Changes of Symptom Distress and Quality of Life in Breast Cancer Patients Receiving Adjuvant Therapy

Jin-Hee Park; Sun Hyoung Bae; Young-Mi Jung

doi:10.5388/aon.2015.15.2.67

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Park, Bae, and Jung: Changes of Symptom Distress and Quality of Life in Breast Cancer Patients Receiving Adjuvant Therapy

Original Article

Asian Oncology Nursing 2015; 15(2): 67-74.

Published online: 30 June 2015

DOI: https://doi.org/10.5388/aon.2015.15.2.67

Changes of Symptom Distress and Quality of Life in Breast Cancer Patients Receiving Adjuvant Therapy

Jin-Hee Park¹, Sun Hyoung Bae², Young-Mi Jung¹

¹College of Nursing, Ajou University, Suwon, Korea.

²Department of Nursing, Dong-A University, Busan, Korea.

Address reprint requests to: Jung, Young-Mi. College of Nursing, Ajou University, 164 World cup-ro, Yongtong-gu, Suwon 443-380, Korea. Tel: +82-31-219-7019, Fax: +82-31-219-7020, jdudal@ajou.ac.kr

Received 6 March 2015 Revised 20 April 2015 Accepted 2 June 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to identify changes of symptom distress and quality of life (QOL) in breast cancer patients receiving adjuvant therapy.

Methods

113 patients with breast cancer were administered the Memorial Symptom Assessment Scale-Short Form and the Functional Assessment of Cancer Therapy-Breast before adjuvant therapy, both a week and 6 months after completing adjuvant therapy. 71 patients (CTx group) were treated with adjuvant chemotherapy and radiotherapy. 42 patients (RTx group) received only adjuvant radiotherapy. Data were analysed using the SPSS/Win 21.0 program.

Results

Compared with the RTx group, patients in the CTx group reported higher overall symptom distress and physical symptom distress. The CTx group reported lower scores in overall QOL, physical well-being and the breast cancer specific domain than the RTx group.

Conclusion

Findings from this study support that chemotherapy results in higher risk for more severe symptoms and leads to impaired QOL for breast cancer patients. Comprehensive symptom management should be implemented for breast cancer patients receiving chemotherapy.

Keywords: Breast Neoplasms, Adjuvant Chemotherapy, Adjuvant Radiotherapy, Quality of Life, Symptoms

Figures and Tables

Table 1

Homogeneity Test of Demographic Variables and Disease/Treatment related Variables between Two Groups

Variables	Categories	Total (N = 113)	CTx group (n = 71)	RTx group (n = 42)	χ²	p
Variables	Categories	Total (N = 113)	n (%) or M ± SD	n (%) or M ± SD	χ²	p
Age (year)	≤ 40	27 (23.9)	20 (28.2)	7 (16.7)	2.79	.248
	41~50	54 (47.8)	30 (42.3)	24 (57.1)
	51~60	32 (28.3)	21 (29.6)	11 (26.2)
Educational level	≤ Middle school	21 (18.6)	14 (19.7)	7 (16.7)	0.26	.880
	High School	57 (50.4)	36 (50.7)	21 (50.0)
	≥ College	35 (31.0)	21 (29.6)	14 (33.3)
Current marital status	Single	23 (20.4)	17 (23.9)	6 (14.3)	0.98	.239
Current marital status	Married	90 (79.6)	54 (76.1)	36 (85.7)	0.98	.239
Monthly household income (10,000 won)	≤ 200	30 (26.5)	22 (31.0)	8 (19.0)	1.93	.381
	> 200~ ≤ 400	56 (49.6)	33 (46.5)	23 (54.8)
	> 400	27 (23.9)	16 (22.4)	11 (26.2)
Occupation^*	No	65 (57.5)	40 (56.3)	25 (59.5)	0.02	.844
Occupation^*	Yes	48 (42.5)	31 (43.7)	17 (40.5)	0.02	.844
Menstruation	Regular	76 (67.3)	48 (67.6)	28 (66.7)	2.89	.235
	Irregular	10 (8.8)	4 (5.6)	6 (14.3)
	Menopause	27 (23.9)	19 (26.8)	8 (19.0)
Healthcare support^*	No	4 (3.5)	3 (4.2)	1 (2.4)	0.00	1.000
Healthcare support^*	Yes	109 (96.5)	68 (95.8)	41 (97.6)	0.00	1.000
Type of surgery^*	PM	107 (94.7)	65 (91.5)	42 (100.0)	2.26	.133
Type of surgery^*	TM	6 (5.3)	6 (8.5)	0 (0.0)	2.26	.133
Site of surgery	Right	53 (46.9)	32 (45.1)	21 (50.0)	0.44	.802
	Left	56 (49.6)	36 (50.7)	20 (47.6)
	Bilateral	4 (3.5)	3 (4.2)	1 (2.4)
Type of lymph node resection^*	SLND	82 (72.6)	57 (80.3)	25 (59.5)
	ALND	10 (8.8)	9 (12.7)	1 (2.4)	0.97	.324
	None	21 (18.6)	5 (7.0)	16 (38.1)
Estrogen receptor	Negative	21 (18.6)	17 (23.9)	4 (9.5)	3.63	.079
Estrogen receptor	Positive	92 (81.4)	54 (76.1)	38 (90.5)	3.63	.079

