title: Applying a conceptual model for examining health-related quality of life in long-term breast cancer survivors: CALGB study 79804.
abstract: OBJECTIVE
  The Survivor's Health and Reaction study used a quality-of-life model adapted for cancer survivors by Dow and colleagues to identify factors related to global health-related quality of life (HRQL) and to document the prevalence of problems and health-oriented behaviors in a follow-up study of breast cancer patients who participated in CALGB 8541.
  
  
  METHODS
  A total of 245 survivors (78% of those invited) who were 9.4-16.5 years post-diagnosis completed surveys that inquired about current HRQL, economic, spiritual, physical and psychosocial concerns, and health-oriented behaviors (e.g. smoking, exercise, and supplement use). A regression model was developed to examine factors related to global HRQL across all domains.
  
  
  RESULTS
  The regression model revealed that decreased energy levels (odds ratio (OR)=1.05, 95% confidence interval (CI): 1.03, 1.07), having heart disease (OR=5.01, 95% CI: 1.39, 18.1), having two or more co-morbidities (OR=2.39, 95% CI: 1.10, 5.19), and lower social support (OR=1.03, 95% CI: 1.02, 1.05) were associated with lower global HRQL. Factors related to psychological, spiritual, and economic domains were not predictive of global HRQL. Regarding lifestyle changes, some women reported engaging in health-oriented behaviors since their cancer diagnosis, such as improving eating habits (54%), increasing exercise (32%), and reducing/quitting smoking (20%). The most prevalent problems reported by women at follow-up were menopausal symptoms (64%), such as hot flashes and vaginal dryness, osteoporosis (25%), and lymphedema (23%).
  
  
  CONCLUSIONS
  Suggestions are provided to target interventions, such as provider-based strategies, in order to improve HRQL in long-term breast cancer survivors.
authors.affiliation: The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210-1240, USA. electra.paskett@osumc.edu
authors.forename: Electra D
authors.initials: ED
authors.lastname: Paskett
authors.forename: James E
authors.initials: JE
authors.lastname: Herndon
authors.forename: Jeannette M
authors.initials: JM
authors.lastname: Day
authors.forename: Nancy N
authors.initials: NN
authors.lastname: Stark
authors.forename: Eric P
authors.initials: EP
authors.lastname: Winer
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Grubbs
authors.forename: Michael D
authors.initials: MD
authors.lastname: Pavy
authors.forename: Charles L
authors.initials: CL
authors.lastname: Shapiro
authors.forename: Marcy A
authors.initials: MA
authors.lastname: List
authors.forename: Martee L
authors.initials: ML
authors.lastname: Hensley
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Naughton
authors.forename: Alice B
authors.initials: AB
authors.lastname: Kornblith
authors.forename: Karleen R
authors.initials: KR
authors.lastname: Habin
authors.forename: Gini F
authors.initials: GF
authors.lastname: Fleming
authors.forename: Marisa A
authors.initials: MA
authors.lastname: Bittoni
mesh_terms: D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000523:psychology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D002979:Climacteric / Q000523:psychology; D003131:Combined Modality Therapy; D015897:Comorbidity; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D008875:Middle Aged; D009367:Neoplasm Staging; D011788:Quality of Life / Q000523:psychology*; D016032:Randomized Controlled Trials as Topic; D012803:Sick Role; D012944:Social Support; D012959:Socioeconomic Factors; D029181:Spirituality; D017741:Survivors / Q000523:psychology*