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      Determinants of Quality of Life for Breast Cancer Patients in Shanghai, China

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          Abstract

          Purpose

          To evaluate the association of social support status, health insurance and clinical factors with the quality of life of Chinese women with breast cancer.

          Methods

          Information on demographics, clinical characteristics, and social support status was collected from 1,160 women with newly diagnosed breast cancer in Shanghai, China. The Perceived Social Support Scale was used to assess different sources of social support for breast cancer patients. The quality of life was evaluated using the Functional Assessment of Cancer Therapy-Breast Cancer that consisted of five domains: breast cancer-specific, emotional, functional, physical, and social & family well-being. Multivariate linear regression models were used to evaluate the associations of demographic variables, clinical characteristics, and social support status with the quality of life measures.

          Results

          Adequate social support from family members, friends and neighbors, and higher scores of Perceived Social Support Scale were associated with significantly improved quality of life of breast cancer patients. Higher household income, medical insurance plans with low copayment, and treatment with traditional Chinese medicine for breast cancer all were associated with higher (better) scores of quality of life measures whereas patients receiving chemotherapy had significantly lower scores of quality of life.

          Conclusion

          Social support and financial aids may significantly improve the quality of life of breast cancer survivors.

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          Most cited references30

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          Quality of life in long-term, disease-free survivors of breast cancer: a follow-up study.

          Women with breast cancer are the largest group of female survivors of cancer. There is limited information about the long-term quality of life (QOL) in disease-free breast cancer survivors. Letters of invitation were mailed to 1336 breast cancer survivors who had participated in an earlier survey and now were between 5 and 10 years after their initial diagnosis. The 914 respondents interested in participating were then sent a survey booklet that assessed a broad range of QOL and survivorship concerns. All P values were two-sided. A total of 817 women completed the follow-up survey (61% response rate), and the 763 disease-free survivors in that group, who had been diagnosed an average of 6.3 years earlier, are the focus of this article. Physical well-being and emotional well-being were excellent; the minimal changes between the baseline and follow-up assessments reflected expected age-related changes. Energy level and social functioning were unchanged. Hot flashes, night sweats, vaginal discharge, and breast sensitivity were less frequent. Symptoms of vaginal dryness and urinary incontinence were increased. Sexual activity with a partner declined statistically significantly between the two assessments (from 65% to 55%, P =.001). Survivors with no past systemic adjuvant therapy had a better QOL than those who had received systemic adjuvant therapy (chemotherapy, tamoxifen, or both together) (physical functioning, P =.003; physical role function, P =.02; bodily pain, P =.01; social functioning, P =.02; and general health, P =.03). In a multivariate analysis, past chemotherapy was a statistically significant predictor of a poorer current QOL (P =.003). Long-term, disease-free breast cancer survivors reported high levels of functioning and QOL many years after primary treatment. However, past systemic adjuvant treatment was associated with poorer functioning on several dimensions of QOL. This information may be useful to patients and physicians who are engaging in discussion of the risks and benefits of systemic adjuvant therapy.
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            Breast cancer in younger women: reproductive and late health effects of treatment.

            In 1997, we initiated a cohort study to evaluate quality of life (QOL) and reproductive health outcomes in younger female breast cancer survivors. Using listings from two tumor registries, we recruited women with stage 0, I, or II breast cancer who were 50 years or younger at diagnosis and were also disease-free survivors for 2 to 10 years. A mailed survey questionnaire assessed medical and demographic factors, health-related QOL, mood, outlook on life, and reproductive health outcomes. We recruited 577 women, who ranged in age from 30 to 61.6 years (mean, 49.5 years) and were surveyed approximately 6 years after diagnosis. Almost three fourths had received some form of adjuvant therapy. Amenorrhea occurred frequently as a result of treatment in women > or = 40 years at diagnosis, and treatment-associated menopause was associated with poorer health perceptions. Across the cohort, physical functioning was quite good, but the youngest women experienced poorer mental health (P =.0002) and less vitality (energy; P =.03). Multiple regression analyses predicting QOL demonstrated better outcomes in African-American women, married or partnered women, and women with better emotional and physical functioning, whereas women who reported greater vulnerability had poorer QOL. Overall QOL in younger women who survive breast cancer is good, but there is evidence of increased emotional disruption, especially among the youngest women. Factors that may contribute to poorer health perceptions and QOL include experiencing a menopausal transition as part of therapy, and feeling more vulnerable after cancer.
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              Quality of life: concepts and definition.

