Quality of Life of Breast Cancer Survivors: A Comparative Study of Age Cohorts

Angela Sammarco, PhD, RN

Disclosures

Cancer Nurs. 2009;32(5):347-356. 

In This Article

Abstract and Introduction

Abstract

The aims of this study were to examine the differences between older and younger breast cancer survivors in perceived social support, uncertainty, quality of life (QOL), and selected demographic variables, and to explore the role of these variables in explaining and predicting QOL. A descriptive research design was used. A sample of 163 older and 129 younger breast cancer survivors was recruited from the New York metropolitan area. Participants completed the Social Support Questionnaire, Mishel Uncertainty in Illness Scale Community Form, and the Quality of Life Index-Cancer Version III. Significant differences between younger and older cohorts were found in total social support, spouse and nurse social support subscales, and socioeconomic and psychological/spiritual QOL subscales. Uncertainty, additional illnesses, social support, older age, surgical treatment, and mastectomy were significant predictors of QOL. Understanding differences in perceived social support, uncertainty, and QOL of breast cancer survivors within a context of psychosocial stage and place in life may likely facilitate healthcare to better enhance QOL outcomes. Awareness of factors predictive of QOL will help breast cancer survivors in maintaining an acceptable QOL.

Introduction

At certain points along the lifespan of women, various role demands that are associated with their psychosocial stage and place in life emerge. In younger women, role demands mainly include expression of sexuality, marital/partner relationship, child bearing, care of young children, and career development.[1–3] In older women, role demands largely entail transitioning to retirement, maintaining independence, adjusting to declining physical function and development of chronic illnesses, dealing with the loss of a spouse/partner through death, having constrained financial resources, and becoming in-home caregivers of young grandchildren, ailing spouses/partners, or elderly parents.[3–4]

Breast cancer necessitates that women adjust to the intrusion of a life-threatening disease into their lives, as well as manage the after-effects of treatment therapies, regardless of age, ethnicity, or stage of life. The illness demands of breast cancer, with accompanying threats to life and functional status, become imposed upon the multiple role demands of their particular psychosocial life stage. This situation clearly affects the quality of life (QOL) of both younger and older women in diverse ways that often continue for years beyond the completion of treatment.[5]

Uncertainty is a key occurrence of breast cancer[6] and is predictive of poorer QOL in both younger and older survivors.[7,8] The unpredictable nature of the disease and the threats of disease recurrence, suffering, and death enhance the potential for uncertainty to emerge and persist in breast cancer survivors.[6,9] In addition, breast cancer creates an amplified need for social support.[10] However, for many breast cancer survivors, social support may be unavailable, inaccessible, or perceived as ineffective.[3–5]

Although there exists a wealth of literature that describes uncertainty, social support, and QOL of breast cancer survivors, few comparative studies of younger and older cohorts that specifically investigate their age-related differences with respect to these variables have been conducted. Because younger and older breast cancer survivors have QOL issues unique to their psychosocial stage and place in life, assumptions about the associations of these variables cannot be extrapolated from one age cohort to another. It is essential to achieve a clear understanding of the age-related differences in perceived social support, uncertainty, and QOL, as well as the role of these variables in explaining and predicting QOL. Such evidence will be important in planning and tailoring care that will significantly enhance QOL outcomes for specific age cohorts of breast cancer survivors.

Thus, the purpose of this study was to examine the differences between older and younger breast cancer survivors in perceived support, uncertainty, and QOL. Furthermore, this study also examined differences between younger and older breast cancer survivors in selected demographic variables and explored the role of these variables in explaining and predicting QOL.

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