INTERRELATIONSHIPS AMONG SOCIAL SUPPORT, WORRY ABOUT CANCER WORSENING, AND HEALTH-RELATED QUALITY OF LIFE AMONG EARLY-STAGE BREAST CANCER PATIENTS

Purpose: Decision aids (DAs) operate on the premise that medical decisions should not be based solely on mortality outcomes, but also quality of life (QOL) considerations.  This may be especially important for diseases with good prognoses such as early-stage breast cancer.  However, worry about the cancer worsening is prevalent among early-stage breast cancer patients and is associated with poorer QOL.  Social support, on the other hand, is associated with better QOL.  This study is the first to examine the direct and interactive relationships among worry, perceived support, and QOL in a sample of recently diagnosed early-stage breast cancer patients.

Method: Women with ductal carcinoma in situ (DCIS) or early invasive breast cancer (EIBC) who were being treated at the Siteman Cancer Center were interviewed 6 months after definitive surgical treatment.  QOL was assessed using the eight subscales of the RAND 36-item Health Survey (i.e., general health, emotional well-being, fatigue, pain, physical functioning, limitations due to emotional problems, limitations due to physical problems and social functioning).  We used analysis of covariance to examine differences in each subscale between worry about the cancer getting worse (median split), perceived support (quartiles), and the interaction between worry and support. Covariates included age, race, education, pre-diagnosis depression history, and cancer stage.

Result: Of 549 participants recruited, 534 (97.3%) were included in the analysis (80.5% white, 33.7% DCIS; mean age=58.4 years [SD=10.6]). Higher worry was associated with worse QOL, and higher support was associated with better QOL on all subscales (each p<.05).  The difference in QOL scores between patients with high and low worry ranged from 7-12 points on a 100-point scale.  The difference in QOL between women with the highest and lowest perceived support ranged from 9-19 points.  The gap in emotional well-being between women with high and low worry was explained by women in the bottom quartile of support (p=.0513), whose well-being was 14 points lower than women in the top three quartiles.

Conclusion: Clinically important differences in QOL scores between patients with high and low worry were observed.  The detrimental relationship between worry and QOL occurred only in patients with very little social support.  Considering the potentially negative effects of worry on decision-making, DA developers should consider providing supplemental decision support to individuals with few social support resources.