title: Depression and quality of life before and after breast cancer diagnosis in older women from the Women's Health Initiative.
abstract: OBJECTIVE
  Distress and reduced quality of life (QOL) are common among people with cancer. No study has compared these variables after breast cancer diagnosis to pre-cancer diagnosis levels.
  
  
  METHODS
  Data on women with breast cancer 50 years of age or older (n = 6949) were analyzed from the Women's Health Initiative (1993-2013). Health-related QOL (physical function, mental health) was measured using Rand-36. Depressive symptoms were measured with the six-item Center for Epidemiologic Studies Depression scale. Assessments occurred before and after the cancer diagnosis. Hierarchical linear modeling compared pre-cancer QOL and depressive symptoms to levels post-diagnosis and tested whether pre-cancer physical activity, stressful life events, sleep disturbance, and pain predicted post-diagnosis outcomes.
  
  
  RESULTS
  Compared with pre-cancer levels, depressive symptoms increased (20.0% increase at 0-6 months, 12.9% increase at 6-12 months), while physical function (-3.882 points at 0-6 months, -3.545 at 6-12 months) and mental health decreased (-2.899 points at 0-6 months, -1.672 at 6-12 months) in the first year after diagnosis (all p < .01). Depressive symptoms returned to pre-cancer levels after 10 years, but QOL remained significantly lower. At more than 10 years post-diagnosis, physical function was 2.379 points lower than pre-cancer levels (p < 0.01) while mental health was 1.922 points lower (p < 0.01). All pre-cancer predictors were associated with all outcomes. Pain predicted uniquely greater decreases in physical function post-diagnosis.
  
  
  CONCLUSIONS
  Depressive symptoms increased and QOL decreased following breast cancer diagnosis compared with pre-cancer levels, particularly in the first year.
  
  
  CONCLUSIONS
  QOL may remain lower for years after breast cancer diagnosis, although decreases are small.
authors.affiliation: Group Health Research Institute, 1730 Minor Ave, Seattle, WA, 98101, USA. jones.s@ghc.org.
authors.forename: Salene M W
authors.initials: SM
authors.lastname: Jones
authors.affiliation: University of California, San Diego, La Jolla, CA, 92093, USA.
authors.forename: Andrea Z
authors.initials: AZ
authors.lastname: LaCroix
authors.affiliation: University of Massachusetts Medical School, Worcester, MA, 01655, USA.
authors.forename: Wenjun
authors.initials: W
authors.lastname: Li
authors.affiliation: University of Haifa, Haifa, Israel.
authors.forename: Oleg
authors.initials: O
authors.lastname: Zaslavsky
authors.affiliation: Albert Einstein College of Medicine, Bronx, NY, 10461, USA.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Wassertheil-Smoller
authors.affiliation: Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA.|Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, 94305, USA.
authors.forename: Julie
authors.initials: J
authors.lastname: Weitlauf
authors.affiliation: Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.
authors.forename: Gretchen A
authors.initials: GA
authors.lastname: Brenes
authors.affiliation: University of California, Davis, Davis, CA, 95616, USA.
authors.forename: Rami
authors.initials: R
authors.lastname: Nassir
authors.affiliation: University of Massachusetts Medical School, Worcester, MA, 01655, USA.
authors.forename: Judith K
authors.initials: JK
authors.lastname: Ockene
authors.affiliation: Center for Research on Food and Development, Hermosillo, México.
authors.forename: Graciela
authors.initials: G
authors.lastname: Caire-Juvera
authors.affiliation: Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA.
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: Danhauer
mesh_terms: D000367:Age Factors; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D006801:Humans; D008603:Mental Health / Q000706:statistics & numerical data; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology; D011788:Quality of Life / Q000523:psychology; D012893:Sleep Wake Disorders / Q000453:epidemiology; D011795:Surveys and Questionnaires; D017741:Survivors / Q000523:psychology; D016387:Women's Health
keywords: Breast cancer; Depression; Distress; Health-related quality of life; Neoplasm; Women’s health