Journal of the Formosan Medical Association
Volume 109, Issue 7 , Pages 493-502, July 2010

Quality of Life in Taiwanese Breast Cancer Survivors With Breast-conserving Therapy

  • Chi-Cheng Huang

      Affiliations

    • Division of General Surgery, Cathay General Hospital Sijhih Branch, Sijhih City, Taiwan
    • School of Medicine, Fu Jen Catholic University, Sinjhuang, Taiwan
    • Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
    • ,
  • Heng-Hui Lien

      Affiliations

    • School of Medicine, Fu Jen Catholic University, Sinjhuang, Taiwan
    • Division of General Surgery, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
    • ,
  • Shih-Hsin Tu

      Affiliations

    • Division of General Surgery, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
    • ,
  • Ching-Shui Huang

      Affiliations

    • Division of General Surgery, Department of Surgery, Cathay General Hospital, Taipei, Taiwan
    • ,
  • Jaan-Yeh Jeng

      Affiliations

    • Division of General Surgery, Cathay General Hospital Sijhih Branch, Sijhih City, Taiwan
    • ,
  • Hui-Lin Chao

      Affiliations

    • Department of Nursing, Cathay General Hospital, Taipei, Taiwan
    • ,
  • Hsiao-Lun Sun

      Affiliations

    • School of Medicine, Fu Jen Catholic University, Sinjhuang, Taiwan
    • Division of Anesthesia, Cathay General Hospital Sijhih Branch, Sijhih City, Taiwan
    • ,
  • Wei-Chu Chie

      Affiliations

    • Preventive Medicine, National Taiwan University, Taipei, Taiwan
    • Corresponding Author InformationCorrespondence to: Dr Wei-Chu Chie, Department of Public Health and Graduate Institute of Preventive Medicine, College of Public Health, National Taiwan University, Room 520, 17 Xuzhou Road, Taipei, 10055, Taiwan

Received 7 April 2009; received in revised form 15 September 2009; accepted 19 November 2009.

Article Outline

Background/Purpose

Breast cancer is the most common female malignancy in Taiwan; however, quality of life (QOL) following breast cancer therapy remains rarely studied. The aim of the present study was to evaluate QOL among Taiwanese breast cancer patients with and without breast-conserving therapy.

Methods

A total of 130 women with breast cancer (37 with breast-conserving therapy and 93 with modified radical mastectomy) were enrolled between August, 2004 and December, 2007 in a single center. Patients who underwent breast-conserving therapy were younger, less likely to be married, had a higher educational level, and were at an earlier clinical stage than those who underwent modified radical mastectomy. The traditional Chinese version of the European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-BR23 questionnaires were used as measuring instruments. Structural equation modeling with mean structural analysis, which evaluates configuration invariance and compares groups for latent functional/symptomatic factors, was constructed using a multi-indicators approach.

Results

Patients with breast-conserving therapy reported worse global QOL status and role function scores and higher symptomatic scores for fatigue, pain, dyspnea, insomnia, appetite loss, breast and arm problem subscales than those without conserving therapy. In addition, age, marital status, hormone manipulation and postoperative adjuvant therapy were significant confounders for QOL. Measurement invariance was ascertained and the same QOL construct could be applied to Taiwanese subjects with and without breast-conserving therapy.

Conclusion

Our study suggests that breast-conserving therapy might be associated with worse perceived QOL for Taiwanese breast cancer survivors.

Key Words:  breast-conserving therapy , EORTC QLQ-BR23 , EORTC QLQ-C30 , quality of life , structural equation modeling

