A new prospective study has found that women who report an increase in physical health during a one-year period (starting at least two years after diagnosis) have better prognosis than those who report a decline in health. Measures of health-related quality of life scores have been inconsistently associated with breast cancer prognosis. The study was designed to assess whether changes in physical health scores were related to breast cancer outcomes. The study included 2,343 breast cancer survivors who had participated in a diet trial that provided self-reported physical health-related quality of life scores at baseline and one year later. The survivors joined the study at various times relative to their breast cancer diagnoses. The participants were assigned to three groups based on change in physical health score: (1) decreased physical health; (2) no/minimal changes; and (3) increased physical health. There were 294 breast cancer recurrences and 162 deaths among the women, who were followed for approximately 7.3 years.

Increased physical health was found to be associated with younger age, being employed, having a lower body mass index (BMI), not taking tamoxifen, lower physical activity, and lower physical and mental health at baseline. No association was found between change in physical health with breast cancer recurrence or mortality among women diagnosed less than or equal to two years before study enrollment (when presumably the women were still recovering from the effects of breast cancer treatment). However, among the women who joined the study at least two years post-diagnosis, the risk of death from any cause (including non-breast cancer death) was 62% higher among those who reported a decrease in physical health compared to those who reported an increase. The authors conclude that the results appear to support testing an intervention to improve physical health in breast cancer patients after the acute stage of treatment.

Comments concerning the study

This is a confusing study because it was not possible to control for factors that served to muddy the results. For example, it has been established that, generally speaking, younger women have a less favorable breast cancer prognosis than older women, yet the study appears to imply the reverse (of course, this is because younger women are more healthy generally and the ones that do survive breast cancer are less likely than older women to die of other causes during the following seven years). Our conclusion based on the study results is that breast cancer survivors should pay attention to their own perceptions of ill health or well being and get an appropriate diagnostic workup earlier rather than later to determine what the problem might be if they do not feel well. Women with stage IV cancer have reported a sense of being unwell for a period of time before being diagnosed with a recurrence.