Vicki Hart

Trends in Health-Related Quality of Life After a Diagnosis of Ductal Carcinoma In Situ

PURPOSE Studies of quality of life (QoL) are scarce among survivors of ductal carcinoma in situ (DCIS). The objective of this study was to assess long-term QoL in DCIS survivors in relation to age at diagnosis, time since diagnosis, and treatments received. METHODS We assessed physical and mental measures of health-related QoL in 1,604 patients with DCIS diagnosed in 1997 to 2006 with up to four follow-up interviews. We further compared baseline QoL to 1,055 control patients without DCIS. QoL was measured using the validated Medical Outcomes Study Short Form 36 Health Status Survey questionnaire. Among patients with DCIS, we examined trends in QoL over time since diagnosis using generalized linear regression models, adjusting for confounders. We tested for effect modification by surgical treatment choice, post-treatment endocrine therapy use, and age at diagnosis. RESULTS Both physical and mental measures of QoL among DCIS survivors at fewer than 2 years after diagnosis were comparable to controls. Mental measures of QoL among patients with DCIS declined at ≥ 10 years after diagnosis and were significantly lower than at less than 2 years after diagnosis (47.4 v 52.0; P < .01). In the first 5 years after a DCIS diagnosis, mental QoL was significantly higher among women diagnosed at ages 50 to 74 years compared with those diagnosed at ages 28 to 49 years, although this difference was not sustained in later time periods. CONCLUSION QoL after a DCIS diagnosis was generally comparable to that of women of similar age without a personal history of DCIS. Our findings suggest that DCIS survivors, and particularly those diagnosed at a younger age, may benefit from support for mental QoL.

Health behavior change following a diagnosis of ductal carcinoma in situ: An opportunity to improve health outcomes.

Ductal carcinoma in situ (DCIS) is a non-invasive breast cancer that comprises approximately 20% of new breast cancer diagnoses. DCIS is predominantly detected by screening mammography prior to the development of any clinical symptoms. Prognosis following a DCIS diagnosis is excellent, due to both the availability of effective treatments and the frequently benign nature of the disease. However, a DCIS diagnosis and its treatment have psychological and physical impacts that often lead to adverse changes in health-related behaviors, including changes in physical activity, body weight, alcohol intake, and smoking, which may represent a greater threat to the womans overall health than the DCIS itself. Depending on age at diagnosis, women diagnosed with DCIS are 3-13 times more likely to die from non-breast cancer related causes, such as cardiovascular disease, than from breast cancer. Thus, the maintenance and improvement of healthy behaviors that influence a variety of outcomes after diagnosis may warrant increased attention during DCIS management. This may also represent an important opportunity to promote the adoption of healthy behaviors, given that DCIS carries the psychological impact of a cancer diagnosis but also a favorable prognosis. Particular focus is needed to address these issues in vulnerable patient subgroups with pre-existing higher rates of unhealthy behaviors and demonstrated health disparities.

Partnership status and socioeconomic factors in relation to health behavior changes after a diagnosis of ductal carcinoma In Situ

Background: Change in health behaviors can occur among women newly diagnosed with ductal carcinoma in situ (DCIS). We sought to understand whether partnership status and socioeconomic status (SES) affected behavioral changes in body weight, physical activity, alcohol consumption, and smoking. Methods: The Wisconsin In Situ Cohort (WISC) study comprises 1,382 women diagnosed with DCIS with information on demographics, SES factors, and pre- and post-DCIS diagnosis health-related behaviors. Logistic regression models were used to determine the association between partnership status, education, and income with change in behavior variables. Results: Higher educational attainment was associated with lower likelihood of stopping physical activity [OR, 0.45; 95% confidence interval (CI), 0.32–0.63; college vs. high school degree], or starting to drink alcohol (OR, 0.34; 95% CI, 0.15–0.80). Results suggested that higher family income was associated with lower likelihood of gaining >5% body mass index (P = 0.07) or stopping physical activity (P = 0.09). Living with a partner was not strongly associated with behavior changes. Conclusion: Higher educational attainment and higher income, but not living with a partner, were associated with positive health behaviors after a DCIS diagnosis. Impact: The associations between higher educational attainment and, to a lesser extent, higher income with positive health behaviors underscore the importance of considering SES when identifying those at risk for negative behavioral change after DCIS diagnosis. Cancer Epidemiol Biomarkers Prev; 25(1); 76–82. ©2015 AACR.

The Association Between Post-Diagnosis Health Behaviors and Quality of Life in Survivors of Ductal Carcinoma In Situ

Background: Survivors of ductal carcinoma in situ (DCIS), an early stage breast cancer, tend to decrease physical activity, gain weight, and maintain alcohol use following treatment. However, the impact of these health behaviors on long-term quality of life (QoL) in DCIS survivors has not been investigated. Methods: We examined the association of post-diagnosis body mass index (BMI), physical activity and smoking with QoL among 1,448 DCIS survivors aged 20–74, who were diagnosed during 1995–2006 and enrolled in the population-based Wisconsin In Situ Cohort. Health behaviors and QoL were self-reported during biennial post- diagnosis interviews. Physical and mental QoL were measured using the validated SF-36 questionnaire (higher scores reflect more positive QoL). Generalized linear regression was used to establish QoL mean scores in cross-sectional analyses, with multivariable adjustment for age, comorbidity status, education, and income. Results: Women reported 3,444 QoL observations over an average 7.9 years of follow-up. Physical health summary scale measures of QoL were significantly higher among women with healthy BMI (46.5 for healthy weight versus 40.5 for obese, P = 0.02) and those who were physically active (45.9 for active women versus 42.6 for inactive, P = 0.03). Mental health summary scale scores were significantly higher among non-smokers (51.2 for non-smokers versus 47.1 for current smokers, P < 0.01). These associations were consistent over increasing time since treatment up to 15 years. Conclusion: Our preliminary analysis suggests that maintaining healthy behaviors following DCIS treatment is associated with improved long-term QoL. Longitudinal analysis using cross-lagged regression is underway to evaluate the temporal association between health behavior and QoL. Understanding factors that impact QoL in DCIS survivors may inform interventions aimed at preventing negative health behaviors and optimizing long term quality of life following a DCIS diagnosis.