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Recurrence risk perception and quality of life following treatment of breast cancer

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

Little is known about different ways of assessing risk of distant recurrence following cancer treatment (e.g., numeric or descriptive). We sought to evaluate the association between overestimation of risk of distant recurrence of breast cancer and key patient-reported outcomes, including quality of life and worry.

Methods

We surveyed a weighted random sample of newly diagnosed patients with early-stage breast cancer identified through SEER registries of Los Angeles County & Georgia (2013–14) ~2 months after surgery (N = 2578, RR = 71%). Actual 10-year risk of distant recurrence after treatment was based on clinical factors for women with DCIS & low-risk invasive cancer (Stg 1A, ER+, HER2−, Gr 1–2). Women reported perceptions of their risk numerically (0–100%), with values ≥10% for DCIS & ≥20% for invasive considered overestimates. Perceptions of “moderate, high or very high” risk were considered descriptive overestimates. In our analytic sample (N = 927), we assessed factors correlated with both types of overestimation and report multivariable associations between overestimation and QoL (PROMIS physical & mental health) and frequent worry.

Results

30.4% of women substantially overestimated their risk of distant recurrence numerically and 14.7% descriptively. Few factors other than family history were significantly associated with either type of overestimation. Both types of overestimation were significantly associated with frequent worry, and lower QoL.

Conclusions

Ensuring understanding of systemic recurrence risk, particularly among patients with favorable prognosis, is important. Better risk communication by clinicians may translate to better risk comprehension among patients and to improvements in QoL.

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Acknowledgements

This work was funded by Grant P01 CA163233 to the University of Michigan from the National Cancer Institute. The collection of Los Angeles County cancer incidence data used in this study was supported by the California Department of Public Health pursuant to California Health and Safety Code Section 103 885; Centers for Disease Control and Prevention’s (CDC) National Program of Cancer Registries, under cooperative agreement 5NU58DP003862-04/DP003862; the National Cancer Institute’s Surveillance, Epidemiology and End Results Program under Contract HHSN261201000140C awarded to the Cancer Prevention Institute of California, Contract HHSN261201000035C awarded to the University of Southern California, and Contract HHSN261201000034C awarded to the Public Health Institute. The ideas and opinions expressed herein are those of the author(s) and endorsement by the State of California, Department of Public Health, the National Cancer Institute, and the CDC or their Contractors and Subcontractors is not intended nor should be inferred. The collection of cancer incidence data in Georgia was supported by Contract HHSN261201300015I, Task Order HHSN26100006 from the NCI and cooperative agreement 5NU58DP003875-04-00 from the CDC. The ideas and opinions expressed herein are those of the author(s) and endorsement by the States of California and Georgia, Department of Public Health the National Cancer Institute, and the Centers for Disease Control and Prevention or their Contractors and Subcontractors is not intended nor should be inferred. We acknowledge the outstanding work of our project staff (Mackenzie Crawford, M.P.H. and Kiyana Perrino, M.P.H. from the Georgia Cancer Registry; Jennifer Zelaya, Pamela Lee, Maria Gaeta, Virginia Parker, B.A., and Renee Bickerstaff-Magee from USC; Rebecca Morrison, M.P.H., Rachel Tocco, M.A., Alexandra Jeanpierre, M.P.H., Stefanie Goodell, B.S., and Rose Juhasz, Ph.D. from the University of Michigan). We acknowledge with gratitude the breast cancer patients who responded to our survey.

Author information

Authors and Affiliations

  1. Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA

    Sarah T. Hawley, Lauren P. Wallner & Steven J. Katz

  2. Department of Health Management and Policy, University of Michigan, Ann Arbor, MI, USA

    Sarah T. Hawley & Steven J. Katz

  3. Ann Arbor VA Center for Clinical Management Research, Ann Arbor VA Health Care System, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, 4th Floor, Ann Arbor, MI, USA

    Sarah T. Hawley

  4. Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA

    Nancy K. Janz

  5. Center for Cancer Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA

    Kent A. Griffith

  6. Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, USA

    Reshma Jagsi

  7. Department of Systems, Populations, and Leadership, School of Nursing, University of Michigan, Ann Arbor, MI, USA

    Christopher R. Friese

  8. Departments of Medicine and Health Research and Policy, Stanford University, Stanford, CA, USA

    Allison W. Kurian

  9. Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Ann S. Hamilton

  10. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Kevin C. Ward

  11. Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA

    Monica Morrow

  12. Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA

    Lauren P. Wallner

Authors
  1. Sarah T. Hawley
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  2. Nancy K. Janz
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  3. Kent A. Griffith
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  4. Reshma Jagsi
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  6. Allison W. Kurian
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  7. Ann S. Hamilton
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  8. Kevin C. Ward
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  9. Monica Morrow
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  10. Lauren P. Wallner
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  11. Steven J. Katz
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Corresponding author

Correspondence to Sarah T. Hawley.

Ethics declarations

Conflict of interest

Dr. Kurian has received research funding for work performed outside of the present study from Myriad Genetics, Invitae, Ambry Genetics, GeneDx, and Genomic Health. All the other authors have no conflict to disclose.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study through their return of a completed survey.

Additional information

Nancy K. Janz and Steven J. Katz share senior authorship.

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Hawley, S.T., Janz, N.K., Griffith, K.A. et al. Recurrence risk perception and quality of life following treatment of breast cancer. Breast Cancer Res Treat 161, 557–565 (2017). https://doi.org/10.1007/s10549-016-4082-7

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  • DOI: https://doi.org/10.1007/s10549-016-4082-7

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