Skip to main content
Top
Published in: Supportive Care in Cancer 5/2016

01-05-2016 | Original Article

Unmet needs mediate the relationship between symptoms and quality of life in breast cancer survivors

Authors: K. K. F. Cheng, W. H. Wong, C. Koh

Published in: Supportive Care in Cancer | Issue 5/2016

Login to get access

Abstract

Purpose

This study aimed to compare the symptoms, unmet needs, and QoL reported by women at 6 months to <2 years and 2 to 5 years following surgery and adjuvant treatment for breast cancer. It also evaluated the relationships among symptoms, unmet needs, and QoL using structural equation modeling.

Methods

In this study, 113 and 137 survivors following breast cancer treatment 6 months to <2 years and 2 to 5 years, respectively, completed the Memorial Symptom Assessment Scale, the Supportive Care Needs Survey-34, and the Medical Outcomes Study 12-item Short Form Health Survey version 2.0 during their medical follow-up.

Results

The mean numbers of symptoms and unmet needs were 5.43 and 3.0, respectively, for survivors at <2 years, and 5.24 and 2.42, respectively, for survivors at 2 to 5 years following treatment. The most common reported symptoms were related primarily to physical domains. No significant differences were found between the two survivor groups on the MSAS scores. Survivors at <2 years reported significantly higher scores in Psychological and Health Care System/Information needs (p < 0.01), and lower composite scores in physical and mental QoL (p < 0.05) than those at 2 to 5 years post-treatment. Significant direct and indirect effects were found of symptom burden through unmet needs on survivors’ physical and mental QoL after adjustment for survival time, and the models showed a good fit.