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References 

  1. Department of Health, Executive Yuan, Taiwan, R.O.C. Cancer Registry Annual Report, Republic of China. Taipei: Department of Health, Executive Yuan, Taiwan, R.O.C., 2004.
  2. Kiebert GM , de Haes JC , van de Velde CJ . The impact of breast-conserving treatment and mastectomy on the quality of life of early-stage breast cancer patients: a review . J Clin Oncol . 1991;9:1059–1070
  3. Ganz PA , Schag AG , Lee JJ , et al.   Breast conservation versus mastectomy. Is there a difference in psychological adjustment or quality of life in the year after surgery? . Cancer . 1992;69:1729–1738
  4. Dorval M , Maunsell E , Deschenes L , et al.   Type of mastectomy and quality of life for long term breast carcinoma survivors . Cancer . 1998;83:2130–2138
  5. Irwig L , Bennetts A . Quality of life after breast conservation or mastectomy: A systemic review . Aust NZ J Surg . 1997;67:750–754
  6. Janni W , Rjosk D , Dimpfl TH , et al.   Quality of life influenced by primary surgical treatment for stage I-III breast cancer-long-term follow-up of a matched-pair analysis . Ann Surg Oncol . 2001;8:542–548
  7. Engel J , Kerr J , Schlesinger-Raab A , et al.   Quality of life following breast conserving therapy or mastectomy: results of a 5-year prospective study . Breast J . 2004;10:223–231
  8. Fisher B , Bauer M , Margolese R , et al.   Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer . N Engl J Med . 1985;312:665–673
  9. Fisher B , Redmond C , Fisher ER , et al.   Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation . N Engl J Med . 1985;312:674–681
  10. Ohsumi S , Shimozuma K , Kuroi K , et al.   Quality of life of breast cancer patients and types of surgery for breast cancer-current status and unresolved issues . Breast Cancer . 2007;14:66–73
  11. Chie WC , Huang CS , Chen JH , et al.   Measurement of the quality of life during different clinical phases of breast cancer . J Formos Med Assoc . 1999;98:254–260
  12. Chie WC , Chang KJ , Huang JS , et al.   Quality of life of breast cancer patients in Taiwan: validation of the Taiwan Chinese version of the EORTC QLQ-C30 and EORTC BR-23 . Psychooncology . 2003;12:729–735
  13. Fayers PM , Aaronson NK , Bjordal K , et al.   EORTC QLQ-C30 Scoring Manual . 3rd edition. Brussels: EORTC; 2006;
  14. Sprangers MA , Groenvold M , Arraras JI , et al.   The European Organization for Research and Treatment of Cancer-Specific Quality-of-Life Questionnaire Module first results from a three-country field study . J Clin Oncol . 1996;14:2756–2768
  15. Chie WC , Hong RL , Lai CC , et al.   Quality of life in patients of nasopharyngeal carcinoma: validation of the Taiwan Chinese version of the EORTC QLQ-C30 and the EORTC QLQ-H&N35 . Qual Life Res . 2003;12:93–98
  16. Chie WC , Yang CH , Hsu C , et al.   Quality of life of lung cancer patients: validation of Taiwan Chinese version of the EORTC QLQ-C30 and QLQ-LC13 . Qual Life Res . 2004;13:257–262
  17. Huang CC , Lien HH , Sung YC , et al.   Quality of life of patients with gastric cancer in Taiwan: validation and clinical application of the Taiwan Chinese version of the EORTC QLQ-C30 and EORTC QLQ-STO22 . Psychooncology . 2007;16:945–949
  18. Fayers PM , Hand DJ , Bjordal K , et al.   Causal indicators in quality of life research . Qual Life Res . 1997;6:393–406
  19. Fayers PM , Hand DJ . Factor analysis, causal indicators and quality of life . Qual Life Res . 1997;6:139–150
  20. Hayduk LA . Structural Equation Modeling With LISREL: Essentials and Advances . Baltimore: Johns Hopkins University Press; 1987;
  21. Hu L , Bentler PM . Cutoff criteria for fit indexes in covari-ance structure analysis: conventional criteria versus new alternatives . Struct Equ Modeling . 1999;6:1–55
  22. Bagozzi RP , Yi Y . The degree of intention formation as a moderator of the attitude-behavior relationship . Soc Psychol Q . 1989;52:266–279
