title: Personality, coping, and social support as predictors of long-term quality-of-life trajectories in older breast cancer survivors: CALGB protocol 369901 (Alliance).
abstract: BACKGROUND
  To determine long-term quality-of-life (QOL) trajectories among breast cancer survivors aged 65+ (older) evaluating the effects of personality and social support.
  
  
  METHODS
  Older women (N = 1280) newly examined with invasive, nonmetastatic breast cancer completed baseline assessments. Follow-up data were collected 6 and 12 months later and then annually for up to 7 years (median 4.5 years). Quality of life was assessed using EORTC-QLQ-C30 emotional, physical, and cognitive scales. Optimism (Life Orientation Test), Coping (Brief COPE), and social support (Medical Outcomes Study) were assessed at baseline. Group-based trajectory modeling identified QOL trajectories; multinomial regression evaluated effects of predictors on trajectory groups. Age, education, systemic therapy, comorbidity, and reported precancer function (SF-12) were considered as controlling variables.
  
  
  RESULTS
  Three trajectories were identified for each QOL domain: "maintained high," "phase shift" (lower but parallel scores to "maintained high" group), and "accelerated decline" (lowest baseline scores and steepest decline). Accelerated decline in emotional, physical, and cognitive function was seen in 6.9%, 31.8%, and 7.6% of older survivors, respectively. Maladaptive coping and lower social support increased adjusted odds of being in the accelerated decline group for all QOL domains; lower optimism was only related to decline in emotional function. Chemotherapy was related to physical and cognitive but not emotional function trajectories.
  
  
  CONCLUSIONS
  Personality and social resources affect the course of long-term emotional well-being of older breast cancer survivors; treatment is more important for physical and cognitive than emotional function. Early identification of those vulnerable to deterioration could facilitate clinical and psychological support.
authors.affiliation: Polibienestar Research Institute, University of Valencia, Valencia, Spain.|Visiting Researcher, Georgetown University, Washington, DC, USA.
authors.forename: Estrella
authors.identifier: http://orcid.org/0000-0002-9958-408X
authors.initials: E
authors.lastname: Durá-Ferrandis
authors.affiliation: Department of Oncology, Georgetown University School of Medicine and Lombardi Comprehensive Cancer Center, Prevention and Control Program, Washington, DC, USA.
authors.forename: Jeanne S
authors.initials: JS
authors.lastname: Mandelblatt
authors.affiliation: Department of Oncology, Georgetown University School of Medicine and Lombardi Comprehensive Cancer Center, Prevention and Control Program, Washington, DC, USA.
authors.forename: Jonathan
authors.identifier: http://orcid.org/0000-0002-8058-5808
authors.initials: J
authors.lastname: Clapp
authors.affiliation: Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center, and Lombardi Comprehensive Cancer Center, Prevention and Control Program, Washington, DC, USA.
authors.forename: George
authors.identifier: http://orcid.org/0000-0001-9013-2207
authors.initials: G
authors.lastname: Luta
authors.affiliation: Department of Oncology, Georgetown University School of Medicine and Lombardi Comprehensive Cancer Center, Prevention and Control Program, Washington, DC, USA.
authors.forename: LeighAnne
authors.initials: L
authors.lastname: Faul
authors.affiliation: Department of Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA.
authors.forename: Gretchen
authors.initials: G
authors.lastname: Kimmick
authors.affiliation: Department of Medicine, Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, NC, USA.
authors.forename: Harvey Jay
authors.initials: HJ
authors.lastname: Cohen
authors.affiliation: Dana-Farber/Partners Cancer Care, Boston, MS, USA.
authors.forename: Rachel L
authors.initials: RL
authors.lastname: Yung
authors.affiliation: Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA.
authors.forename: Arti
authors.initials: A
authors.lastname: Hurria
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D001943:Breast Neoplasms / Q000523:psychology*; D000073116:Cancer Survivors / Q000523:psychology*; D003071:Cognition; D015897:Comorbidity; D005260:Female; D006801:Humans; D008603:Mental Health; D008875:Middle Aged; D010551:Personality; D011788:Quality of Life / Q000523:psychology; D012944:Social Support; D017741:Survivors / Q000523:psychology; D057832:Watchful Waiting
keywords: cancer; long-term quality-of-life trajectories; older breast cancer survivors; oncology; personality; social support