Table 2 Psychosocial determinants of QoL in breast cancer survivors

 Ashing –Giwa K.T.. 2010 [33]

Cross-sectional

United States

703 participants aged 29–91 years (mean = 55, SD = 13). European- (n = 179), African- (n = 135), Latina- (n = 183), and Asian- (n = 206) Americans. 14.4% = < secondary education; 10.8% = completed secondary education; 74.8% = > secondary education

11.1% = Stage 0 36.7% = Stage 1 38.5% = Stage 2 13.7% = Stage 3

58.5% = Lumpectomy/other; 38.4% = Mastectomy; 15.6% = Mastectomy and reconstruction; 57.8% = Chemotherapy; 66.0% = Radiation

1–5 years since diagnosis (mean = 3 years)

Medical Outcomes Study (MOS) Social Support Survey

FACT-B- Physical and emotional well-being scale

SF-36 -general health perception sub-domain and pain sub-domain

Social support did not have a significant direct relationship with QoL

Life stress scale. Health care system- patient-doctor relationship, comfort in health care system and diagnostic care delay and sociodemographic variables

 Carver C.S. 2006 [13]

Longitudinal

United States

163 women with a mean age of 51.4 (SD = 10.61). 70% = Caucasian, 20% = Hispanic; 10% = African American

72% were married

3% = Stage 0

62% = Stage 1

35% = Stage 2

53% = Lumpectomy

47% = Mastectomy 31% = Chemotherapy

50% = Radiation

56% = Tamoxifen

25% = Reconstruction

Recruitment between 1988 and 1995 and 1994–1996 Data collection in 2001. 5–13 years since surgery

Interpersonal Support Evaluation List (ISEL)

QLACS

Social support was negatively correlated with lack of positive feelings, pain, sexual impairment, family distress and recurrence distress (subset of 101 participants). Not investigated in multivariate analysis

Optimism, cancer confidence and sociodemographic, clinical and treatment variables

 Cheng H, 2013 [34]

Cross-sectional

China

100 Asian/Chinese women aged 37–71 (mean = 53.75, SD = 7.27). 7% = < secondary education; 76% = completed secondary education; 17% = > secondary education 84% were married

15% = Stage 1

61% = Stage 2

24% = Stage 3

44% = Radiotherapy

75% = Hormonal therapy

60% = Traditional Chinese Medicine

Median number of months since treatment was 44 (IQR = 23–61)

Social Support Questionnaire (SSQ-6)

QOL-CS

Participants who had moderate and high levels of social support satisfaction had a significantly

better overall QOL as well as better physical

psychological and social QoL

Annual household income and length of survivorship

 DiSipio T et al., 2009 [35]

Cross-sectional

Australia

323 women. 67% of women were aged ≥50 years. 202 regional based and 121 rural

54% = < secondary education; 32% = completed secondary education; 14% = > secondary education

77% were married

61% = Complete local excision

39% = Mastectomy / partial / radical Adjuvant treatment

18% = No treatment

82% = Chemotherapy / Radiotherapy

Recruitment between April 2006 March 2012 post diagnosis

Social Networks Index

Supportive Care Needs Survey – Health system and information needs

FACT-B

Lack of a confidante was associated with a significantly lower QoL Lower health care service needs was associated with a higher QoL

Amount of stress, perceived handling of stress, overall health self-efficacy and sociodemographic and clinical variables

 Dura-Ferrandis E, 2016 [28]

Longitudinal

United States

1280 women aged 65–91 (mean = 77, SD = 9). 88.1% = Caucasian; 11.9% = Non-Caucasian

42.1% = < or completed secondary education; 57.9% = > secondary education

55.3% were married

45.6% = Stage 1

31.2% = Stage 2a 23.2% = Stage 2b or higher

67.6% = Breast Cancer Surgery 32.4% = Mastectomy

57.0% = Hormonal therapy only

43.0% = Chemotherapy

Recruitment was conducted from January, 2004 -April 2011 with follow-up in June 2011. Baseline data was collected nearly 2 months after last surgery. Follow-up data was collected 6 and 12 months after the baseline interview and annually for up to 7 years

Medical Outcomes Study (MOS) Social Support Survey

EORTC QLQ-C30

Higher tangible support

decreased the probability of being in accelerated emotional and physical functional decline group versus maintained high emotional and physical functional

group

Optimism, coping and sociodemographic variables

 Goyal N. G, 2018 [23]

Longitudinal

United States

565 women aged 25–96 (mean = 55, SD = 16). 90% Caucasian; 10% = Non-Caucasian.

63% were college educated

72% were partnered

52% = Stage 1

40% = Stage 2

8% = Stage 3

36% = Mastectomy

67% = Chemotherapy

72% = Radiation 73% = Hormonal therapy

Baseline data was collected within 8 months of diagnosis. Follow-up data was collected at 6, 12, and 18 months post baseline

Medical Outcomes Study (MOS) Social Support Survey

FACT-B

Those in the “consistently high” QoL trajectory

had greater social support compared to all other groups

Depression, coping, spirituality, optimism, Illness Intrusiveness Rating Scale and sociodemographic and clinical variables

 Huang C.Y. 2013 [36]

Cross-sectional

Taiwan

150 women aged 23–83 (mean = 56, SD = 10.4). 57% had less than 9 years of education.

77% were married.

