Study Identifies Factors Influencing Quality of Life for Young Breast Cancer Survivors

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Oftentimes, the quality of life (QOL) of young breast cancer survivors (YBCS) may be worse than those of older breast cancer survivors or age-matched peers without a history of breast cancer. Although family units may support YBCS—especially during treatment—there is little known about the long-term YBCS’s and family member’s QOL. Authors of a study published in Cancer Medicine examined potential factors that could influence QOL of long-term YBCS and their female first- or second-degree biological relatives.

According to the authors, this is a secondary analysis of baseline and 18-month follow-up data from a randomized controlled trial (RCT). The purpose is to increase genetic awareness among YBCS and first- and second-degree relatives. A random sample of 3000 YBCS was obtained from the Michigan Cancer Surveillance Program (stage cancer registry) and YBSC were invited to enroll in the RCT. Additionally, relatives were eligible to participate if they were female, first- or second-degree relatives of the YBSC, aged 25 to 64 years, and cancer-free at the time of recruitment.

A total of 883 individuals agreed to participate, and of these, 573 YBCS participated in the RCT alone and were excluded in the present analysis. The final sample enrolled includes 189 family units consisting of a YBSC and a relative (dyads), and 121 family units with a YBSC and 2 relatives (triads). Additionally, most (84.2%) of the enrolled relatives were first-degree relatives and included sisters (n = 231; 53.6%), daughters (n = 123; 28.5%), nieces (n = 41; 9.5%), half-sisters (n = 14; 3.2%), aunts (n = 13; 3.0%), and mothers (n = 9; 2.1%).

Both the physical and mental QOL of YBSC and relatives were assessed at baseline and 18-month follow-up with the Short-Form Health Survey (SF-12), which consisted of 12 items that assess 8 domains: physical functioning; physical role function; bodily pain; general health perception; vitality; social functioning; emotional role functioning; and mental health. Individual domain scores were used to create a physical and mental QOL composite score. Scores ranged from 0 to 100, with higher scores indicating a better QOL.

At baseline, YBSC were much older than relatives in the dyadic sample (mean ages: 51.7 vs 43.8 years), and although they reported a much lower physical QOL compared with their relatives (mean score: 48.7 vs 51.5), there were no differences between the average mental QOL scores (48.7 vs 49.2). Similarly, YBCS and older relatives were much older than younger relatives (50.9 vs 48.9 vs 37.1 years) in the triads. The YBCS’s physical QOLs were similar to those of their older relatives (50.9 vs 49.2), but they were much lower when compared with their younger relatives (50.9 vs 53.9). There were no differences between the mental QOL scores of YBCS, older relatives, and younger relatives (51.1 vs 51.9 vs 51.0).

Additionally, the authors observed that in the dyads, YBCS’s age, physical QOL, and lack of cost-related barriers to health care at baseline were positive predictors of their own physical QOL at follow-up. Alternatively, years after their cancer diagnosis and their perceived breast cancer risk at baseline were negative predictors of YBCS’s own physical QOL at follow-up. For relatives, physical QOL, income, history of anxiety, and family support at baseline were positive predictors of their own physical QOL at follow-up.

For dyad YBCS, mental QOL, and being married or living as married at baseline were positive predictors of their own mental QOL at follow-up, and age was a negative predictor. For relatives, mental QOL at baseline was a positive predictor, and history of anxiety was a negative predictor of their own mental QOL.

Additionally, triad YBCS’s baseline physical QOL was positively associated with their own physical QOL at follow-up, and both older and younger relatives’ physical QOL and income at baseline were positive predictors of their own physical QOL at follow-up. Additionally, younger relatives’ ages and marriage status (being married or living as married) at baseline were negative predictors of their own physical QOL at follow-up.

For triad YBCS, mental QOL at baseline was a positive indicator of their own mental QOL at follow-up, and similar findings were present among both older and younger relatives. Older relatives’ education as well as their history of anxiety and depression were negatively associated with their own mental QOL at follow-up. Additionally, years since the YBCS’s cancer diagnosis at baseline was positively associated with older relatives’ mental QOL at follow-up, indicated that a longer time since diagnosis predicted a better mental QOL in older relatives. Further, fear of cancer recurrence at baseline was negatively associated with younger relative’s mental QOL at follow-up. Further, lack of cost-related barriers to health care and history of anxiety among older relatives was negatively associated with YBCS’s mental QOL at follow-up.

According to the authors, additional family relationships—forming family units larger than triads—could have been included to better evaluate the health of families during cancer survivorship. Additionally, some effects were not present in the dyads but were in the triads, possibly because of the smaller unit size. The authors also noted that YBCS who enrolled as dyads may have done so because they might not have had as many connections or supportive relationships compared with those who enrolled as triads. They suggested that future studies should also focus on the long-term outcomes of a cancer diagnosis at a young age and its effects on the individual and their family. Additionally, larger samples and family units may better represent variations among participants.

REFERENCE

Ellis KR, Koechlin H, Rudaz M, et al. Predictors and Interdependence of Quality of Life in a Random Sample of Long-Term Young Breast Cancer Survivors and Their Biological Relatives. Cancer Med, 2024;13:e70328. doi:10.1002/cam4.70328