Conclusions

Results suggest that breast cancer survivors continue to endure many symptoms independent of the survivorship period. The unmet needs mediate the relationship between symptom burden and survivors’ QoL.
Literature
1.
go back to reference Siegel R, DeSantis C, Virgo K, Stein K, Mariotto A, Smith T, Cooper D, Gansler T, Lerro C, Fedewa S, Lin C, Leach C, Cannady RS, Cho H, Scoppa S, Hachey M, Kirch R, Jemal A, Ward E (2012) Cancer treatment and survivorship statistics. CA Cancer J Clin 62(4):220–241CrossRefPubMed Siegel R, DeSantis C, Virgo K, Stein K, Mariotto A, Smith T, Cooper D, Gansler T, Lerro C, Fedewa S, Lin C, Leach C, Cannady RS, Cho H, Scoppa S, Hachey M, Kirch R, Jemal A, Ward E (2012) Cancer treatment and survivorship statistics. CA Cancer J Clin 62(4):220–241CrossRefPubMed
2.
go back to reference Hodgkinson K, Butow P, Hunt GE, Pendlebury S, Hobbs KM, Wain G (2007) Breast cancer survivors’ supportive care needs 2–10 years after diagnosis. Support Care Cancer 15(5):515–523CrossRefPubMed Hodgkinson K, Butow P, Hunt GE, Pendlebury S, Hobbs KM, Wain G (2007) Breast cancer survivors’ supportive care needs 2–10 years after diagnosis. Support Care Cancer 15(5):515–523CrossRefPubMed
3.
go back to reference Mullan F (1985) Seasons of survival: reflections of a physician with cancer. N Engl J Med 313(4):270–273CrossRefPubMed Mullan F (1985) Seasons of survival: reflections of a physician with cancer. N Engl J Med 313(4):270–273CrossRefPubMed
4.
go back to reference Gosain R, Miller K (2013) Symptoms and symptom management in long-term cancer survivors. Cancer J 19(5):405–409CrossRefPubMed Gosain R, Miller K (2013) Symptoms and symptom management in long-term cancer survivors. Cancer J 19(5):405–409CrossRefPubMed
6.
go back to reference Cleeland CS (2007) Symptom burden: multiple symptoms and their impact as patient-reported outcomes. J Natl Cancer Inst Monogr 37:16–21CrossRef Cleeland CS (2007) Symptom burden: multiple symptoms and their impact as patient-reported outcomes. J Natl Cancer Inst Monogr 37:16–21CrossRef
7.
go back to reference Janz NK, Mujahid M, Chung LK, Lantz PM, Hawley ST, Morrow M, Schwartz K, Katz SJ (2007) Symptom experience and quality of life of women following breast cancer treatment. J Women’s Health 16(9):1348–1361CrossRef Janz NK, Mujahid M, Chung LK, Lantz PM, Hawley ST, Morrow M, Schwartz K, Katz SJ (2007) Symptom experience and quality of life of women following breast cancer treatment. J Women’s Health 16(9):1348–1361CrossRef
8.
go back to reference Fu OS, Crew KD, Jacobson JS, Greenlee H, Yu G, Campbell J, Ortiz Y, Hershman DL (2009) Ethnicity and persistent symptom burden in breast cancer survivors. J Cancer Surviv 3(4):241–250CrossRefPubMedPubMedCentral Fu OS, Crew KD, Jacobson JS, Greenlee H, Yu G, Campbell J, Ortiz Y, Hershman DL (2009) Ethnicity and persistent symptom burden in breast cancer survivors. J Cancer Surviv 3(4):241–250CrossRefPubMedPubMedCentral
9.
go back to reference Binkley JM, Harris SR, Levangie PK, Pearl M, Guglielmino J, Kraus V, Rowden D (2012) Patient perspectives on breast cancer treatment side effects and the prospective surveillance model for physical rehabilitation for women with breast cancer. Cancer 118(8 Suppl):2207–2216CrossRefPubMed Binkley JM, Harris SR, Levangie PK, Pearl M, Guglielmino J, Kraus V, Rowden D (2012) Patient perspectives on breast cancer treatment side effects and the prospective surveillance model for physical rehabilitation for women with breast cancer. Cancer 118(8 Suppl):2207–2216CrossRefPubMed
10.
go back to reference Costanzo ES, Lutgendorf SK, Mattes ML, Robinson CB, Tewfik F, Roman SL (2007) Adjusting to life after treatment: distress and quality of life following treatment for breast cancer. Br J Cancer 97:1625–1631CrossRefPubMedPubMedCentral Costanzo ES, Lutgendorf SK, Mattes ML, Robinson CB, Tewfik F, Roman SL (2007) Adjusting to life after treatment: distress and quality of life following treatment for breast cancer. Br J Cancer 97:1625–1631CrossRefPubMedPubMedCentral
