title: Patterns, correlates, and prognostic significance of quality of life following breast cancer.
abstract: OBJECTIVE
  To describe quality of life (QOL) over a 12-month period among women with breast cancer, consider the association between QOL and overall survival (OS), and explore characteristics associated with QOL declines.
  
  
  METHODS
  A population-based sample of Australian women (n=287) with invasive, unilateral breast cancer (Stage I+) was observed prospectively for a median of 6.6 years. QOL was assessed at 6, 12, and 18 months post-diagnosis, using the Functional Assessment of Cancer Therapy, Breast (FACT-B+4) questionnaire. Raw scores for the FACT-B+4 and subscales were computed and individuals were categorized according to whether QOL declined, remained stable or improved between 6 and 18 months. Kaplan-Meier and Cox proportional hazards survival methods were used to estimate OS and its associations with QOL. Logistic regression models identified factors associated with QOL decline.
  
  
  RESULTS
  Within FACT-B+4 subscales, between 10% and 23% of women showed declines in QOL. Following adjustment for established prognostic factors, emotional well-being and FACT-B+4 scores at 6 months post-diagnosis were associated with OS (p<0.05). Declines in physical (p<0.01) or functional (p=0.02) well-being between 6 and 18 months post-diagnosis were also associated significantly with OS. Receiving multiple forms of adjuvant treatment, a perception of not handling stress well and reporting one or more other major life events at 6 months post-diagnosis were factors associated with declines in QOL in multivariable analyses.
  
  
  CONCLUSIONS
  Interventions targeted at preventing QOL declines may ultimately improve quantity as well as quality of life following breast cancer.
authors.affiliation: Institute of Health and Biomedical Innovation, Queensland University of Technology, Queensland, Australia. t.disipio@qut.edu.au
authors.forename: Tracey
authors.initials: T
authors.lastname: DiSipio
authors.forename: Sandi
authors.initials: S
authors.lastname: Hayes
authors.forename: Diana
authors.initials: D
authors.lastname: Battistutta
authors.forename: Beth
authors.initials: B
authors.lastname: Newman
authors.forename: Monika
authors.initials: M
authors.lastname: Janda
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000367:Age Factors; D001943:Breast Neoplasms / Q000175:diagnosis / Q000523:psychology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008016:Life Change Events; D016015:Logistic Models; D008137:Longitudinal Studies; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D011788:Quality of Life / Q000523:psychology*; D011793:Queensland; D013315:Stress, Psychological / Q000209:etiology / Q000523:psychology