^*Fishers exact test; ALND=Axillary lymph node dissection; CTx=Chemotherapy; PM=Partial mastectomy; SD=Standard deviation; SLND=Sentinel lymph node dissection; RTx=Radiotherapy; TM=Total Mastectomy.

Table 2

Homogeneity Test of Symptom Distress and Quality of life between Two Groups

Variables	Total (N = 113)	CTx group (n = 71)	RTx group (n = 42)	t	p
Variables	Total (N = 113)	M ± SD	M ± SD	t	p
TMSAS-SF	0.80 ± 0.50	0.79 ± 0.48	0.82 ± 0.55	0.29	.771
PHYS	0.86 ± 0.58	0.84 ± 0.55	0.90 ± 0.63	0.49	.622
PSYCH	1.39 ± 0.84	1.41 ± 0.79	1.36 ± 0.91	- 0.32	.746
FACT-B total	96.90 ± 18.62	96.73 ± 17.94	97.19 ± 19.93	0.13	.900
PWB	20.98 ± 4.74	21.13 ± 4.68	20.74 ± 4.88	- 0.42	.675
SWB	19.10 ± 6.33	19.68 ± 6.64	18.12 ± 5.71	- 1.27	.208
EWB	15.71 ± 5.13	15.87 ± 5.01	15.43 ± 5.38	- 0.44	.658
FWB	16.50 ± 5.67	15.97 ± 5.55	17.40 ± 5.83	1.30	.195
BCS	22.73 ± 5.16	22.63 ± 5.02	22.88 ± 5.45	0.24	.807

BCS=Breast cancer-specific subscale; CTx=Chemotherapy; EWB=Emotional well-being; FACT-B=Functional assessment of cancer therapy-breast; FWB=Functional well-being; PHYS=Physical symptom subscale; PSYCH=Psychological symptom subscale; PWB=Physical well-being; RTx=Radiotherapy; SD=Standard deviation; SWB=Social/family well-being; TMSAS-SF=Total mean scores of memorial symptom assessment scales-short form.

Table 3

Changes in Symptom Distress and Quality of Life between Two Groups (N=113)

