Comparison of younger and older breast cancer survivors and age-matched controls on specific and overall quality of life domains.

BACKGROUND: Younger survivors (YS) of breast cancer often report more survivorship symptoms such as fatigue, depression, sexual difficulty, and cognitive problems than older survivors (OS). This study sought to determine the effect of breast cancer and age at diagnosis on quality of life (QoL) by comparing 3 groups: 1) YS diagnosed at age 45 years or before, 2) OS diagnosed between 55 and 70, and 3) for the YSs, age-matched controls (AC) of women not diagnosed with breast cancer. METHODS: Using a large Eastern Cooperative Oncology Group (ECOG) database, 505 YS were recruited who were aged 45 years or younger when diagnosed and 622 OS diagnosed at 55 to 70 years of age. YS, OS, and AC were compared on physical, psychological, social, spiritual, and overall QoL variables. RESULTS: Compared to both AC and to OS, YS reported more depressive symptoms (P = .005) and fatigue (P < .001), poorer self-reported attention function (P < .001), and poorer sexual function (P < .001) than either comparison group. However, YS also reported a greater sense of personal growth (P < .001) and perceived less social constraint (P < .001) from their partner than AC. CONCLUSIONS: YS reported worse functioning than AC relative to depression, fatigue, attention, sexual function, and spirituality. Perhaps even more important, YS fared worse than both AC and OS on body image, anxiety, sleep, marital satisfaction, and fear of recurrence, indicating that YS are at greater risk for long-term QoL problems than survivors diagnosed at a later age.

Effects of personal characteristics on African-American women's beliefs about breast cancer.

PURPOSE: This study measured the effect of demographic and clinical characteristics on health and cultural beliefs related to mammography. DESIGN: Cross-sectional study. SETTING: Interviews were conducted during 2003 and 2004 in a Midwestern urban area. SUBJECTS: Subjects were 344 low-income African-American women 40 years and older who had not had mammography within the previous 18 months. MEASURES: The instrument measured personal characteristics, belief and knowledge scales, and participants' mammography experience and plans. ANALYSIS: Multiple regression analysis assessed the effect of specific demographic and clinical characteristics on each of the scale values and on subjects' stages of readiness to change. RESULTS: The subjects' levels of education significantly affected six of the 12 belief and knowledge scales. Higher-educated women felt less susceptible to breast cancer, had higher self-efficacy, had less fear, had lower fatalism scores, were less likely to be present-time oriented, and were more knowledgeable about breast cancer. Older women felt they were less susceptible to breast cancer, had higher fatalism scores, were more present-time oriented, and were less knowledgeable about breast cancer. CONCLUSIONS: The findings suggest that mammography promotion programs for African-Americans should consider the education levels and ages of the target women to be most effective.

Development and psychometric testing of a breast cancer survivor self-efficacy scale.

PURPOSE/OBJECTIVES: To describe the development of a self-efficacy instrument that measures perceived ability to manage symptoms and quality-of-life problems resulting from the diagnosis and treatment of breast cancer. DESIGN: Items were developed and content validity assessed. A 14-item scale was psychometrically evaluated using internal consistency reliability and several types of construct validity. SAMPLE: 1,127 female breast cancer survivors (BCSs). METHODS: Written consents were mailed to the research office. Data were collected via mail and telephone. MAIN RESEARCH VARIABLES: Demographics, symptom bother, communication with healthcare provider, attention function, fear of recurrence, depression, marital satisfaction, fatigue, sexual functioning, trait and state anxiety, and overall well-being. FINDINGS: Data demonstrated that the breast cancer self-efficacy scale (BCSES) was reliable, with an alpha coefficient of 0.89, inter-item correlations ranging from 0.3-0.6, and item-total correlation coefficients ranging from 0.5-0.73. Three of 14 items were deleted because of redundancy as identified through high (> 0.7) inter-item correlations. Factor analysis revealed that the scale was unidimensional. Predictive validity was supported through testing associations between self-efficacy and theoretically supported quality-of-life variables, including physical, psychological, and social dimensions, as well as overall well-being. CONCLUSIONS: The BCSES demonstrated high internal consistency reliability, unidimensionality, and excellent content and construct validity. This scale should be integrated into interventions that target self-efficacy for managing symptoms in BCSs. IMPLICATIONS FOR NURSING: Nurses working with BCSs may use this tool to assess areas in which survivors might need to build confidence to adequately cope with their specific survivorship concerns. KNOWLEDGE TRANSLATION: The use of the BCSES can inform nurse researchers about the impact of an intervention on self-efficacy in the context of breast cancer survivorship, improving the ability to deliver effective interventions. The scale is brief and easy to administer. Results of this study demonstrate clear psychometric reliability and validity, suggesting that the BCSES should be put to use immediately in interventions targeting the quality of life of BCSs.