  23. Bentler PM , Bonett DG . Significance tests and goodness of fit in the analysis of covariance structures . Psychol Bull . 1980;88:588–606
  24. Jarvenpaa SL , Tractinsky N , Vitale M . Consumer trust in an internet Store . Inf Technol Manage . 2000;1:45–71
  25. McDonald RP , Ho MR . Principles and practice in reporting structural equation analyses . Psychol Methods . 2002;7:64–82
  26. Hair JF , Anderson RE , Tatham RL , et al.   Multivariate Data Analysis . 5th edition. Englewood Cliffs: Prentice Hall; 1998;
  27. Pandey M , Thomas BC , Ramdas K , et al.   Early effect of surgery on quality of life in women with operable breast cancer . Jpn J Clin Oncol . 2006;36:468–472
  28. Nano MT , Gill PG , Kollias J , et al.   Psychological impact and cosmetic outcome of surgical breast cancer strategies . ANZ J Surg . 2005;75:940–947
  29. Janz NK , Mujahid M , Lantz PM , et al.   Population-based study of the relationship of treatment and sociodemographics on quality of life for early stage breast cancer . Qual Life Res . 2005;14:1467–1479
  30. Shimozuma K , Ganz PA , Petersen L , et al.   Quality of life in the first year after breast cancer surgery: rehabilitation needs and patterns of recovery . Breast Cancer Res Treat . 1999;56:45–57
  31. Keller SD , Ware JE , Bentler PM , et al.   Use of structural equation modeling to test the construct validity of the SF-36 Health Survey in ten countries: results from the IQOLA Project. International Quality of Life Assessment . J Clin Epidemiol . 1998;51:1179–1188
  32. Anagnostopoulos F , Niakas D , Pappa E . Construct validation of the Greek SF-36 Health Survey . Qual Life Res . 2005;14:1959–1965
  33. Fayer P , Machin D . Quality of Life: The Assessment, Analysis and Interpretation of Patient-reported Outcomes . 2nd edition. New York: Wiley; 2007;
  34. Boehmer S , Luszczynska A . Two kinds of items in quality of life instruments: ‘indicator and causal variables’ in the EORTC QLQ-C30 . Qual Life Res . 2006;15:131–141
  35. Schagen SB , van Dam FS , Muller MJ , et al.   Cognitive deficits after postoperative adjuvant chemotherapy for breast carcinoma . Cancer . 1999;85:640–650
  36. Ahles TA , Saykin AJ , Furstenberg CT , et al.   Neuropsycho-logic impact of standard-dose systemic chemotherapy in long-term survivors of breast cancer and lymphoma . J Clin Oncol . 2002;20:485–493
  37. Tchen N , Juffs HG , Downie FP , et al.   Cognitive function, fatigue, and menopausal symptoms in women receiving adjuvant chemotherapy for breast cancer . J Clin Oncol . 2003;21:4175–4183
  38. Day R , Ganz PA , Costantino JP , et al.   Health-related quality of life and tamoxifen in breast cancer prevention: a report from the National Surgical Adjuvant Breast and Bowel Project P-1 Study . J Clin Oncol . 1999;17:2659–2669
  39. Land SR , Wickerham DL , Costantino JP , et al.   Patient-reported symptoms and quality of life during treatment with tamoxifen or raloxifene for breast cancer prevention: the NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial . JAMA . 2006;295:2742–2751
  40. Poulsen B , Graversen HP , Beckmann J , et al.   A comparative study of post-operative psychosocial function in women with primary operable breast cancer randomized to breast conservation therapy or mastectomy . Eur J Surg Oncol . 1997;23:327–334
  41. Curran D , van Dongen JP , Aaronson NK , et al.   Quality of life of early-stage breast cancer patients treated with radical mastectomy or breast-conserving procedures: results of EORTC Trial 10801 . Eur J Cancer . 1998;34:307–314
  42. Huang CC , Lien HH , Wang PC , et al.   Quality of life in disease-free adenocarcinoma survivors: impacts of clinical stages and reconstructive surgical procedures . Dig Surg . 2007;24:59–65

PII: S0929-6646(10)60083-6

doi:10.1016/S0929-6646(10)60083-6

Journal of the Formosan Medical Association
Volume 109, Issue 7 , Pages 493-502, July 2010

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