Long-Term Adjustment and Quality of Life Among Breast Cancer Survivors Following Treatment 

Tiffany Tibbs, M.A. with Teresa Deshields, Ph.D., and Laura Bayer, Ph.D.

Project Overview: 
We are applying to the Longer Life Foundation to fund a pilot project to extend our previous research on quality of life in cancer survivorship. We are currently completing a project examining short-term, or acute, adjustment to survivorship among 95 breast cancer patients in the six months following the end of radiation treatment. This project has identified critical factors in adjustment and quality of life over time, and these trends have compelled us to consider longer-term evaluation of adjustment to survivorship. Preliminary data analyses suggest that significant changes in depression and quality of life occur as early as the first six weeks post-treatment. Older women (aged 55 and over) demonstrate higher quality of life and lower depression following treatment as compared to younger women. With regard to quality of life and depression, age is a more significant predictor of outcome than medical variables, including stage of cancer, number of comorbid illnesses, type of treatment, or number of treatments. It appears that older women make significant gains in quality of life over this short period of time. The proposed pilot study and subsequent investigations will help us to understand the course of recovery for older and younger cancer patients. 

Request for Funding: 
We are seeking a Mini Grant from the Longer Life Foundation to support a pilot study that will assess long-term survivorship among breast cancer patients at eighteen months post-treatment. This pilot study will provide us with data regarding women’s transition to long-term survivorship, which will be compared to results from our initial study of acute adjustment. We anticipate high rates of response, as the retention rate for our initial study of acute adjustment was excellent, with only three participants dropping out of the study despite the demands of five telephone interviews over six months. The current project will help to determine whether the early trends in psychological status continue or change at eighteen months post-treatment, and whether these results are related to age and medical status. Ultimately, the data collected in the pilot study will provide a first step toward the larger goal of applying for national funding to study the quality of life and psychological issues of cancer survivors over the course of five years. Demonstrating the complex changes seen across time and our capability for completing long-term follow-up with patients will be a strong platform for our future application for funding. 

Plans for Future Grant Proposals: 
We plan to further explore the issues of survivorship through the support of a National Cancer Institute (NCI) Career Development Award (applying in October 2003) for Tiffany Tibbs, a young investigator who is joining the WUMS faculty at the Division of Health Behavior Research in Fall 2002. Using the pilot data generated by the current proposal, we plan to seek funding for an ongoing study of short and long-term adjustment to survivorship among breast cancer and prostate cancer patients. Differences in quality of life and adjustment by age, cancer stage, medical status, and gender will be explored over time. In addition, we plan to examine the relationships between depression, fatigue and pain and their impact on quality of life. The issue of symptom comorbidity for cancer patients has recently been identified by the NCI as an area for future research. Successful completion of this proposed pilot study will strengthen our proposal to the NCI by demonstrating the feasibility of retaining participants over time and refining our methodology. Pilot Study Aims: The aims for the current pilot study are: (1) To document the psychological status of breast cancer survivors at 18 months after the conclusion of cancer treatment. (2) To compare the short-term and long-term psychological adjustment and quality of life among breast cancer survivors and to document the course of recovery. (3) To examine how age and medical status relate to adjustment and quality of life during the later phases of survivorship. 

We propose to recruit participants from the cohort that completed the initial six month study of short-term adjustment following breast cancer treatment. They include 95 breast cancer patients (Stage 0-III) who underwent radiation treatment. Participants range in age from 27 - 86 years of age. Approximately one quarter of the participants are African American. 

With funding from the Longer Life Foundation, we propose to conduct computer-assisted telephone interviews (CATI) to assess long-term psychological adjustment and quality of life in our cohort of breast cancer survivors at eighteen months post-treatment. We utilized this methodology in our initial study and found that it promotes retention of participants and reduces missing data; therefore, we plan to use this approach in studying long-term survivorship. In addition to the telephone interview, we plan to review medical chart information to document mortality and recurrence through the Medical Oncology database. 

Many of the measures will be repeated for comparison to results at earlier assessments. Measures include: the Center for Epidemiologic Studies – Depression Scale, Spielberger’s State Anxiety Inventory, the State Hope Scale, the Post-Traumatic Growth Inventory, and the Functional Assessment of Cancer Treatment – Breast Cancer Version with the addition of the Spirituality subscale. The interviews will include an update of demographic information, health behaviors, and medical status. 

Data Analyses: 
Descriptive statistics will be used to characterize the sample and will be compared to reports in the literature. For comparison with early adjustment, multivariate repeated measures ANOVAs with Bonferroni t-tests will be performed to compare scores on the outcome variables from end of treatment, six months post-treatment, and eighteen months post-treatment. Additional analyses to examine the relationship between age and medical status on adjustment and quality of life will be conducted. Multiple regression procedures will be used to determine predictors of long-term adjustment from initial psychosocial data.

Successful completion of our proposed study through the Longer Life Foundation will further the research on quality of life among breast cancer patients, identify factors that promote better adjustment, and lead to a national grant application investigating the psychological aspects of cancer survivorship.

Final Report:
Goals and Objectives: The purpose of this project was to follow-up with survivors who participated in a study of short-term adjustment after treatment for breast cancer. In the initial project, we interviewed 95 women on 5 occasions over 6 months, beginning with the end of radiation therapy. The subsequent project (funded by the Longer Life Foundation) added a 6th interview with the same women 18 months after the conclusion of treatment. The specific aims for this study were:

  1. To document the course of psychological adjustment and quality of life in longer-term survivorship – at 18 months after the conclusion of cancer treatment.
  2. To examine how age, medical status, and psychosocial factors relate to adjustment and quality of life during later phases of survivorship.
  3. To pilot our methodology for examining long-term issues in cancer survivorship. 

Read the Full Final Report