11.
go back to reference Eckhoff L, Knoop AS, Jensen MB, Ewertz M (2014) Persistence of docetaxel-induced neuropathy and impact on quality of life among breast cancer survivors. Eur J Cancer 51(3):292–300CrossRefPubMed Eckhoff L, Knoop AS, Jensen MB, Ewertz M (2014) Persistence of docetaxel-induced neuropathy and impact on quality of life among breast cancer survivors. Eur J Cancer 51(3):292–300CrossRefPubMed
12.
go back to reference Ganz PA, Kwan L, Stanton AL, Krupnick JL, Rowland JH, Meyerowitz BE (2004) Quality of life at the end of primary treatment of breast cancer: first results from the moving beyond cancer randomized trial. J Natl Cancer Inst Monogr 96(5):376–387CrossRef Ganz PA, Kwan L, Stanton AL, Krupnick JL, Rowland JH, Meyerowitz BE (2004) Quality of life at the end of primary treatment of breast cancer: first results from the moving beyond cancer randomized trial. J Natl Cancer Inst Monogr 96(5):376–387CrossRef
13.
go back to reference Kim SH, Lee R, Lee KS (2012) Symptoms and uncertainty in breast cancer survivors in Korea: differences by treatment trajectory. J Clin Nurs 21(7–8):1014–1023CrossRefPubMed Kim SH, Lee R, Lee KS (2012) Symptoms and uncertainty in breast cancer survivors in Korea: differences by treatment trajectory. J Clin Nurs 21(7–8):1014–1023CrossRefPubMed
14.
go back to reference Cheng KK, Darshini Devi R, Wong WH, Koh C (2014) Perceived symptoms and the supportive care needs of breast cancer survivors six months to five years post-treatment period. Eur J Oncol Nurs 18:3–9CrossRefPubMed Cheng KK, Darshini Devi R, Wong WH, Koh C (2014) Perceived symptoms and the supportive care needs of breast cancer survivors six months to five years post-treatment period. Eur J Oncol Nurs 18:3–9CrossRefPubMed
15.
go back to reference Portenoy RK, Thaler HT, Kornblith AB, Lepore JM, Friedlander-Klar H, Kiyasu E (1994) The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress. Eur J Cancer 30A(9):1326–1336CrossRefPubMed Portenoy RK, Thaler HT, Kornblith AB, Lepore JM, Friedlander-Klar H, Kiyasu E (1994) The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress. Eur J Cancer 30A(9):1326–1336CrossRefPubMed
16.
go back to reference Boyes A, Girgis A, Lecathelinais C (2009) Brief assessment of adult cancer patients’ perceived needs: development and validation of the 34-item Supportive Care Needs Survey (SCNS-SF34). J Eval Clin Pract 15(4):602–606CrossRefPubMed Boyes A, Girgis A, Lecathelinais C (2009) Brief assessment of adult cancer patients’ perceived needs: development and validation of the 34-item Supportive Care Needs Survey (SCNS-SF34). J Eval Clin Pract 15(4):602–606CrossRefPubMed
17.
go back to reference Ware JE, Kosinski M, Turner-Bowker DM, Gandek B (2005) How to score version 2 of the SF-12 health survey. QualityMetric Inc., Lincoln Ware JE, Kosinski M, Turner-Bowker DM, Gandek B (2005) How to score version 2 of the SF-12 health survey. QualityMetric Inc., Lincoln
18.
go back to reference Saris-Baglama RN, Dewy CJ, Chisholm GB, Plumb E, King J, Rasicot P, Kosinski M, Bjorner JB, Ware JW (2010) QualityMetric Health Outcomes™ Scoring Software 4.0 user’s guide. QualityMetric Inc, Lincoln Saris-Baglama RN, Dewy CJ, Chisholm GB, Plumb E, King J, Rasicot P, Kosinski M, Bjorner JB, Ware JW (2010) QualityMetric Health Outcomes™ Scoring Software 4.0 user’s guide. QualityMetric Inc, Lincoln
19.
go back to reference Sow WT, Wee HL, Wu Y, Tai ES, Gandek B, Lee J, Ma S, Heng D, Thumboo J (2014) Normative data for the Singapore English and Chinese SF-36 version 2 Health Survey. Ann Acad Med Singap 43:15–23PubMed Sow WT, Wee HL, Wu Y, Tai ES, Gandek B, Lee J, Ma S, Heng D, Thumboo J (2014) Normative data for the Singapore English and Chinese SF-36 version 2 Health Survey. Ann Acad Med Singap 43:15–23PubMed
20.
go back to reference Hoyle RH (1995) Structural equation modelling: concepts, issues and application. Sage Publications, Thousand Oaks Hoyle RH (1995) Structural equation modelling: concepts, issues and application. Sage Publications, Thousand Oaks