13% = Stage 0

27% = Stage 1

46% = Stage 2

75% = Adjuvant treatment

Average duration of treatment was 33 months

Interpersonal Support Evaluation List (ISEL)

SF-36

Appraisal support, self-esteem support and belonging support were significantly associated with physical QoL Belonging support was also significantly associated with mental QoL

Sociodemographic and clinical variables

 Janz N.K., 2014 [26]

Longitudinal

United States

772 women aged on average 59.1 (SD = 13). 47.3% = Caucasian; 16.8% = Black; 36.9% = Latina. 21% = < secondary education; 20.9% = completed secondary education; 58.1% = > secondary education

55% were married

55.3% = Stage 1

36.0% = Stage 2

8.7% = Stage 3

40.7% = Mastectomy

57.8% = Lumpectomy

64.5% = Radiation 45.2% = Chemotherapy

Data was taken 9 months post diagnosis. Follow-up occurred 4 years post diagnosis

Emotional support from others and satisfaction with partner scale

FACT-B- Emotional well-being subscale

No association between social support and satisfaction with partner relationship and emotional well-being

Depression, spirituality, appraisal and sociodemographic and clinical variables

 Lewis, J., 2001 [37]

Cross-sectional

United States

64 women aged between 30 and 81 years (mean = 59.2 SD = 9.8). 80% = Caucasian; 20% = African American / Hispanic / Asian / West Indian

6.5% = < secondary education 28% = completed secondary education; 65.5% = > secondary education

66% were married

89% = Chemotherapy / Radiation

71% = Mastectomy

23% = Lumpectomy

Last treatment ranged from 1 to 15 years prior (mean = 7)

Interpersonal Support Evaluation List (ISEL) – Appraisal subscale

SF-36

Perceived social support was not associated with physical quality of life but was significantly associated with a better mental quality of life

Impact of Events(Intrusive thoughts) and sociodemographic variables

 Sammarco, A., 2008 [32]

Cross-sectional

United States

89 Latina breast cancer survivors with a mean age of 57.35 years (SD = 12.74, range 30–86 years). 65% = Caucasian; 35% = Latina.7% = < secondary education; 41% = completed secondary education; 52% = > secondary education

61% were married

17% = Surgery only

6% = Adjuvant only 77% = Both

Breast cancer treatment was completed between 1 and 35 years prior (mean = 4.99 years, SD = 4.73)

Social Support Questionnaire (SSQ)

QLI-CV

Increased perceived social support was associated with improved QoL

Uncertainty in illness

 Northouse, L.L (1999) [38]

Cross-sectional

United States

98 African American women aged 29–81 years (mean = 55, SD = 18). Average education was 13 years (SD = 6). 41% were married

70% = Mastectomy

The average time since diagnosis was 6 years (SD = 3). Time since diagnosis ranged from 1 to 15 years

Family APGAR-family functioning

FACT-B

Family functioning was significantly associated with QoL

Optimism, symptom distress, current concerns, appraisal of illness and sociodemographic and clinical variables

 Pedro L.W. (2001) [39]

Cross-sectional

United States

62 women aged ≥60 years. Majority were married, retired, white and college-educated

Majority surgery or a combination of surgery and radiation

5 to 10 years beyond initial diagnosis and disease and recurrence free

Norbeck Social Support Questionnaire

(NSSQ)

QLI-CV

A statistically significant univariate inverse relation was found between total loss (recent loss, number of individuals lost, and amount of that loss) and QoL. In multivariate analysis, this relationship was no longer significant

Self-esteem and learned resourcefulness

 Edib Z (2016) [40]

Cross-sectional

Malaysia

117 women.13.7% = < 40; 24.8% = 40–49;

61.6% = > 50. 58.1% = Malaysian;

29.9% = Chinese; 12.0% = Indian

29.1% = < secondary education; 39.3% = completed secondary education; 31.6% = > secondary education

77.8% were married

6.8% = Stage 0

20.5% = Stage 1

36.8% = Stage 2

23.9% = Stage 3

12.0% = Stage 4

31.6% = Breast Cancer Surgery 68.4% = Mastectomy

80.3% = Radiotherapy 71.8% = Chemotherapy 79.3% = Hormone therapy

22.6% = Immune therapy

Women were at least 1 year post diagnosis. 42.7% were < 2 years post- diagnosis. 42.7% were 2–5 years post diagnosis and 14.6% were > 5 years post diagnosis

Supportive Care Needs Survey- Short Form

EORTC QLQ-C30

Physical and psychological unmet needs were significantly independently associated with QOL

Sociodemographic and clinical variables

 Avis N.E. (2005) [41]

Cross-sectional

United States

202 women between the age of 25 and 50 years (mean 43.5 years). 96% were White. 20.3% = < or completed secondary education; 79.7% = > secondary education 81% were married/partner

43.4% = Mastectomy

75.1% = Chemotherapy

69.6% = Radiation therapy

Diagnosed with their first breast cancer in the previous 3 years and were at least 4 months after diagnosis

Cancer Rehabilitation Evaluation System (CARES)

FACT-B

Ladder of Life

Relationship problems was negatively associated with FACT-B and overall QoL (Ladder of Life)

Coping, sociodemographic and clinical variables

 Begovic-Juhant, A., 2012 [42]

Cross-sectional

United States

70 women aged 23–79 (mean = 49.72, SD = 10.62). 65% = Caucasian; 45% = African American.8% = < secondary education; 41% = completed secondary education; 51% > secondary education. 84% reported employment

60% = Mastectomy

27% = Lumpectomy

73% = Chemotherapy

57% = Radiation 36% = Hormone therapy

67 women were diagnosed between 2005 and 2011, 3 were diagnosed between 1981 and 1999

Center of Epidemiologic Studies Depression Scale (CES-D)

FACT-G

EORTC QLQ-BR23

Depression was significantly correlated with QoL

Body image, physical attractiveness, and femininity, sociodemographic and clinical variables

 Cheng A.S.K., 2016 [43]

Cross-sectional

China

90 women aged between 18 and 60 years. 30 were breast cancer survivors, 30 had musculoskeletal conditions, and 30 healthy women. 86.7% = < or completed secondary education; 13.3% = > secondary education 53.3% were married

42.3% = Early Stage

30.8% = Mid Stage

26.9% = Late Stage

10% = Surgery

13.3% = Radiation

10% = Surgery + Radiation

66.7% = Surgery + Radiation + Chemotherapy

Time since completing treatment was 36 months (SD = 33)

Hospital Anxiety and Depression Scale (HADS)

