Telephone Intervention and Quality of Life in Patients With Breast Cancer

Salonen, Päivi MNSc; Tarkka, Marja-Terttu PhD, RN; Kellokumpu-Lehtinen, Pirkko-Liisa MD, PhD; Åstedt-Kurki, Päivi PhD, RN; Luukkaala, Tiina MSc; Kaunonen, Marja PhD, RN


Cancer Nurs. 2009;32(3):177-190. 

In This Article

Abstract and Quality of Life in Patients With Breast Cancer


The aim of this quasi-experimental study was to examine the effectiveness of a telephone support intervention 1 week after surgery on the quality of life (QOL) of patients with breast cancer. The sample consisted of 228 patients with breast cancer allocated to an intervention group (n = 120) and control group (n = 108). The data were collected using Ferrans and Powers Quality of Life Index-Cancer Version (QLI-CV) and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Breast Cancer Module (EORTC QLQ-BR23). The self-reported QOL of patients with breast cancer was considered moderately high. Statistically significant associations were found between QOL and the demographic characteristics of age, education, and employment status and of having underage children. Statistically significant associations were found between QOL and clinical characteristics such as type of surgery and axilla treatment. The strongest predictors of poor QOL were age, control group, and type of surgery. Age was the strongest predictor of poor QOL in global QLI and in the health and functioning, socioeconomic, and family subscales. The patients' experiences show that the telephone intervention was helpful and the timing was appropriate. The QOL in patients with breast cancer was better in subscales of body image, future perspective, and postoperative side effects. The intervention group showed significantly better body image; they worried less about the future and had less postoperative side effects than the control group did. These results may help in discussing QOL issues and should be considered when planning and implementing interventions for patients with breast cancer.

Quality of Life in Patients With Breast Cancer

Breast cancer is the most common malignancy among women in the world.[1] In Finland, about 1 in 10 women will develop breast cancer during her lifetime.[2] Most new cases are found at those aged between 50 and 54 years.[3] A diagnosis of breast cancer and its treatment affect the physical and psychosocial well-being of women and their quality of life (QOL) in many different ways.[4,5,6,7,8,9,10,11] The present study is based on Ferrans'[12] definition of QOL, according to which QOL is a person's sense of well-being that stems from satisfaction or dissatisfaction with the areas of life that are important to him or her. Ferrans' conceptual model treats QOL as a multidimensional construct that is composed of the health and functioning domain, the socioeconomic domain, the psychological/spiritual domain, and the family domain.

Patients with breast cancer have reported the highest QOL in the family domain[6,13] and the lowest in the health and functioning domain[6] and psychological/spiritual domain.[13] Overall, the findings of earlier studies suggest that patients with breast cancer had a poorer QOL than patients with other cancer diagnoses,[6,9] especially in the psychological, sexual,[6] and emotional functioning domains.[9]

Previous studies have also reported associations between QOL and age[6,7,14]; educational level[7,14,15]; employment status[7]; problems in upper arm mobility and edema[7,8]; pain, changes in sexual functioning, fatigue, and menopausal symptoms[4]; and, furthermore, whether patients lived alone or together with another person.[6] Adequate and complete information,[16,17] communication with healthcare staff, the opportunity to express one's feelings, access to information about self-care,[16] and participation in professional-led supportive groups[17] also had a positive effect on the QOL of patients with breast cancer.

Several studies have shown that younger women with breast cancer experience significantly greater QOL disturbances than older women do.[10,11,13,14,18] In addition, the problems they face are often very different from those faced by older women: these include concerns about loss of fertility and having children and greater concerns about body image and sexuality, career, job, and financial security.[4,11,3] Women younger than 50 years are reported to be more likely to have emotional distress, breast-carcinoma-specific concerns, symptoms of depression, and disease-specific intrusive thoughts.[7,14,18] Furthermore, younger women seem to be psychologically more affected by their cancer experience,[9,18] with poorer social[7] and emotional functioning[10,18] and negative body image,[7,11,14] more pain, severe arm dysfunction,[14] more disrupted daily habits,[7] and more future health worries than older women.[10] In addition, QOL is affected by surgical treatment. Patients who had a mastectomy reported reduced sexual functioning and more difficulties in body image[10,14] than did patients who underwent breast-conserving surgery.[7] Furthermore, the extent of axilla surgery significantly contributes to arm problems: the more lymph nodes removed, the more arm side effects.[8] However, Wentzel et al[18] reported no significant age-related differences in sexual dysfunction or body image. In the studies of Engel et al,[8,10] patients without arm problems had better QOL over 5 years than those with arm problems. Women with high education and employment had better QOL compared with women who were unemployed or retired.[15]


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