21.
go back to reference Pachman DR, Barton DL, Swetz KM, Loprinzi CL (2012) Troublesome symptoms in cancer survivors: fatigue, insomnia, neuropathy, and pain. J Clin Oncol 30(30):3687–3696CrossRefPubMed Pachman DR, Barton DL, Swetz KM, Loprinzi CL (2012) Troublesome symptoms in cancer survivors: fatigue, insomnia, neuropathy, and pain. J Clin Oncol 30(30):3687–3696CrossRefPubMed
22.
go back to reference Ganz PA, Kwan L, Stanton AL, Bower JE, Belin TR (2011) Physical and psychosocial recovery in the year after primary treatment of breast cancer. J Clin Oncol 29(9):1101–1109CrossRefPubMedPubMedCentral Ganz PA, Kwan L, Stanton AL, Bower JE, Belin TR (2011) Physical and psychosocial recovery in the year after primary treatment of breast cancer. J Clin Oncol 29(9):1101–1109CrossRefPubMedPubMedCentral
23.
go back to reference Ganz PA, Kwan L, Stanton AL, Bower JE, Belin TR (2000) Fatigue in breast cancer survivors: occurrence, correlates, and impact of quality of life. J Clin Oncol 18(4):743–753CrossRefPubMed Ganz PA, Kwan L, Stanton AL, Bower JE, Belin TR (2000) Fatigue in breast cancer survivors: occurrence, correlates, and impact of quality of life. J Clin Oncol 18(4):743–753CrossRefPubMed
24.
go back to reference Stone P, Richardson A, Ream E, Smith AG, Kerr DJ, Kearney N (2000) Cancer-related fatigue: inevitable, unimportant and untreatable? Results of a multi-centre patient survey. Ann Oncol 11(8):971–975CrossRefPubMed Stone P, Richardson A, Ream E, Smith AG, Kerr DJ, Kearney N (2000) Cancer-related fatigue: inevitable, unimportant and untreatable? Results of a multi-centre patient survey. Ann Oncol 11(8):971–975CrossRefPubMed
25.
go back to reference Kim Y, Hickok JT, Morrow G (2006) Fatigue and depression in cancer patients undergoing chemotherapy: an emotion approach. J Pain Symptom Manag 32(4):311–321CrossRef Kim Y, Hickok JT, Morrow G (2006) Fatigue and depression in cancer patients undergoing chemotherapy: an emotion approach. J Pain Symptom Manag 32(4):311–321CrossRef
26.
27.
go back to reference Girgis A, Boyes A, Sanson-Fisher RW, Burrows S (2000) Perceived needs of women diagnosed with breast cancer: rural versus urban location. Aust N Z J Public Health 24(2):166–173CrossRefPubMed Girgis A, Boyes A, Sanson-Fisher RW, Burrows S (2000) Perceived needs of women diagnosed with breast cancer: rural versus urban location. Aust N Z J Public Health 24(2):166–173CrossRefPubMed
28.
go back to reference Armes J, Crowe M, Colbourne L, Morgan H, Murrells T, Oakley C, Palmer N, Ream E, Young A, Richardson A (2009) Patients’ supportive care needs beyond the end of cancer treatment: a prospective longitudinal survey. J Clin Oncol 27(36):6172–6179CrossRefPubMed Armes J, Crowe M, Colbourne L, Morgan H, Murrells T, Oakley C, Palmer N, Ream E, Young A, Richardson A (2009) Patients’ supportive care needs beyond the end of cancer treatment: a prospective longitudinal survey. J Clin Oncol 27(36):6172–6179CrossRefPubMed
29.
go back to reference Thewes B, Butow P, Girgis A, Pendlebury S (2004) The psychosocial needs of breast cancer survivors: a qualitative study of the shared and unique needs of younger versus older survivors. Psycho-Oncology 13(3):177–189CrossRefPubMed Thewes B, Butow P, Girgis A, Pendlebury S (2004) The psychosocial needs of breast cancer survivors: a qualitative study of the shared and unique needs of younger versus older survivors. Psycho-Oncology 13(3):177–189CrossRefPubMed
30.
go back to reference Yoon J, Malin JL, Tisnado DM, Tao ML, Adams JL, Timmer MJ, Ganz PA, Kahn KL (2008) Symptom management after breast cancer treatment: is it influenced by patient characteristics? Breast Cancer Res Treat 108(1):69–77CrossRefPubMed Yoon J, Malin JL, Tisnado DM, Tao ML, Adams JL, Timmer MJ, Ganz PA, Kahn KL (2008) Symptom management after breast cancer treatment: is it influenced by patient characteristics? Breast Cancer Res Treat 108(1):69–77CrossRefPubMed
31.