EORTC QLQ-C30

There was no significant differences in depression among the groups

Anxiety, cognitive symptoms, work limitations and sociodemographic and clinical variables

 DeShields, T., 2006 [24]

Longitudinal

United States

84 women aged 28–87 (mean = 56, SD = 14). 73% = Caucasian,27% = African American 38% = < or completed secondary education; 62% = > secondary education 61% were married

10% = Stage 0

44% = Stage 1

39% = Stage 2

7% = Stage 3

77% = Lumpectomy

23% = Mastectomy; 48% = Chemotherapy

70% = Hormonal therapy

1 week prior to radiation treatment. 3 and 6 months post treatment

Center of Epidemiologic Studies Depression Scale (CES-D)

FACT-B

At time 1 the Depressed, groups

demonstrated significantly worse QoL than the Never Depressed group. Findings were similar at Time 2. At Time 3, the Recover group demonstrated equivalent QoL to the Never Depressed group, while the other groups exhibited significantly worse QoL

Sociodemographic and clinical variables

 Goyal N. G, 2018 [23]

Longitudinal

United States

565 women aged 25–96 (mean = 55, SD = 16). 90% Caucasian; 10% = Non-Caucasian.

63% were college educated

72% were partnered

52% = Stage 1

40% = Stage 2

8% = Stage 3

36% = Mastectomy

67% = Chemotherapy

72% = Radiation 73% = Hormonal therapy

Baseline data was collected within 8 months of diagnosis. Follow-up data was collected at 6, 12, and 18 months post baseline

Becks Depression Inventory

FACT-B

Those in the “consistently high” QoL trajectory

had lower depression compared to all other groups

Social support, coping, spirituality, optimism, Illness Intrusiveness Rating Scale and sociodemographic and clinical variables

 Simone, S.M. H, 2013 [31]

Cross-sectional

China

148 Chinese women aged on average 50.5 (SD = 9.1).

7.4% = no formal education, 27.1% = primary education, 51.3% = secondary education, 14.1% = post-secondary. 76.2% were married/co-habiting

6.7% = Stage 0

12.3% = Stage 1

43.5% = Stage 2

27.9% = Stage 3

9.7% = Stage 4

92.6% = Surgery

84.0% = Chemotherapy

78.4% = Radiotherapy

47.2% = Hormonal therapy

0.4% = Traditional Chinese medicine

Recruitment occurred from 2010 to 2011. Treatment had been completed within that last year

Hospital Anxiety and Depression Scale (HADS) Cantonese/Chinese version

FACT-G

Depression was a significant predictor of physical wellbeing functional wellbeing and social/family wellbeing

Anxiety, sociodemographic and clinical variables

 Janz N.K., 2014 [26]

Longitudinal

United States

772 women aged on average 59.1 (SD = 13). 47.3% = Caucasian; 16.8% = Black; 36.9% = Latina. 21% = < secondary education; 20.9% = completed secondary education; 58.1% = > secondary education

55% were married

55.3% = Stage 1

36.0% = Stage 2

8.7% = Stage 3

40.7% = Mastectomy

57.8% = Lumpectomy

64.5% = Radiation 45.2% = Chemotherapy

Data was taken 9 months post diagnosis. Follow-up occurred 4 years post diagnosis

Depression history

FACT-B- Emotional well-being (EWB) subscale

Compared with women without a history of depression,

women with a history of depression and women with current depression were significantly more likely to report

EWB declines

Social support, spirituality, appraisal and sociodemographic and clinical variables

 Kim, S.H.., 2008 [44]

Cross-sectional

Korea

1933 women aged on average 44 (SD = 9.3). 62.4% = < 50; 37.6% = > 50; 29.3% = < secondary education; 41.3% = completed secondary education; 29.4% = > secondary education 84.9% were married

7.9% = Stage 0;

34.3% = Stage 1;

48.8% = Stage 2;

8.9% = Stage 3

32.9% = Surgery 67.0% = Mastectomy

28.6% = Chemotherapy

13.1% = Hormone therapy

34.8% = Chemotherapy + Hormone therapy

The average time since surgery was 6 years (SD = 4)

Becks Depression Inventory

EORTC QLQ-C30

EORTC QLQ-BR23

There were large differences in mean scores (lower scores) for those with depression vs. not for global QOL, emotional

functioning, and future perspective scales and smaller mean differences in sexual functioning

or sexual enjoyment scores

Fatigue, sociodemographic and clinical variables

 Akechi, T., 2015 [45]

Cross-sectional

Japan

146 women aged 27–87 years (mean = 57, SD 11) 38% > 12 years education. 75% were married

9% = Stage 0

49% = Stage 1

38% = Stage 2

4% = Stage 3

99% = Surgery; 35% = Chemotherapy

1% = Trastuzumab

71% = Hormonal therapy

43% = Radiation therapy

February 2006–February 2007. 733–4131 days since diagnosis (mean = 1569, SD = 786)

Hospital Anxiety and Depression Scale (HADS)

EORTC QLQ-C 30

Anxiety level was significantly correlated with all QoL measures -global health status, physical, role emotional cognitive and social functioning

Depression, perceived needs and sociodemographic and clinical variables

 Cheng A.S.K., 2016 [43]

Cross-sectional

China

90 women aged between 18 and 60 years. 30 were breast cancer survivors, 30 had musculoskeletal conditions, and 30 healthy women. 86.7% = < or completed secondary education; 13.3% = > secondary education. 53.3% were married

42.3% = Early Stage

30.8% = Mid Stage

26.9% = Late Stage

10% = Surgery

13.3% = Radiation

10% = Surgery + Radiation

66.7% = Surgery + Radiation + Chemotherapy

Time since completing treatment was 36 months (SD = 33)

Hospital Anxiety and Depression Scale (HADS)

EORTC QLQ-C30

There was no significant differences in anxiety among the groups

Depressiom, cognitive symptoms, work limitations and sociodemographic and clinical variables

 Simone, S.M. H, 2013 [31]

