title: Health-related quality of life in breast cancer: A cross-cultural survey of German, Japanese, and South Korean patients.
abstract: OBJECTIVE
  The aim of this study was to evaluate health-related quality of life (HRQOL) in breast cancer patients across countries, and to cross-culturally examine the impact of psychosocial factors on HRQOL.
  
  
  METHODS
  A total of 413 women with breast cancer from Germany (n = 195), Japan (n = 112), and Korea (n = 106) completed a survey assessing HRQOL and HRQOL-related factors. HRQOL was measured using the Short-Form Health Survey (SF-8). Measures of psychological distress (Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised), coping (Dealing with Illness Inventory-German Revised), and social support (Illness-Specific Social Support Scale-German Revised) were included.
  
  
  RESULTS
  The effect of the factor country on physical QOL was seen to be significant, but small (P = 0.049, ES = 0.018). The scales of General Health (P = 0.023), Vitality (P = 0.004), and Role Emotional (P = 0.003) differed across countries, with the South Korean patients having lower scores compared to the German and Japanese patients. The nature of the impact of psychosocial factors on HRQOL did not differ greatly across countries except with regard to avoidance, however, the degree to which these factors influence HRQOL did differ greatly. Overall, depression, depressive coping, and problematic support showed a strong detrimental effect on the HRQOL of breast cancer patients.
  
  
  CONCLUSIONS
  Results from this study suggest that strategies which target an improvement of HRQOL in cancer patients should also consider the patients' cultural and healthcare system contexts. Interventions are needed to improve detrimental psychosocial factors.
authors: Institute of Medical Psychology, University Medical Center Hemburg-Eppendorf, Martinistr,52-S35, 20246, Hamburg, Germany.
authors: Eun-Jung
authors: EJ
authors: Shim
authors: Anja
authors: A
authors: Mehnert
authors: Atsuko
authors: A
authors: Koyama
authors: Seong-Jin
authors: SJ
authors: Cho
authors: Hiroki
authors: H
authors: Inui
authors: Nam-Sun
authors: NS
authors: Paik
authors: Uwe
authors: U
authors: Koch