QL more favorably than ou tpatients with other common medical conditions, and they identify many positive aspects from the cancer experience.