Study On Improving Quality Of Life In Community Breast Cancer Patients

Part I Impact of lifestyle behaviors and comorbidity on quality of life in community breast cancer patientsObjective:To analyze the impact of lifestyle behaviors and comorbidity on quality of life in community breast cancer patients, and to discuss the strategies and measures to improve quality of life in community breast cancer patients.Methods:A cross-sectional study was conducted among community breast cancer patients between April and July 2013, in Shanghai, China. Patients were sampled from community cancer rehabilitation organizations in all 17 districts of Shanghai. Data was collected using a self-reported questionnaire, which included socio-demographic characteristics, situation of cancer diagnosis, treatment and rehabilitation, general health condition, lifestyle behaviors, EORTC QLQ-C30 (V3.0) Simplified Chinese version and FACT-G (Fourth Edition) Simplified Chinese version. A total of 3344 valid questionnaires were collected. Crude quality of life scores were compared between groups. General linear models were used to estimate the least square mean, the adjusted mean difference and standard error, and to test the difference between groups and the interaction of lifestyle behaviors and comorbidity on quality of life.Results:1. Breast cancer patients who exercised reported significantly higher EORTC physical functioning scores, role functioning scores, emotional functioning scores, global health scores, and FACT-G physical well-being scores, social well-being scores, emotional well-being scores, functional well-being scores, FACT-G total scores than patients who didn’t exercise (P<0.05, PAdjusted<0.05). Breast cancer patients who exercised more than or equal 5 times/week reported significantly higher EORTC role functioning scores, cognitive functioning scores, emotional functioning scores, global health scores and FACT-G physical well-being scores, functional well-being scores, FACT-G total scores than patients who exercised less than 5 times/week (P<0.05, PAdjusted<0.05).2. Breast cancer patients who ate more than 250g vegetables reported significantly higher EORTC physical functioning scores, cognitive functioning scores, emotional functioning scores, global health scores, and FACT-G social well-being scores, function well-being scores, FACT-G total scores than patients who ate equal or less than 250g vegetables (P<0.05, PAdjusted<0-05). Breast cancer patients who ate fruit everyday reported significantly higher EORTC physical functioning scores, role functioning scores, cognitive functioning scores, emotional functioning scores, social functioning scores, global health scores, and FACT-G physical well-being scores, social well-being scores, emotional well-being scores, functional well-being scores, FACT-G total scores than patients who didn’t eat fruit everyday (P<0.05, PAdjusted< 0.05).3. Comorbidity, including hypertension, hyperlipidemia, hyperuricemia, diabetes, heart disease, stroke, respiratory system disease, liver and gastrointestinal system disease, musculoskeletal system disease, had significant impacts on multiple dimension scores and total scores of quality of life in community breast cancer patients. Patients who had comorbidity reported significantly lower quality of life than patients without comorbidity, especially the EORTC physical functioning scores, emotional functioning scores, global health scores, and FACT-G physical well-being scores, FACT-G total scores (P<0.01, PAdjusted<0.01).4. Almost all dimension scores and total scores of quality of life were inversely associated with the number of the types of comorbidities, except FACT-G social well-being scores. With the increasing number of the types of comorbidities, the quality of life decreased. The P-value of Trend test was 0.0001.5. Physical exercise and comorbidity had a significant interaction on FACT-G social well-being scores, functional well-being scores and FACT-G total scores in breast cancer patients (P values were 0.0205,0.0181,0.0176). The adjusted mean difference of SWB, FWB and FACT-G total scores, between patients who exercised and patients who didn’t exercise, was lower in patients who had comorbidity than that in patients who didn’t have comorbidity.Conclusion:Healthy lifestyle behaviors help improve quality of life in community breast cancer patients. Comorbidity has negative impacts on quality of life in patients. Healthy lifestyle behaviors, including engagement in physical exercise and increased intake of fruits and vegetables, should be promoted. Valuing comorbidity’s negative impacts on quality of life will be critical among breast cancer patients who have comorbidity.Part Ⅱ Evaluation on effect of psychosocial interventions on quality of life in breast cancer patientsObjective:To evaluate the effect of psychosocial interventions on quality of life in breast cancer patients by meta-analysis.Methods:Related randomized controlled trials(RCTs) were collected according to inclusion and exclusion criteria. Stata 11.0 was applied for combining the standardized mean difference (SMD) and determining heterogeneity.Results:6 RCTs and 658 patients were included. The middle-term(1-6 months) quality of life of intervention group was better than control group(SMD=0.268, 95%CI=0.101～0.436,P=0.002). The short-term(less than 1 month) effect was unclear because of poor instability in sensitivity analysis.Conclusion:After receiving psychosocial interventions, the middle-term quality of life in breast cancer patients was improved, while the short-term effect is unclear. Psychosocial interventions can be implemented as tertiary prevention content in breast cancer patients.