Quality of Life in Younger Breast Cancer Survivors
Background Breast cancer is the most common cancer in women younger than age 50 years. Cancer treatments in younger women may cause premature menopause, infertility, and negative psychosocial effects. In this systematic review, we examined three key domains of functioning that are particularly relevant for younger breast cancer survivors: health-related quality of life (QOL), menopausal symptoms and fertility concerns, and behavioral health outcomes.
Methods We conducted a literature review using PubMed and secondary sources and examined 840 articles published between January 1990 and July 2010. Inclusion criteria for articles were 1) published in English after 1989; 2) exclusively analyzed female breast cancer survivors aged 50 years or younger or premenopausal at diagnosis, with baseline characteristics and/or quantitative or descriptive analyses for this age group; 3) investigated QOL (health-related QOL including physical functioning and mental health, depression, and anxiety), menopause- or fertility-related concerns, and weight gain or physical activity-related behavioral health outcomes. Data were extracted using a standardized table collecting the purpose, design, population, and results of each study. Extracted data were reviewed for accuracy by two investigators and presented as descriptive tables.
Results A total of 28 articles met the inclusion criteria (15 cross-sectional studies, eight longitudinal studies, and five randomized trials). Regarding data review, no discordance between investigators was noted. Standardized measures of QOL and depressive symptoms identified worse outcomes as being more frequent or severe in breast cancer survivors aged 50 years or younger when compared with the general age-matched population of women without cancer and to older women (aged >50 years) with breast cancer. Concerns about premature menopause, menopausal symptoms, and infertility were common in younger women (aged ≤50 years) and had a role in the level of distress after treatment. Weight gain and physical inactivity were common health outcomes in younger women.
Conclusions Younger women with breast cancer were found to experience distinct psychosocial and menopause-related concerns, weight gain, and physical inactivity. A need for more longitudinal research, including efforts at intervention to manage these symptoms and adverse health outcomes, remains.
Breast cancer is the most common cancer in women, and for those younger than 50 years of age, it is the leading cause of death in the United States. However, the survival rate for these younger women with breast cancer has improved continuously over the past two decades, primarily because of the widespread introduction of adjuvant chemotherapy and endocrine therapies. Today many younger women can expect long-term survival; however, the quality of their lives may be hampered by premature menopause, infertility, negative psychosocial effects, and risk for recurrence and second episodes of primary breast cancer. From the perspective of cancer control, younger breast cancer survivors are an important target population for interventions that focus on physical and psychological symptom relief, cancer prevention, and risk reduction.
To identify potential opportunities for cancer prevention and control interventions in this population, we undertook a systematic review of the literature focused on potentially mutable outcomes. We were particularly interested in the impact of breast cancer on health-related quality of life (QOL) (ie, physical functioning and emotional well-being, depression, and anxiety), unique psychosocial difficulties related to treatment-associated reproductive changes (ie, onset of menopause and its symptoms, concerns about menopause and fertility), and modifiable behavioral health outcomes (specifically weight gain and lack of physical activity). Although there is no generally accepted definition for "younger women with breast cancer," we chose to use the chronological age of younger than 51 years (the average age of menopause) and/or premenopausal, to define "younger women" in this review and be as inclusive as possible in capturing the experience of these women who have been diagnosed with breast cancer (note that some researchers consider younger than 40 years as being "young age"). The purpose of this review was to highlight what is currently known, to identify gaps in the research literature, and to specify potential targets for intervention research and improvements in clinical care.
Abstract and Introduction
Abstract
Background Breast cancer is the most common cancer in women younger than age 50 years. Cancer treatments in younger women may cause premature menopause, infertility, and negative psychosocial effects. In this systematic review, we examined three key domains of functioning that are particularly relevant for younger breast cancer survivors: health-related quality of life (QOL), menopausal symptoms and fertility concerns, and behavioral health outcomes.
Methods We conducted a literature review using PubMed and secondary sources and examined 840 articles published between January 1990 and July 2010. Inclusion criteria for articles were 1) published in English after 1989; 2) exclusively analyzed female breast cancer survivors aged 50 years or younger or premenopausal at diagnosis, with baseline characteristics and/or quantitative or descriptive analyses for this age group; 3) investigated QOL (health-related QOL including physical functioning and mental health, depression, and anxiety), menopause- or fertility-related concerns, and weight gain or physical activity-related behavioral health outcomes. Data were extracted using a standardized table collecting the purpose, design, population, and results of each study. Extracted data were reviewed for accuracy by two investigators and presented as descriptive tables.
Results A total of 28 articles met the inclusion criteria (15 cross-sectional studies, eight longitudinal studies, and five randomized trials). Regarding data review, no discordance between investigators was noted. Standardized measures of QOL and depressive symptoms identified worse outcomes as being more frequent or severe in breast cancer survivors aged 50 years or younger when compared with the general age-matched population of women without cancer and to older women (aged >50 years) with breast cancer. Concerns about premature menopause, menopausal symptoms, and infertility were common in younger women (aged ≤50 years) and had a role in the level of distress after treatment. Weight gain and physical inactivity were common health outcomes in younger women.
Conclusions Younger women with breast cancer were found to experience distinct psychosocial and menopause-related concerns, weight gain, and physical inactivity. A need for more longitudinal research, including efforts at intervention to manage these symptoms and adverse health outcomes, remains.
Introduction
Breast cancer is the most common cancer in women, and for those younger than 50 years of age, it is the leading cause of death in the United States. However, the survival rate for these younger women with breast cancer has improved continuously over the past two decades, primarily because of the widespread introduction of adjuvant chemotherapy and endocrine therapies. Today many younger women can expect long-term survival; however, the quality of their lives may be hampered by premature menopause, infertility, negative psychosocial effects, and risk for recurrence and second episodes of primary breast cancer. From the perspective of cancer control, younger breast cancer survivors are an important target population for interventions that focus on physical and psychological symptom relief, cancer prevention, and risk reduction.
To identify potential opportunities for cancer prevention and control interventions in this population, we undertook a systematic review of the literature focused on potentially mutable outcomes. We were particularly interested in the impact of breast cancer on health-related quality of life (QOL) (ie, physical functioning and emotional well-being, depression, and anxiety), unique psychosocial difficulties related to treatment-associated reproductive changes (ie, onset of menopause and its symptoms, concerns about menopause and fertility), and modifiable behavioral health outcomes (specifically weight gain and lack of physical activity). Although there is no generally accepted definition for "younger women with breast cancer," we chose to use the chronological age of younger than 51 years (the average age of menopause) and/or premenopausal, to define "younger women" in this review and be as inclusive as possible in capturing the experience of these women who have been diagnosed with breast cancer (note that some researchers consider younger than 40 years as being "young age"). The purpose of this review was to highlight what is currently known, to identify gaps in the research literature, and to specify potential targets for intervention research and improvements in clinical care.
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