Cross-sectional

China

148 Chinese women aged on average 50.5 (SD = 9.1).

7.4% = no formal education, 27.1% = primary education, 51.3% = secondary education, 14.1% = post-secondary. 76.2% were married/co-habiting

6.7% = Stage 0

12.3% = Stage 1

43.5% = Stage 2

27.9% = Stage 3

9.7% = Stage 4

92.6% = Surgery

84.0% = Chemotherapy

78.4% = Radiotherapy

47.2% = Hormonal therapy

0.4% = Traditional Chinese medicine

Recruitment occurred from 2010 to 2011. Treatment had been completed within that last year

Hospital Anxiety and Depression Scale (HADS)- Cantonese/Chinese version

FACT-G

Anxiety was a significant predictor of physical, functional and emotional wellbeing

Depression and sociodemographic and clinical variables

 Kessler, T. A. 2002 [46]

Cross-sectional

United States

148 women aged on average 52.4 years (SD = 11.56). 85% = Caucasian; 11% = African American; 3% = Hispanic; 1% = Other. 5% = < secondary education; 38% = completed secondary education; 57% = > secondary education 72% were married

24% = Mastectomy

18% = Mastectomy + Chemotherapy

11% = Mastectomy + Hormone therapy

1% = Mastectomy + Radiation

7% = Lumpectomy + Radiation

Time since diagnosis was between 0.3–19 years (M = 54, SD = 6)

Positive and Negative Affect Scale (PANAS)

QOLM

Positive affect

was related positively to QoL and negative affect was related negatively to QoL

 Dura-Ferrandis E, 2016 [28]

Longitudinal

United States

1280 women aged 65–91 (mean = 77, SD = 9). 88.1% = Caucasian; 11.9% = Non-Caucasian

42.1% = < or completed secondary education; 57.9% = > secondary education

55.3% were married

45.6% = Stage 1

31.2% = Stage 2a 23.2% = Stage 2b or higher

67.6% = Breast Cancer Surgery 32.4% = Mastectomy

57.0% = Hormonal therapy only

43.0% = Chemotherapy

Recruitment was conducted from January, 2004 and April 2011 with follow-up in June, 2011. Baseline data was collected nearly 2 months after last surgery. Follow-up data was collected 6 and 12 months after the baseline interview and annually for up to 7 years

Brief COPE

EORTC QLQ-C30

The accelerated emotional decline group (vs maintained high) were more likely to use disengagement coping strategies and self-distraction

Social support. Optimism and sociodemographic variables

 Goyal N. G, 2018 [23]

Longitudinal

United States

565 women aged 25–96 (mean = 55, SD = 16). 90% Caucasian; 10% = Non-Caucasian.

63% were college educated

72% were partnered

52% = Stage 1

40% = Stage 2

8% = Stage 3

36% = Mastectomy

67% = Chemotherapy

72% = Radiation 73% = Hormonal therapy

Baseline data was collected within 8 months of diagnosis. Follow-up data was collected at 6, 12, and 18 months post baseline

Brief COPE

FACT-B

Those in the “consistently high” QoL trajectory

had lower passive coping scores compared to all other groups

Social support, depression, spirituality, optimism, Illness Intrusiveness Rating Scale and sociodemographic and clinical variables

 Paek M, 2016 [47]

Cross-sectional

United States

156 women aged on average 55.29 years (SD = 9.69). 55% = Chinese, 45% = Korean 26.9% = < or completed secondary education; 73.1% = > secondary education

75% were married

7.1% = Stage 0

35.9% = Stage 1

43.6% = Stage 2

13.5% = Stage 3

68% = Chemotherapy

53% = Mastectomy

There was an average of 3.49 years since diagnosis (SD = 1.47)

Family Crisis Oriented Personal Scale (F-COPES)

FACT-B- Emotional Well-Being subscale

SF-36- Vitality subscale

Use of external family coping had a direct positive effect on mental health outcomes, whereas internal family coping had no effect

Negative self-image and life stress, family communication strain

 Paek, M., 2016 [25]

Longitudinal

United States

637 women aged 26–97 years (mean = 55, SD = 16). 89.6% = Caucasian; 5.5% = Black; 4.9% = Other

12.6% = < or completed secondary education; 87.4% = > secondary education

71.9% were married

52.4% = Stage 1

39.7% = Stage 2

7.8% = Stage 3

72.2% = Radiotherapy

66.4% = Chemotherapy

64.2% = Lumpectomy

35.8% = Mastectomy

Recruitment occurred from 2002 to 2006. Baseline (Time 1) data was taken 1 and 3 months since diagnosis (mean = 5, SD = 3). Time 2 was 12–20 months post diagnosis. Time 3 was 18–26 months post diagnosis

Brief COPE

FACT-B

The direct paths from Time 1 negative coping to Time 2 QoL and Time 2 QoL to Time 3 negative coping were both statistically significant. No reciprocal relation between QoL and positive coping

Sociodemographic and clinical variables

 Avis N.E. (2005) [41]

Cross-sectional

United States

202 women between the age of 25 and 50 years (mean 43.5 years). 96% were White. 20.3% = < or completed secondary education; 79.7% = > secondary education 81% were married/partner

43.4% = Mastectomy

75.1% = Chemotherapy

69.6% = Radiation therapy

Diagnosed with their first breast cancer in the previous 3 years and were at least 4 months after diagnosis

Ways of Coping

FACT-B

Ladder of Life (overall QoL)

Keeping to self was negatively associated with functional well-being. Positive cognitive restructuring, making change and being prepared was positively associated with QoL. Wishful thinking was negatively associated with QoL

Social support, sociodemographic and clinical variables

 Carver C.S. et al. 2006 [13]

Longitudinal

United States

163 women with a mean age of 51.4 (SD = 10.61). 70% = Caucasian, 20% = Hispanic; 10% = African American.