go back to reference Schmid-Buchi S, Halfens RJ, Dassen T, van den Borne B (2011) Psychosocial problems and needs of posttreatment patients with breast cancer and their relatives. Eur J Oncol Nurs 15(3):260–266CrossRefPubMed Schmid-Buchi S, Halfens RJ, Dassen T, van den Borne B (2011) Psychosocial problems and needs of posttreatment patients with breast cancer and their relatives. Eur J Oncol Nurs 15(3):260–266CrossRefPubMed
32.
go back to reference Philips KM, McGinty HL, Gonzalez BD, Jim HSL, Small BJ, Minton S, Andrykowski MA, Jacobsen PB (2013) Factors associated with breast cancer worry 3 years after completion of adjuvant treatment. Psycho-Oncology 22(4):936–939CrossRef Philips KM, McGinty HL, Gonzalez BD, Jim HSL, Small BJ, Minton S, Andrykowski MA, Jacobsen PB (2013) Factors associated with breast cancer worry 3 years after completion of adjuvant treatment. Psycho-Oncology 22(4):936–939CrossRef
33.
go back to reference Dunn LB, Langford DJ, Paul SM, Berman MB, Shumay DM, Kober K, Merriman JD, West C, Neuhaus JM, Miaskowski C (2014) Trajectories of fear of recurrence in women with breast cancer. Support Care Cancer. doi:10.1007/s00520-014-2513-8 Dunn LB, Langford DJ, Paul SM, Berman MB, Shumay DM, Kober K, Merriman JD, West C, Neuhaus JM, Miaskowski C (2014) Trajectories of fear of recurrence in women with breast cancer. Support Care Cancer. doi:10.​1007/​s00520-014-2513-8
34.
go back to reference Sanson-Fisher R, Girgis A, Boyes A, Bonevski B, Burton L, Cook P (2000) The unmet supportive care needs of patients with cancer. Cancer 88(1):226–237CrossRefPubMed Sanson-Fisher R, Girgis A, Boyes A, Bonevski B, Burton L, Cook P (2000) The unmet supportive care needs of patients with cancer. Cancer 88(1):226–237CrossRefPubMed
35.
go back to reference Gray RE, Fitch M, Greenberg M, Hampson A, Doherty M, Labrecque M (1998) The information needs of well, longer-term survivors of breast cancer. Patient Educ Couns 33(3):245–255CrossRefPubMed Gray RE, Fitch M, Greenberg M, Hampson A, Doherty M, Labrecque M (1998) The information needs of well, longer-term survivors of breast cancer. Patient Educ Couns 33(3):245–255CrossRefPubMed
36.
go back to reference Yeom H, Heidrich SM (2009) Effect of perceived barriers to symptom management on quality of life in older breast cancer survivors. Cancer Nurs 23(4):309–316CrossRef Yeom H, Heidrich SM (2009) Effect of perceived barriers to symptom management on quality of life in older breast cancer survivors. Cancer Nurs 23(4):309–316CrossRef
37.
go back to reference So WKW, Chow KM, Chan HYL, Choi KC, Wan RWM, Mak SSS, Chair SY, Chan CWH (2014) Quality of life and most prevalent unmet needs of Chinese breast cancer survivors at one year after cancer treatment. Eur J Oncol Nurs 18:323–328CrossRefPubMed So WKW, Chow KM, Chan HYL, Choi KC, Wan RWM, Mak SSS, Chair SY, Chan CWH (2014) Quality of life and most prevalent unmet needs of Chinese breast cancer survivors at one year after cancer treatment. Eur J Oncol Nurs 18:323–328CrossRefPubMed
38.
go back to reference Akechi T, Okuyama T, Endo C, Sagawa R, Uchida M, Nakaguchi T, Akazawa T, Yamashita H, Toyama T, Furukawa TA (2011) Patient’s perceived need and psychological distress and/or quality of life in ambulatory breast cancer patients in Japan. Psycho-Oncology 20:497–505CrossRefPubMed Akechi T, Okuyama T, Endo C, Sagawa R, Uchida M, Nakaguchi T, Akazawa T, Yamashita H, Toyama T, Furukawa TA (2011) Patient’s perceived need and psychological distress and/or quality of life in ambulatory breast cancer patients in Japan. Psycho-Oncology 20:497–505CrossRefPubMed
Metadata
Title
Unmet needs mediate the relationship between symptoms and quality of life in breast cancer survivors
Authors
K. K. F. Cheng
W. H. Wong
C. Koh
Publication date
01-05-2016
Publisher
Springer Berlin Heidelberg
Published in
Supportive Care in Cancer / Issue 5/2016
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-015-2994-0

Other articles of this Issue 5/2016

Supportive Care in Cancer 5/2016 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine