Employment status and quality of life in recently diagnosed breast cancer survivors.

BACKGROUND: Breast cancer survivors are less likely to be employed than similar healthy women, yet effects of employment on the well being of survivors are largely unknown. In a prospective cohort study of 2013 women diagnosed from 2006 to 2011 with invasive breast cancer in Kaiser Permanente Northern California, we describe associations between hours worked per week and change in employment with quality of life (QOL) from diagnosis through active treatment. METHODS: Participants completed information on employment status and QOL approximately 2 and 8 months post-diagnosis. QOL was assessed by the Functional Assessment of Cancer Therapy--Breast Cancer. Multivariable linear regression models were adjusted for potential confounders including demographic, diagnostic, and medical care factors to examine associations between employment and QOL. RESULTS: At baseline, overall well being was higher for women who worked at least some hours per week compared with women who were not working. Women working 1-19 h/week at baseline also had higher functional well being compared with women who were not working. There was a significant, positive association between hours worked per week and physical and social well being. At the 6-month follow-up, women working at least 20 h/week had higher physical and functional well being than those who were not working. Lower scores for physical and functional well being were observed among women who stopped working during the 6-month follow-up period. CONCLUSIONS: Continuing to work after a breast cancer diagnosis may be beneficial to multiple areas of QOL. Strategies to help women continue working through treatment should be explored.

Change in physical activity during active treatment in a prospective study of breast cancer survivors.

Physical activity offers many benefits to breast cancer survivors, yet research on physical activity during the immediate period following a breast cancer diagnosis is limited. In a prospective cohort study of 1,696 women diagnosed with invasive breast cancer in the Kaiser Permanente Northern California Medical Care Program from 2006-2009, we describe change in self-reported physical activity levels from around diagnosis to 6 months post-diagnosis and determine factors associated with change. Participants completed a comprehensive physical activity questionnaire at baseline (2 months post-diagnosis) and at follow-up (8 months post-diagnosis). Predictors of physical activity change were determined by multivariable linear regression. Reductions in all physical activity levels were observed (P < 0.0001); mean (SD) change (h/week) of moderate-vigorous physical activity (MVPA) was -1.28 (4.48) and sedentary behavior was -0.83 (6.95). In fully-adjusted models, overweight and obesity were associated with greater declines in MVPA of -1.58 h/week (SD = 0.92) and -1.29 h/week (SD = 0.93), respectively (P = 0.0079). Receipt of chemotherapy only was also associated with a greater decrease in MVPA (-2.12 h/week; SD = 0.92; P < 0.0001), specifically for recreational activities (-1.62 h/week; SD = 0.64; P = 0.0001). These data suggest challenges in maintaining physical activity levels during active treatment among women with breast cancer. Interventions to encourage physical activity in breast cancer survivors should be pursued.

A practical method for collecting food record data in a prospective cohort study of breast cancer survivors.

Multiple-day diet records can be unsuitable for cohort studies because of high administrative and analytical costs. Costs could be reduced if a subsample of participants were analyzed in a nested case-control study. However, completed records are usually reviewed ("documented") with participants to correct errors and omissions before analysis. The authors evaluated the suitability of using undocumented 3-day food records in 2 samples of women in a Northern California cohort study of breast cancer survivorship (2006-2009). One group of participants (n = 130) received an introduction to the food record at enrollment, while another (n = 70) received more comprehensive instruction. Food records were mailed to participants 6 months later for follow-up and were analyzed as received and after phone documentation. Error rates for adequate completion were high in the first group but substantially lower among persons receiving instruction; prevalences of missing data on serving size and incomplete food descriptions changed from 30% to 4% and from 32% to 6%, respectively (P < 0.0001). Correlations between nutrient intakes calculated from undocumented and documented records were 0.72-0.93 in the first group and were significantly stronger (0.84-0.99) among persons receiving instruction. Documentation had little effect on intraclass correlation coefficients across days, but training increased the coefficients for many nutrients. When participants receive proper instruction, undocumented food records can be satisfactory for large epidemiologic studies.

Quality of life among women recently diagnosed with invasive breast cancer: the Pathways Study.

Few studies have assessed quality of life (QOL) of women diagnosed with breast cancer within the first few weeks of their initial diagnosis. We describe QOL among 950 women recently diagnosed with invasive breast cancer. Starting in January 2006, we invited women aged > or =21 years who were diagnosed with first primary invasive breast cancer within Kaiser Permanente Northern California (KPNC) to enroll in the Pathways Study, a prospective study of breast cancer survivorship. QOL was measured using the Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B), along with sociodemographic and social support information. Clinical characteristics were obtained from the KPNC cancer registry and electronic medical record. We used multivariable linear regression models to identify factors associated with QOL scores calculated from the FACT-B. The mean age +/- SD of the sample was 59.6 years (+/-11.9 years), and the mean time +/-SD from diagnosis until interview was 8.0 weeks (+/-3.2 weeks). Younger age at diagnosis was associated with lower scores in all QOL domains (P < 0.01), and later stage at diagnosis was associated with lower scores in all domains (P < 0.05) except for social well-being. Higher levels of social support were associated with higher QOL except for physical well-being (P < 0.05). These associations were stronger within 2 months of breast cancer diagnosis. Quality of life as influenced by a diagnosis of breast cancer is an important factor in cancer survivorship. Age, stage at diagnosis, and social support are key factors in this important variable.