72% were married

3% = Stage 0

62% = Stage 1

35% = Stage 2

53% = Lumpectomy

47% = Mastectomy 31% = Chemotherapy

50% = Radiation

56% = Tamoxifen

25% = Reconstruction

Recruitment between 1988 and 1995 and 1994–1996. Data collection in 2001. 5–13 years since surgery

Question- confidence about remaining cancer free

QLACS

In multivariate analysis confidence was significantly associated with cognitive impairment (subscale of QLACS)

Optimism, social support and sociodemographic, clinical and treatment variables

 DiSipio T et al., 2009 [35]

Cross-sectional

Australia

323 women. 67% of women were aged ≥50 years. 202 regional based and 121 rural.

54% = < secondary education; 32% = completed secondary education; 14% = > secondary education

77% were married

61% = Complete local excision

39% = Mastectomy / partial / radical Adjuvant treatment

18% = No treatment

82% = Chemotherapy / Radiotherapy

Recruitment between April 2006 March 2012 post diagnosis

Health efficacy- Self-rated Abilities for Health Practices

FACT-B

Poorer health self-efficacy was associated with a lower QoL

Social support, amount of stress, perceived handling of stress and sociodemographic and clinical variables

 Pedro L.W. (2001) [39]

Cross-sectional

United States

62 women aged ≥60 years. Majority were married, retired, white and college-educated.

Majority surgery or a combination of surgery and radiation

5 to 10 years beyond initial diagnosis and disease and recurrence free

Rosenberg Self-Esteem Scale and Rosenbaum Self-Control Schedule

QLI-CV

A statistically significant positive correlation was found between self-esteem and QoL. In multiple regression Learned resourcefulness was found to be related inversely to QoL

Social support

 Goyal N. G, 2018 [23]

Longitudinal

United States

565 women aged 25–96 (mean = 55, SD = 16). 90% Caucasian; 10% = Non-Caucasian.

63% were college educated

72% were partnered

52% = Stage 1

40% = Stage 2

8% = Stage 3

36% = Mastectomy

67% = Chemotherapy

72% = Radiation 73% = Hormonal therapy

Baseline data was collected within 8 months of diagnosis. Follow-up data was collected at 6, 12, and 18 months post baseline

Functional Assessment of Chronic Illness Therapy–Spiritual

Well-Being scale

FACT-B

Those in the “consistently high” QoL trajectory

had higher scores on meaning/peace and role of faiths compared to all other groups

Social support, depression, coping, optimism, Illness Intrusiveness Rating Scale and sociodemographic and clinical variables

 Janz N.K., 2014 [26]

Longitudinal

United States

772 women aged on average 59.1 (SD = 13). 47.3% = Caucasian; 16.8% = Black; 36.9% = Latina. 21% = < secondary education; 20.9% = completed secondary education; 58.1% = > secondary education

55% were married

55.3% = Stage 1

36.0% = Stage 2

8.7% = Stage 3

40.7% = Mastectomy

57.8% = Lumpectomy

64.5% = Radiation 45.2% = Chemotherapy

Data was taken 9 months post diagnosis. Follow-up occurred 4 years post diagnosis

System of Beliefs Inventory (SBI-15R)

FACT-B- Emotional well-being subscale

A higher mean score on the beliefs and practices subscale of Spiritual Beliefs Inventory–15R was associated with emotional decline

Social support, depression, appraisal and sociodemographic and clinical variables

 Manning-Walsh J, 2005 [48]

Cross-sectional

United States

100 women aged 30–74 years (mean = 45.98, SD = 8.85) 93% = Caucasian; 3% = American Indian; 2% = Hispanic; 2% = Other

2% = < secondary education; 23% = completed secondary education;

73% = > secondary education

74% were married

48% = Stage 1

41% = Stage 2

5% = Stage 3

4% = Stage 4

2% = Missing

51% = Mastectomy

48% = Lumpectomy

70% = Chemotherapy

68% = Radiation therapy

41% = Hormone therapy

Recruitment occurred in 2000. 1–24 months post-surgery

Religious Coping (RCOPE) - negative coping subscale

FACT-B

A negative significant correlation between spiritual struggle and QoL

 Wildes, K.A. 2009 [49]

Cross-sectional

United States

117 Latina women aged on average 57.2 years (SD = 10.21). 64.1% = Mexican/ American/Chicano;

1.7% = Central American; 0.9% = Puerto Rican; 0.9% = Cuban; 2.6% = South American; 26.5% = Other Latino/Hispanic;

3.4% = Other. 35% = < secondary education; 35% = completed secondary education; 30% = > secondary education.50.4% were married

99.1% = Surgery

92% were diagnosed less than 10 years ago

Systems of Belief Inventory (SBI-15R)

FACT–B

Spirituality was significantly associated with functional wellbeing

Sociodemographic and clinical variables

 Carver C.S. et al. 2006 [13]

Longitudinal

United States

163 women with a mean age of 51.4 (SD = 10.61). 70% = Caucasian, 20% = Hispanic; 10% = African American.

72% were married

3% = Stage 0

62% = Stage 1

35% = Stage 2

53% = Lumpectomy

47% = Mastectomy 31% = Chemotherapy

50% = Radiation

56% = Tamoxifen

25% = Reconstruction

Recruitment between 1988 and 1995 and 1994–1996. Data collection in 2001. 5–13 years since surgery

Life Orientation Test

QLACS

In multivariate analysis optimism was significantly inversely associated with negative feelings, lack of positive feelings, sexual impairment social avoidance, fatigue, lack of benefits, recurrence distress and appearance worries

Social Support, cancer confidence and sociodemographic, clinical and treatment variables

 Dura-Ferrandis E, 2016 [28]

Longitudinal

United States

1280 women aged 65–91 (mean = 77, SD = 9). 88.1% = Caucasian; 11.9% = Non-Caucasian

42.1% = < or completed secondary education; 57.9% = > secondary education.

