title: Prospective changes in quality of life after ductal carcinoma-in-situ: results from the Nurses' Health Study.
abstract: OBJECTIVE
  The incidence of ductal carcinoma-in-situ (DCIS) of the breast has been increasing. However, uncertainties exist about its prognosis, optimal treatment, and effect on women's health-related quality-of-life (HRQoL). Our study assessed the prospective changes in HRQoL in women diagnosed with DCIS.
  
  
  METHODS
  Between 1992 and 2000, HRQoL was assessed at three 4-year intervals among women enrolled in two Nurses' Health Study cohorts using the Medical Outcomes Survey Short-Form 36 health survey. Using mixed effects and logistic regression modeling, we compared the prospective changes in HRQoL scores among women with and without DCIS.
  
  
  RESULTS
  The study included 114,728 women; 510 were diagnosed with DCIS during the study period. During 4 years, women with DCIS had small, but statistically significantly greater declines in the domains of role limitations due to physical problems (-6.74; SE, 1.69), vitality (-2.06; SE, 0.78), and social functioning (-2.40; SE, 0.93) than women without DCIS. Among those with DCIS, clinically significant declines were more often observed within 6 months of the diagnosis in the domains of social functioning (odds ratio, 1.78; 95% CI, 1.03 to 3.07) and mental health (odds ratio, 2.03; 95% CI, 1.09 to 3.79) than after 6 months after diagnosis.
  
  
  CONCLUSIONS
  Women with DCIS experienced small long-term declines in HRQoL, although these declines did not seem to be clinically important. Short-term clinically significant declines in the psychosocial domains were noted. In counseling women with DCIS, clinicians should provide reassurance but prepare them to deal with the short-term sequelae.
authors.affiliation: Department of Ambulatory Care and Prevention, Harvard Medical School/Harvard Pilgrim Health Care, Boston, MA 02215, USA. larissa_nekhlyudov@harvardpilgrim.org
authors.forename: Larissa
authors.initials: L
authors.lastname: Nekhlyudov
authors.forename: Candyce H
authors.initials: CH
authors.lastname: Kroenke
authors.forename: Inkyung
authors.initials: I
authors.lastname: Jung
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Holmes
authors.forename: Graham A
authors.initials: GA
authors.lastname: Colditz
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000523:psychology* / Q000628:therapy; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000523:psychology* / Q000628:therapy; D015331:Cohort Studies; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008875:Middle Aged; D011788:Quality of Life