Association between socioeconomic status and altered appearance distress, body image, and quality of life among breast cancer patients.
BACKGROUND
Breast cancer patients experience a variety of altered appearance--such as loss or disfigurement of breasts, discolored skin, and hair loss--which result in psychological distress that affect their quality of life. This study aims to evaluate the impact of socioeconomic status on the altered appearance distress, body image, and quality of life among Korean breast cancer patients.


METHODS
A cross-sectional survey was conducted at advocacy events held at 16 different hospitals in Korea. Subjects were eligible to participate if they were 18 years of age or older, had a histologically confirmed diagnosis of breast cancer, had no evidence of recurrence or metastasis, and had no psychological problems at the time of the survey. Employment status, marital status, education, and income were assessed for patient socioeconomic status. Altered appearance distress was measured using the NCI's cancer treatment side effects scale; body image and quality of life were measured by the EORTC QLC-C30 and BR23. Means and standard deviations of each outcome were compared by socioeconomic status and multivariate linear regression models for evaluating the association between socioeconomic status and altered appearance distress, body image, and quality of life.


RESULTS
A total of 126 breast cancer patients participated in the study; the mean age of participants was 47.7 (SD=8.4). Of the total, 83.2% were married, 85.6% received more than high school education, 35.2% were employed, and 41% had more than $3000 in monthly household income. About 46% had mastectomy, and over 30% were receiving either chemotherapy or radiation therapy at the time of the survey. With fully adjusted models, the employed patients had significantly higher altered appearance distress (1.80 vs 1.48; p<0.05) and poorer body image (36.63 vs 51.69; p<0.05) compared to the patients who were unemployed. Higher education (10.58, standard error (SE)=7.63) and family income (12.88, SE=5.08) was positively associated with better body image after adjusting for age, disease stage at diagnosis, current treatment status, and breast surgery type. Similarly, patients who were married and who had higher education had better quality of life were statistically significant in the multivariate models.


CONCLUSIONS
Socioeconomic status is significantly associated with altered appearance distress, body image, and quality of life in Korean women with breast cancer. Patients who suffer from altered appearance distress or lower body image are much more likely to experience psychosocial, physical, and functional problems than women who do not, therefore health care providers should be aware of the changes and distresses that these breast cancer patients go through and provide specific information and psychosocial support to socioeconomically more vulnerable patients.
Krieger School of Arts and Sciences, Johns Hopkins University, Baltimore, USA E-mail : jcho@skku.edu.
Oliver
O
Chang
Eun-Kyung
EK
Choi
Im-Ryung
IR
Kim
Seok-Jin
SJ
Nam
Jeong Eon
JE
Lee
Se Kyung
SK
Lee
Young-Hyuck
YH
Im
Yeon Hee
YH
Park
Juhee
J
Cho
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001828:Body Image / Q000523:psychology*; D001943:Breast Neoplasms / Q000473:pathology / Q000523:psychology* / Q000628:therapy; D017024:Chemotherapy, Adjuvant / Q000379:methods / Q000523:psychology; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015412:Mastectomy, Segmental / Q000379:methods / Q000523:psychology; D008875:Middle Aged; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant / Q000379:methods / Q000523:psychology; D056910:Republic of Korea; D018570:Risk Assessment; D012649:Self Concept; D012959:Socioeconomic Factors; D013315:Stress, Psychological; D017741:Survivors