55.3% were married

45.6% = Stage 1

31.2% = Stage 2a 23.2% = Stage 2b or higher

67.6% = Breast Cancer Surgery 32.4% = Mastectomy

57.0% = Hormonal therapy only

43.0% = Chemotherapy

Recruitment was conducted from January, 2004 and April 2011 with follow-up in June, 2011. Baseline data was collected nearly 2 months after last surgery. Follow-up data was collected 6 and 12 months after the baseline interview and annually for up to 7 years.

Life Orientation Test

EORTC QLQ-C30

Those in the accelerated emotional decline group (vs maintained high) were significantly less optimistic

Social support, coping and sociodemographic variables

 Goyal N. G, 2018 [23]

Longitudinal

United States

565 women aged 25–96 (mean = 55, SD = 16). 90% Caucasian; 10% = Non-Caucasian.

63% were college educated

72% were partnered

52% = Stage 1

40% = Stage 2

8% = Stage 3

36% = Mastectomy

67% = Chemotherapy

72% = Radiation 73% = Hormonal therapy

Baseline data was collected within 8 months of diagnosis. Follow-up data was collected at 6, 12, and 18 months post baseline

Life Orientation Test

FACT-B

Those in the “consistently high” QoL trajectory

had higher scores on optimism compared to all other groups (p < 0.001)

Social support, depression, coping, spirituality, Illness Intrusiveness Rating Scale and sociodemographic and clinical variables

 Northouse, L.L (1999) [38]

Cross-sectional

United States

98 African American women aged 29–81 years (mean = 55, SD = 18). Average education was 13 years (SD = 6). 41% were married

70% = Mastectomy

The average time since diagnosis was 6 years (SD = 3). Time since diagnosis ranged from 1 to 15 years

Life Orientation Test

FACT-B

Optimism was not significantly associated with QoL

Symptom distress, current concerns, family functioning, appraisal of illness and sociodemographic and clinical variables

 Petersen L.R. (2008) [50]

Cross-sectional

United States

268 women aged 32–95 years (mean = 71, SD = 11.90)

10.9% = Stage 0

63.3% = Stage 1

21.3% = Stage 2

4.5% = Stage 3

QoL was measured on average 8 years after diagnosis. The mean number of years between completion of MMPI to breast cancer diagnosis was 10 (SD = 8.4) and 18.3 (SD = 9.2) between MMPI and SF-36 completion

The Minnesota Multiphasic Personality Inventory (MMPI) – optimism-pessimism (PSM) scale

SF-36

Women with a pessimistic explanatory style had significantly lower mental QoL compared to those with a non-pessimistic style

 Sammarco, A., 2008 [32]

Cross-sectional

United States

89 Latina breast cancer survivors with a mean age of 57.35 years (SD = 12.74, range 30–86 years). 65% = Caucasian; 35% = Latina.7% = < secondary education; 41% = completed secondary education; 52% = > secondary education.

61% were married

17% = Surgery only

6% = Adjuvant only 77% = Both

Breast cancer treatment was completed between 1 and 35 years prior (mean = 4.99 years, SD = 4.73)

Mishel Uncertainty in Illness Scale-Community (MUIS-C)

QLI-CV

Decreased uncertainty was associated with improved QoL

Social support

 Northouse, L.L (1999) [38]

Cross-sectional

United States

98 African American women aged 29–81 years (mean = 55, SD = 18). Average education was 13 years (SD = 6). 41% were married

70% = Mastectomy

The average time since diagnosis was 6 years (SD = 3). Time since diagnosis ranged from 1 to 15 years

Appraisal of Illness Questionnaire

FACT-B

Appraisal of illness mediated the influence of optimism and current concerns and partially mediated the influence of symptom distress on women’s QoL

Optimism, symptom distress, current concerns, family functioning, and sociodemographic and clinical variables

 Farren, A. T, 2010 [51]

Cross-sectional

United States

104 women aged 28–81 years (mean = 53). 92% were Caucasian. 40% = < or completed secondary education; 60% = > secondary education. 69% were married

The majority of women completed treatment (52%) more than 5 years prior to the study

Power as Knowing Participation in Change Tool (PKPCT)

Mishel Uncertainty in Illness Scale – Community Form (MUISC)

Self-Transcendence Scale (STS)

QLI-CV

39% of the variance in QoL could be explained by power, uncertainty and self-transcendence when considered together

Uncertainty and self-transcendence

made a statistically significant contribution to the explained variance, power did not

Sociodemographic variables

 Janz N.K., 2014 [26]

Longitudinal

United Stat es

772 women aged on average 59.1 (SD = 13). 47.3% = Caucasian; 16.8% = Black; 36.9% = Latina. 21% = < secondary education; 20.9% = completed secondary education; 58.1% = > secondary education

55% were married

55.3% = Stage 1

36.0% = Stage 2

8.7% = Stage 3

40.7% = Mastectomy

57.8% = Lumpectomy

64.5% = Radiation 45.2% = Chemotherapy

Data was taken 9 months post diagnosis. Follow-up occurred 4 years post diagnosis.

Recurrence information, likelihood and worry about recurrence, decision regret

FACT-B- Emotional well-being subscale

Women who did not receive enough information about the risk of breast cancer recurrence, perceived that their likelihood of breast cancer recurrence was quite/very likely and had higher worry about recurrence (Time 1 to Time 2) were significantly more likely to report emotional decline.

