Assessing Factors Associated with Health-Related Quality of Life In Patients with Breast Cancer In the United States

Background and Purpose: Cancer remains a major public health challenge and a leading cause of morbidity and mortality in the United States and worldwide. As the second leading cause of death, approximately one in three individuals in the U.S. is expected to be diagnosed with cancer during their lifetime, with an estimated 1.6 million new cases annually (Siegel et al., 2018). Breast cancer may have a high emotional impact on patients, and this can impair their health-related quality of life (HRQoL), encompassing individual’s perceptions of physical, psychological, social, environmental, spiritual well-being, and independence. Understanding the factors that predict HRQoL among individuals diagnosed with breast cancer is therefore critical. This study seeks to examine factors associated with HROoL among US adults with breast cancer.

Methods: This cross-sectional study utilized secondary data from the 2023 National Health Interview Survey (NHIS). The sample size included 753 adults aged 29-97 years (M=79.13, SD=11.81) from the civilian, noninstitutionalized population residing in the 50 U.S. states and the District of Columbia at the time of the interview. Descriptive statistics were conducted to characterize the study sample. Multivariate logistic regression analysis identified predictors of HRQoL, with HRQoL as the outcome variable. The independent variables included gender, education, comorbidity, depression, emotional distress, pain and work life, self-care, and mobility.

Results: The study participants were 29 and older; the majority were non-Hispanic white (83.8%), 38.0% were divorced, 39.4% had bachelor’s degrees, 98.5% had health insurance and 74.2% were not employed. Patients reporting good HRQoL were significantly more satisfied with their lives compared with those reporting poor HRQoL (p < 0.001).

Bivariate analyses using chi-square tests and independent-samples t tests demonstrated significant associations between most independent variables and HRQoL, with the exception of anxiety, age, and health insurance.

Our findings indicate a strong, statistically significant association between mobility (OR = 2.269, 95% CI [1.513, 3.404], p < .001) and HRQoL, indicating that mobility was associated with greater odds of reporting good health. Similarly, emotional distress (OR=1.149, 95% CI [1.040, 1.270], p=.006), pain and work life (OR=1.742, 95%CI [1.264, 2.400], p<.001), education (OR = .691, 95% CI [.513, .929], p =.014) were associated with HRQoL. Self-care, depression, gender and comorbidity were not statistically significant.

The overall logistic regression model was statistically significant, χ²(9) = 130.63, p < .001, indicating that mobility, emotional distress and education predicted HRQoL. The model explained approximately 42.8% of the variance in HRQoL (Nagelkerke R² = 42.8).

Conclusions and implications:

The study findings identified mobility, pain and work life, life satisfaction, and emotional distress as key factors associated health-related quality of life (HRQoL) among individuals with breast cancer in the United States. These results underscore the need for targeted efforts by policymakers and healthcare practitioners, including social workers, to promote education, provide appropriate pain management to reduce pain levels, and offer mobility assistance and therapeutic services for individuals living with breast cancer.