Elsevier

European Journal of Cancer

Volume 41, Issue 17, November 2005, Pages 2613-2619
European Journal of Cancer

Review
Quality of life among long-term breast cancer survivors: A systematic review

https://doi.org/10.1016/j.ejca.2005.05.017Get rights and content

Abstract

The aim of this study was to review the literature on quality of life among long-term survivors of breast cancer and identify the specific aspects of quality of life that were affected in these survivors. We also describe predictors of quality of life. Published research reports were included if they described the quality of life of breast cancer survivors diagnosed at least five years earlier. The methodological quality of the 10 selected studies, conducted between 1997 and 2004, was high according to a list of predefined criteria. Most studies reported that long-term survivors of breast cancer experienced good overall quality of life. However, almost all studies reported that breast cancer survivors experienced some specific problems (e.g., a thick and painful arm and problems with sexual functioning). The current medical condition, amount of social support and current income level were strong positive predictors of quality of life, and the use of adjuvant chemotherapy emerged as a negative predictor. More research on the specific medical and psychosocial needs of survivors is needed in order to be able to design appropriate intervention studies. If anything, this review shows that focusing on the long-term effects of breast cancer is important when evaluating the full extent of cancer treatment.

Introduction

Breast cancer is the most prevalent malignancy among women in the industrialized world. One out of every nine women will ultimately be diagnosed with breast cancer in the USA before the age of 85 [1], while this figure is 1 in 11 in Europe. The prevalence of breast cancer rises markedly with age from 3–4% at age 50–69 to 6% of women older than 70 [2]. The number of long-term survivors, defined by the American Cancer Society as every person who is still alive 5 years after diagnosis [1], is increasing rapidly due to the growing rates of detection and incidence; the marked increase in the number and proportion of elderly; and improved survival 2, 3. This is in part also due to advances in cancer treatment. The relative survival of women with breast cancer at five years after initial diagnosis is now 86% [4]. All in all, this has led to increasing numbers of individuals who are either cured of their cancer or are living with it as a chronic disease [5].

The increasing numbers of long-term breast cancer survivors urge the examination of the long-term effects of breast cancer and specific treatments. The latter may need to be adapted in case of severe long-term side effects. In addition, specific medical and psychosocial needs of survivors should be assessed to be able to optimise aftercare. The goal of this review was to identify the specific aspects of quality of life that were affected in long-term breast cancer survivors, and to identify predictors. We reviewed the literature on well-being of breast cancer survivors in a systematic way.

Section snippets

Search strategy

A computerised search of the literature was performed in Pubmed and PsychINFO from 1960 to May 2004. The term ‘breast cancer’ was used in combination with other key terms: survivors, long-term, quality of life, QoL, health-related quality of life, HRQoL, well-being. The reference lists of all identified publications were checked to retrieve other relevant publications, which were not identified by means of the computerised search.

Selection criteria

Studies were included if they described aspects of the quality of

Study characteristics

In total, 10 studies were included, all published after 1996. All but two 7, 11 were conducted in the USA. The main findings are summarised in Table 3. Quality of life was a primary endpoint in all studies. Four studies compared the quality of life between breast cancer survivors and the general population 6, 7, 10, 11. Two studies examined the quality of life between breast cancer survivors diagnosed at different ages 8, 12. In addition, one study specifically examined the role of ethnicity [9]

Discussion

This systematic review summarises the results of 10 studies on the quality of life of long-term survivors of breast cancer (i.e. >5 years). Most studies reported that long-term survivors of breast cancer experienced good overall quality of life. In general, it can be concluded that survivors with a high quality of life are probably those who did not need chemotherapy; who have no comorbid diseases; who received sufficient emotional support from family and friends; and who had a relatively high

Conflict of interest statement

None declared.

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