Variables	Group	T₁	T₂	T₃	F (p)			T₁~T₂			T₂~T₃			T₁~T₃
Variables	Group	M±SD	M±SD	M±SD	Group	Time	Group x Time	MD±SE	95% CI	p	MD±SE	95% CI	p	MD±SE	95% CI	p
TMSAS-SF	CTx	0.79±0.06	1.30±0.07	0.98±0.07	5.94 (.016)	1.40 (.249)	10.59 (<.001)	-0.51±0.06	-0.67~-0.35	<.001	0.32±0.07	0.15~0.48	<.001	-0.19±0.07	-0.37~-0.01	.032
TMSAS-SF	RTx	0.81±0.08	0.83±0.09	0.81±0.09	5.94 (.016)	1.40 (.249)	10.59 (<.001)	-0.02±0.07	-0.20~0.15	1.000	0.02±0.08	-0.17~0.20	1.000	-0.00±0.10	-0.25~0.24	1.000
PHYS	CTx	0.86±0.07	1.29±0.07	0.97±0.07	5.40 (.022)	2.08 (.127)	8.64 (<.001)	-0.43±0.08	-0.63~-0.23	<.001	0.32±0.07	0.14~0.50	<.001	-0.11±0.08	-0.31~0.08	.484
PHYS	RTx	0.90±0.09	0.80±0.10	0.75±0.10	5.40 (.022)	2.08 (.127)	8.64 (<.001)	0.10±0.09	-0.14~0.31	1.000	0.05±0.10	-0.19~0.29	1.000	0.15±0.12	-0.16~0.43	.748
PSYCH	CTx	1.42±0.10	1.54±0.10	1.55±0.11	0.74 (.390)	0.13 (.753)	0.38 (.563)	-0.13±0.04	-0.23~-0.02	.009	-0.01±0.11	-0.28~0.25	1.000	-0.13±0.11	-0.41~0.13	.653
PSYCH	RTx	1.36±0.13	1.36±0.13	1.43±0.14	0.74 (.390)	0.13 (.753)	0.38 (.563)	0.00±0.00	0.00~0.00	0.00	-0.07±0.15	-0.43~0.29	1.000	-0.07±0.15	-0.43~0.29	1.000
FACT-B total	CTx	96.80±2.23	84.36±2.49	94.12±2.54	7.43 (.007)	4.59 (.013)	8.93 (<.001)	12.44±2.77	5.37~18.97	<.001	-9.76±2.23	-15.28~-4.35	<.001	2.68±3.03	-5.09~9.79	1.000
FACT-B total	RTx	97.08±2.90	101.22±3.24	103.73±3.31	7.43 (.007)	4.59 (.013)	8.93 (<.001)	-4.14±2.18	-9.13~1.75	.293	-2.51±2.23	-7.96~3.16	.859	-6.65±2.47	-12.27~0.08	.054
PWB	CTx	21.13±0.57	17.86±0.67	19.97±0.65	6.50 (.012)	3.80 (.027)	6.97 (.002)	3.27±0.85	1.09~5.28	.001	-2.11±0.65	-3.69~-0.51	.006	1.16±0.86	-1.02~3.19	.634
PWB	RTx	20.73±0.74	21.73±0.87	22.49±0.84	6.50 (.012)	3.80 (.027)	6.97 (.002)	-1.00±0.68	-2.56~0.84	.645	-0.76±0.67	-2.45~0.92	.796	-1.76±0.74	-3.48~0.24	.107
SWB	CTx	19.61±0.74	17.04±0.72	17.34±0.75	2.97 (.088)	3.41 (.035)	0.04 (.964)	2.57±0.90	0.42~4.82	.014	-0.30±0.77	-2.15~1.62	1.000	2.27±0.89	0.17~4.54	.030
SWB	RTx	18.23±0.97	15.30±0.94	15.69±0.97	2.97 (.088)	3.41 (.035)	0.04 (.964)	2.93±1.01	0.34~5.37	.021	-0.39±0.89	-2.67~1.76	1.000	2.54±1.03	-0.18~4.98	0.75
EWB	CTx	15.91±0.61	15.51±0.53	15.86±0.55	1.28 (.261)	2.14 (.124)	3.55 (.034)	0.40±0.54	-0.98~1.68	1.000	-0.35±0.52	-1.62~0.94	1.000	0.05±0.68	-1.66~1.69	1.000
EWB	RTx	15.36±0.79	17.06±0.69	17.44±0.72	1.28 (.261)	2.14 (.124)	3.55 (.034)	-1.70±0.68	-3.31~0.07	.065	-0.38±0.61	-1.92~1.11	1.000	-2.08±0.69	-3.76~-0.29	.017
FWB	CTx	15.99±0.67	15.24±0.63	16.94±0.67	3.06 (.083)	1.36 (.259)	1.06 (.343)	0.75±0.77	-1.17~2.60	1.000	-1.70±0.65	-3.31~-0.13	.030	-0.95±0.81	-2.99~0.99	.666
FWB	RTx	17.38±0.88	17.08±0.82	18.29±0.88	3.06 (.083)	1.36 (.259)	1.06 (.343)	0.30±0.77	-1.56~2.27	1.000	-1.21±0.56	-2.60~0.22	.122	-0.91±0.78	-2.78~1.11	.871
BCS	CTx	22.63±0.62	17.78±0.66	21.30±0.67	8.67 (.004)	3.64 (.028)	15.65 (<.001)	4.85±0.69	3.15~6.52	<.001	-3.52±0.64	-5.14~-2.01	<.001	1.33±0.72	-0.51~3.02	.258
BCS	RTx	22.89±0.80	23.60±0.86	23.01±0.87	8.67 (.004)	3.64 (.028)	15.65 (<.001)	-0.71±0.56	2.09~0.71	.678	0.59±0.67	-0.99~2.37	.933	-0.12±0.77	-1.91~1.91	1.000

BCS=Breast cancer-specific subscale; CI=Confidence interval; CTx=Chemotherapy; EWB=Emotional well-being; FACT-B=Functional assessment of cancer therapy-breast; FWB=Functional well-being; MD=Mean difference; PHYS=Physical symptom subscale; PSYCH=Psychological symptom subscale; PWB=Physical well-being; RTx=Radiotherapy; SD=Standard deviation; SE=Standard error; SWB=Social/family well-being; TMSAS-SF=Total mean scores of memorial symptom assessment scales-short form.

Notes

This work was supported by the National Research Foundation of Korea (KRF) funded by the Korea government (MEST) (2011-0012145).

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