title: Quality of life after breast cancer diagnosis and survival.
abstract: OBJECTIVE
  To examine the association of quality of life (QOL) after diagnosis of breast cancer with mortality and recurrence.
  
  
  METHODS
  From 2002 to 2004, a total of 2,230 breast cancer survivors completed the General Quality of Life Inventory-74 6 months after diagnosis as part of the Shanghai Breast Cancer Survivor Study. Also collected at baseline was information on demographic and clinical characteristics. At 36 months postdiagnosis, 1,845 of these women were re-evaluated for QOL. Outcomes were ascertained by in-person interview and record linkage to the vital statistics registry. The association of QOL with total mortality and cancer recurrence was assessed by using Cox regression analysis.
  
  
  RESULTS
  During a median follow-up of 4.8 years after the 6-month postdiagnosis QOL assessment, 284 deaths were identified. Recurrence was documented in 267 patients after 108 patients with stage IV breast cancer or recurrence before study enrollment were excluded. Women with the highest tertile of social well-being QOL score, compared with those with the lowest score, had a 38% decreased risk of mortality (95% CI, 0.46 to 0.85; P for trend = .002) and a 48% decreased risk of breast cancer recurrence (95% CI, 0.38 to 0.71; P for trend < .001). QOL assessed at 36 months postdiagnosis was not significantly associated with subsequent risk of mortality or recurrence.
  
  
  CONCLUSIONS
  Social well-being in the first year after cancer diagnosis is a significant prognostic factor for breast cancer recurrence or mortality, suggesting a possible avenue of intervention by maintaining or enhancing social support for women soon after their breast cancer diagnosis to improve disease outcomes.
authors.affiliation: Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN 37203, USA. meira.epplein@vanderbilt.edu
authors.forename: Meira
authors.initials: M
authors.lastname: Epplein
authors.forename: Ying
authors.initials: Y
authors.lastname: Zheng
authors.forename: Wei
authors.initials: W
authors.lastname: Zheng
authors.forename: Zhi
authors.initials: Z
authors.lastname: Chen
authors.forename: Kai
authors.initials: K
authors.lastname: Gu
authors.forename: David
authors.initials: D
authors.lastname: Penson
authors.forename: Wei
authors.initials: W
authors.lastname: Lu
authors.forename: Xiao-Ou
authors.initials: XO
authors.lastname: Shu
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000523:psychology*; D002681:China; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011788:Quality of Life; D012008:Recurrence; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012944:Social Support; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology*; D013997:Time Factors; D055815:Young Adult