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Table 2 Psychosocial determinants of QoL in breast cancer survivors

From: The psychosocial determinants of quality of life in breast cancer survivors: a scoping review

Primary Author, Year Study design Country Participant characteristics Cancer stage & treatment Time period Psychosocial measure (predictor) Quality of Life measure (outcome) Results Covariates (adjusted)
Social Support
 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
Depression
 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
Anxiety
 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
Positive and Negative Affect
 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
 
Coping
 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
Confidence and self-efficacy
 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
Spirituality
 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
Optimism
 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  
Future perspective and appraisal
 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
Impact of Events
 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
Stress
 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
Post-traumatic Growth
 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
Cognitive Symptoms
 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
Work Limitations
 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
Health care system
 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
  1. Functional Assessment of Cancer - Breast Cancer (FACT-B), Medical Outcomes Study Short Form (SF-36), The European Organisation of Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), The European Organisation of Research and Cancer Treatment Quality of Life Questionnaire - Breast Cancer (QLQ-BR23), Functional Assessment of Cancer Therapy - General (FACT-G), Quality of Life Index - Cancer Version (QLI-CV), Quality of Life Measurement (QoL-M), Quality of Life in Adult Cancer Survivors (QLACS), Quality of Life Cancer Survivor Version (QOL-CS), Global Life Satisfaction Scale (GLSS)