No significant differences

were observed for decision regret

Social support, depression, spirituality and sociodemographic and clinical variables

 Koch, L 2014 [29]

Cross-sectional

Germany

2671 women aged on average 65 (SD = 9.7). 52% = < secondary education 48% = completed or > secondary education 66% were married

45% = Stage 1

47% = Stage 2

8% = Stage 3

< 1% = Stage 4

32% = Mastectomy

68% = Breast Cancer Surgery

60% = Chemotherapy

84% = Radiation 49% = Hormonal therapy

Recruitment took place from 2009 to 2010. The mean time since diagnosis was 2 years (ranged 5–16)

Fear of Progression Questionnaire-Short Form

EORTC QLQ-C30-

EORTC QLQ-BR23

Fear of progression was significantly associated with global, physical, functional, social, emotional and cognitive QoL

Sociodemographic and clinical variables

 Taylor, T.R., 2012 [30]

Cross-sectional

United States

51 women aged 31–87 (mean = 64, SD = 13). 100% were African American. 13.7% = completed secondary education; 84.3% = > secondary education; 2% = Missing. 35.3% were married

27.5% = Stage 0

43.1% = Stage 1

19.6% = Stage 2

9.8% = Stage 3

45.1% = Breast Cancer Surgery

52.9% = Mastectomy

33.3% = Surgery + Radiation

15.7% = Surgery + Chemotherapy

31.4% = Surgery + Chemotherapy + Radiation

7.8% = Surgery + Hormone + Other

Time since diagnosis ranged from 1 to 18 years (mean = 2, SD = 3)

Concerns of Recurrence Scale

FACT-B

Overall fear of recurrence was negatively related to QoL

 Ganz P.A. (2003) [52]

Cross-sectional

United States

577 women aged 30–61.6 years (mean = 49.5). 70.2% = Caucasian; 11.6% = African American;

7.3% = Hispanic; 8.5% = Asian; 2.4% = Other

6.3% = < or completed secondary education; 93.7% = > secondary education. 70.3% were married

55.8% = Lumpectomy

44.2% = Mastectomy

62% = Adjuvant chemotherapy

37.4% = Tamoxifen

On average 6 years after breast cancer diagnosis

Vulnerability

SF-36 general health perceptions scale

Ladder of Life

Feeling vulnerable was significantly associated with poorer health perceptions and QoL

Physical and emotional functioning, sociodemographic and clinical variables

 Lewis J., 2001 [37]

Cross-sectional

United States

64 women aged between 30 and 81 years (mean = 59.2 SD = 9.8). 80% = Caucasian; 20% = African American / Hispanic / Asian / West Indian

6.5% = < secondary education 28% = completed secondary education; 65.5% = > secondary education

66% were married

89% = Chemotherapy / Radiation

71% = Mastectomy

23% = Lumpectomy

Last treatment ranged from 1 to 15 years prior (mean = 7)

Impact of Events Survey (IES)- Intrusion subscale.

SF-36

A higher frequency of intrusive thoughts was associated with poorer physical QoL and mental QoL

Social support and sociodemographic variables

 Goyal N. G, 2018 [23]

Longitudinal

United States

565 women aged 25–96 (mean = 55, SD = 16). 90% Caucasian; 10% = Non-Caucasian.

63% were college educated

72% were partnered

52% = Stage 1

40% = Stage 2

8% = Stage 3

36% = Mastectomy

67% = Chemotherapy

72% = Radiation 73% = Hormonal therapy

Baseline data was collected within 8 months of diagnosis. Follow-up data was collected at 6, 12, and 18 months post baseline

Illness Intrusiveness Rating Scale

FACT-B

Those in the “consistently high” QoL trajectory

had lower scores on illness intrusiveness compared to all other groups

Social support, depression, coping, spirituality, optimism and sociodemographic and clinical variables

 Bouskill K. (2016) [53]

Cross-sectional

Austria

152 women aged on average 48.78 (SD 8.79). 12% = < secondary education; 46% = completed secondary education; 40% = > secondary education; 2% = Missing. 67% were married/long-term partner

On average women diagnosed 13 years prior to study start date (2001) (SD 3.17)

Impact of Cancer scale

SF-36- the physical and the mental component summary

The positive impact of cancer was associated with an increase in physical QoL while the negative impact of cancer was associated with a decrease in physical QoL and mental QoL

Sociodemographic and clinical variables

 Morrill, E.F., 2008 [54]

Cross-sectional

United States

161 women aged 36–87 years (mean = 59, SD = 10.6). 85% = Caucasian; 12% = African American.3% = < secondary education44% = completed secondary education; 53% = > secondary education. 73% were married

55% = Stage 1

43% = Stage 2

99% = Surgery

54% = Chemotherapy 62% = Radiation

67% = Tamoxifen

The average time since diagnosis was 4 years (SD = 1)

Post-traumatic Stress Disorder Checklist Civilian Version (PCL-C)

FACT-B

Post-traumatic stress symptoms were significantly associated with QoL and depression

Posttraumatic growth, sociodemographic and clinical variables

 Northouse, L.L (1999) [38]

Cross-sectional

United States

98 African American women aged 29–81 years (mean = 55, SD = 18). Average education was 13 years (SD = 6). 41% were married

70% = Mastectomy

The average time since diagnosis was 6 years (SD = 3). Time since diagnosis ranged from 1 to 15 years

Omega Screening Questionnaire (OSQ)

FACT-B

Symptom distress made a significant independent contribution to women’s QoL. The influence of current concerns on women’s QoL was mediated by appraisal of illness

Optimism, appraisal of illness, family functioning, and sociodemographic and clinical variables

 Ashing –Giwa K.T.. 2010 [33]

Cross-sectional

United States

703 participants aged 29–91 years (mean = 55, SD = 13). European- (n = 179), African- (n = 135), Latina- (n = 183), and Asian- (n = 206) Americans. 14.4% = < secondary education; 10.8% = completed secondary education; 74.8% = > secondary education

11.1% = Stage 0 36.7% = Stage 1 38.5% = Stage 2 13.7% = Stage 3

58.5% = Lumpectomy/other; 38.4% = Mastectomy; 15.6% = Mastectomy and reconstruction; 57.8% = Chemotherapy; 66.0% = Radiation

1–5 years since diagnosis (mean = 3 years)

Life burden- Life Stress Scale

FACT-B- Physical and emotional well-being scale

SF-36 -general health perception sub-domain and pain sub-domain

Life burden was significantly related to physical and psychological QoL

Social support. Health care system- patient-doctor relationship, comfort in health care system and diagnostic care delay and sociodemographic variables

 DiSipio T et al., 2009 [35]

Cross-sectional

Australia

323 women. 67% of women were aged ≥50 years. 202 regional based and 121 rural.