              After years of second-class status, supportive care is increasingly being recognized for its importance. Included in this recognition is a concern for making more explicit the long-held conviction within medicine that no goal can logically be more important than optimal patient functioning and well-being. This effort to make more explicit the timeless value of medical care has evolved over the past two decades, and come to be labeled "quality of life" research. At its most fundamental level, quality of life is understood to be both subjective and multidimensional. Because it is subjective, it is best measured from the patient's perspective. Because it is multidimensional, its measurement requires the investigator to inquire about a range of areas of the patient's life, including physical well-being, functional ability, emotional well-being, and social well-being. The usual concern for symptom control, familiar to the palliative-care physician, can conceptually be expanded into a consideration of costs and benefits of various treatment options relative to their subjective perception of personal function and well-being. As our interest turns to the aggressive alleviation of specific ("target") symptoms, we must critically evaluate the complex relationships among symptom intensity, symptom duration, and overall quality of life.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                15 April 2016
                2016
                : 11
                : 4
                : e0153714
                Affiliations
                [1 ]Shanghai Pudong New Area Center for Disease Control and Prevention, Shanghai, China
                [2 ]Division of Cancer Control and Population Sciences, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania, United States of America
                [3 ]School of Bioscience and Bioengineering, South China University of Technology, Guangzhou, China
                [4 ]Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
                [5 ]Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
                Sudbury Regional Hospital, CANADA
                Author notes

                Competing Interests: All authors declare that they have no competing or conflicts of interest.

                Conceived and designed the experiments: BY QS. Performed the experiments: BY QS LMY LPH CY LHW ZW XPL. Analyzed the data: BY JMY QS LMY LPH CY LHW ZW XPL. Wrote the paper: JMY BY LMY LPH CY LQ LHW ZW XPL YTG QS.

                Article
                PONE-D-15-38061
                10.1371/journal.pone.0153714
                4833339
                27082440
                b3a360ff-13ce-474e-acfc-b31abb4c4098
                © 2016 Yan et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 14 September 2015
                : 1 April 2016
                Page count
                Figures: 0, Tables: 5, Pages: 14
                Funding
                Funded by: Pudong Health Bureau of Shanghai (Young Medical Talents Training Program)
                Award ID: PWRq2012-24
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000054, National Cancer Institute;
                Award ID: R01CA144034
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000054, National Cancer Institute;
                Award ID: UM1CA182876
                Award Recipient :
                Funded by: Pudong Health and Family Planning Commission of Shanghai
                Award ID: PWZz2013-15
                Award Recipient :
                This work was supported by award number PWRq2012-24 of the Young Medical Talents Training Program of the Pudong Health Bureau of Shanghai (BY). Research reported in this publication was also partially supported by the National Cancer Institute of the National Institutes of Health under award numbers R01CA144034 and UM1CA182876 (J-MY). Grant number: PWZz2013-15. Funding agency: Pudong Health and Family Planning Commission of Shanghai Funding to QS.
                Categories
                Research Article
                Medicine and Health Sciences
                Oncology
                Cancers and Neoplasms
                Breast Tumors
                Breast Cancer
                Medicine and Health Sciences
                Oncology
                Cancer Detection and Diagnosis
                Medicine and Health Sciences
                Health Care
                Quality of Life
                Social Sciences
                Economics
                Health Economics
                Health Insurance
                Medicine and Health Sciences
                Health Care
                Health Economics
                Health Insurance
                Medicine and Health Sciences
                Oncology
                Medicine and Health Sciences
                Oncology
                Cancer Treatment
                People and Places
                Geographical Locations
                Asia
                China
                Medicine and Health Sciences
                Oncology
                Cancer Treatment
                Chemotherapy
                Medicine and Health Sciences
                Clinical Medicine
                Clinical Oncology
                Chemotherapy
                Medicine and Health Sciences
                Oncology
                Clinical Oncology
                Chemotherapy
                Medicine and Health Sciences
                Pharmaceutics
                Drug Therapy
                Chemotherapy
                Custom metadata
                Due to identifying patient information, data is available upon request to the corresponding author Dr. Jian-Min Yuan.

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