54% = < secondary education; 32% = completed secondary education; 14% = > secondary education.

77% were married

61% = Complete local excision

39% = Mastectomy / partial / radical Adjuvant treatment

18% = No treatment

82% = Chemotherapy / Radiotherapy

Recruitment between April 2006 March 2012 post diagnosis

Amount of stress and perceived handling of stress

FACT-B + 4 (plus arm morbidity)

Amount of stress and perceived handling of stress was associated with a lower QoL

Social support, health care service needs, overall health self-efficacy and sociodemographic and clinical variables

 Paek M, 2016 [47]

Cross-sectional

United States

156 women aged on average 55.29 years (SD = 9.69). 55% = Chinese, 45% = Korean 26.9% = < or completed secondary education; 73.1% = > secondary education.

75% were married

7.1% = Stage 0

35.9% = Stage 1

43.6% = Stage 2

13.5% = Stage 3

68% = Chemotherapy

53% = Mastectomy

There was an average of 3.49 years since diagnosis (SD = 1.47).

Negative Self-Image (FACT-B)

Urban Life Stress Scale.

Secondary Stressor The Family Communication Scale of the Family Adaptability and Cohesion Evaluation (FACES-IV) and the Family Avoidance of Communication about Cancer (FACC)

FACT-B- Emotional Well-Being subscale

SF-36- Vitality subscale

Greater primary stressors (negative self-image and life stress) were associated with poorer mental health Greater secondary stress (family communication strain) had negative effects on mental health outcomes

Coping

 Morrill, E.F., 2008 [54]

Cross-sectional

United States

161 women aged 36–87 years (mean = 59, SD = 10.6). 85% = Caucasian; 12% = African American.3% = < secondary education44% = completed secondary education; 53% = > secondary education. 73% were married

55% = Stage 1

43% = Stage 2

99% = Surgery

54% = Chemotherapy 62% = Radiation

67% = Tamoxifen

The average time since diagnosis was 4 years (SD = 1).

Posttraumatic Growth Inventory

FACT-B

Posttraumatic growth was significantly associated with QoL Posttraumatic growth was not related to depressive symptoms but interacted with post-traumatic stress symptoms in predicting depressive symptoms

Post-traumatic stress symptoms, sociodemographic and clinical variables

 Bellizzi K.M. (2009) [27]

Longitudinal

United States

802 women aged on average 57.2 years (SD = 10.1). 62.3% = Caucasian; 12.2% = Hispanic; 25.5% = Black. 25.4% = < or completed secondary education;74.6% = > secondary education 56% were married

32.4% = Surgery only

36.8% = Surgery + Radiation

9.1% = Surgery + Chemotherapyh

21.7% = Surgery + Radiation + Chemotherapy

Baseline questionnaire – on average 6.1 months following diagnosis, Time 2–24 months after baseline, Time 3–35 months after baseline

Posttraumatic Growth Inventory

SF-36 – physical component score (PCS) and mental component score (MCS)

Posttraumatic growth was significantly associated with a lower mental QoL No association with physical QoL

Religiosity and sociodemographic and clinical variables

 Cheng A.S.K., 2016 [43]

Cross-sectional

China

90 women aged between 18 and 60 years. 30 were breast cancer survivors, 30 had musculoskeletal conditions, and 30 healthy women. 86.7% = < or completed secondary education; 13.3% = > secondary education. 53.3% were married

42.3% = Early Stage

30.8% = Mid Stage

26.9% = Late Stage

10% = Surgery

13.3% = Radiation

10% = Surgery + Radiation

66.7% = Surgery + Radiation + Chemotherapy

Time since completing treatment was 36 months (SD = 33)

Cognitive Symptom Checklist-Work

EORTC QLQ-C30

The number of cognitive

symptoms was significantly higher in breast cancer survivors, especially for the symptoms related with working memory. The cognitive limitations were significantly associated with QoL

Anxiety, depression, work limitations and sociodemographic and clinical variables

 Cheng A.S.K., 2016 [43]

Cross-sectional

China

90 women aged between 18 and 60 years. 30 were breast cancer survivors, 30 had musculoskeletal conditions, and 30 healthy women. 86.7% = < or completed secondary education; 13.3% = > secondary education. 53.3% were married

42.3% = Early Stage

30.8% = Mid Stage

26.9% = Late Stage

10% = Surgery

13.3% = Radiation

10% = Surgery + Radiation

66.7% = Surgery + Radiation + Chemotherapy

Time since completing treatment was 36 months (SD = 33)

Work

Limitation Questionnaire (WLQ)

EORTC QLQ-C30

There was no significant difference in the overall WLQ productivity loss score among the three groups

Depression, anxiety, cognitive symptoms, and sociodemographic and clinical variables

 Ashing –Giwa K.T.. 2010 [33]

Cross-sectional

United States

703 participants aged 29–91 years (mean = 55, SD = 13). European- (n = 179), African- (n = 135), Latina- (n = 183), and Asian- (n = 206) Americans. 14.4% = < secondary education; 10.8% = completed secondary education; 74.8% = > secondary education

11.1% = Stage 0 36.7% = Stage 1 38.5% = Stage 2 13.7% = Stage 3

58.5% = Lumpectomy/other; 38.4% = Mastectomy; 15.6% = Mastectomy and reconstruction; 57.8% = Chemotherapy; 66.0% = Radiation

1–5 years since diagnosis (mean = 3 years)

Health care system- patient-doctor relationship, comfort in health care system and diagnostic care delay

FACT-B- Physical and emotional well-being scale

SF-36 -general health perception sub-domain and pain sub-domain

Only European and Latina-Americans showed positive relationships between patient-doctor relationship and psychological well-being. European-Americans showed the direct impact of diagnostic

care delay on physical QoL

Social support, life burden and sociodemographic variables