Health-Related Quality of Life of Breast Cancer Patients in iran: Pooled Analysis using Generalized Estimating Equations

  • Kiadaliri, Aliasghar Ahmad (Division of Health Economics, Department of Clinical Sciences, Lund University) ;
  • Bastani, Peivand (Department of Health Service Management, Tehran University of Medical Sciences) ;
  • ibrahimipour, Hossein (Health Sciences Research Center, Department of Health and Management, School of Public Health, Mashhad University of Medical Sciences)
  • Published : 2012.03.31


Objective: The aim of current study was to evaluate the changes of health-related quality of life (HRQoL) and its clinical, demographic and socioeconomic determinants during chemotherapy and 4 months follow-up in women with breast cancer using a repeated measures framework. Methods and Materials: A double blind cohort study was performed in 100 breast cancer patients given fluorouracil, doxorubicin and cyclophosphamide (FAC) or docetaxel, doxorubicin, cyclophosphamide (TAC) in south of Iran. HRQoL was assessed at baseline, end of chemotherapy and four months thereafter using the QLQ-C30 questionnaire from European Organization for Research and Treatment of Cancer (EORTC). Generalized estimating equations (GEE) was applied for statistical analysis. Results: The mean of age at baseline was $48.5{\pm}10.6$. 70% and 14% of patients were married and smokers, respectively, and 20% suffered from another disease besides breast cancer. The results of GEE showed that after control for baseline scores, the HRQoL significantly improved over time. Although, the patients in FAC group had higher scores than the TAC group, the differences also diminished over time. Smoking, marital status and having child affected some scales of HRQoL. None of other variables were significantly related to HRQoL. Conclusion: Although patients in TAC groups had lower level of HRQoL over 8 months follow up, they experienced faster improvement than the FAC group. This implies that in long-term, improvements in TAC group are higher than FAC. Having children was positively correlated with HRQoL. Generally, there were no demographic and socio-economic differences in HRQoL in these patients between the chemotherapeutic regimens.



  1. Aaronson NK, Ahmedzai S, Bergman B, et al (1993). The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst, 85, 365-76.
  2. Atef-vahid MK, Nasr-Esfahani M, Esfeedvajani MS, et al (2011). Quality of life, religious attitude and cancer coping in a sample of Iranian patients with cancer. J Res Med Sci, 16, 928-37.
  3. Bastani P, Ahmad Kiadaliri A (2011). Health related quality of life after chemotherapy cycle in breast cancer in Iran. Med Oncol, 28, S70-4.
  4. Burwell SR, Case LD, Kaelin C, et al (2006). Sexual problems in younger women after breast cancer surgery. J Clin Oncol, 24, 2815-21.
  5. Duffy SA, Terrell JE, Valenstein M, et al (2002). Effect of smoking, alcohol, and depression on the quality of life of head and neck cancer patients. Gen Hosp Psychiatry, 24, 140-7.
  6. Early Breast Cancer Trialists' Collaborative Group (2005). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet, 365, 1687-717.
  7. Elder EE, Brandberg Y, Bjorklund T, et al (2005). Quality of life and patient satisfaction in breast cancer patients after immediate breast reconstruction: a prospective study. Breast, 14, 201-8.
  8. Fayers PM, Aaronson NK, Bjordal K, et al (2001). The EORTC QLQ-C30 Scoring Manual (3rd Edition). Published by: European Organisation for Research and Treatment of Cancer, Brussels.
  9. Ganz PA, Rowland JH, Desmond K, et al (1998). Life after breast cancer: understanding women's health-related quality of life and sexual functioning. J Clin Oncol, 16, 501-14.
  10. Garces YI, Yang P, Parkinson J, et al (2004). The relationship between cigarette smoking and quality of life after lung cancer diagnosis. Chest, 126, 1733-41.
  11. Harirchi I, Karbakhsh M, Kashefi A, et al (2004) Breast Cancer in Iran: Results of a Multi-center study. Asian Pacific J Cancer Prev, 5, 24-7.
  12. Harirchi I, Kolahdoozan S, Karbakhsh M, et al (2011). Twenty years of breast cancer in Iran: downstaging without a formal screening program. Ann Oncol, 22, 93-7.
  13. Hatam N, Ahmadloo N, Ahmad Kiadaliri A, et al (2011). Quality of life and toxicity in breast cancer patients using adjuvant TAC (docetaxel, doxorubicin, cyclophosphamide), in comparison with FAC (doxorubicin, cyclophosphamide, 5-fluorouracil). Arch Gynecol Obstet, 284, 215-20.
  14. Kontodimopoulos N,Aletras VH, Paliouras D, et al (2009). Mapping the Cancer-SpecificEORTCQLQ-C30 to the Preference-Based EQ-5D, SF-6D, and 15D Instruments. Value Health, 12, 1151-7.
  15. Lam CLK, Lauder IJ (2000). The impact of chronic diseases on the health-related quality of life (HRQOL) of Chinese patients in primary care. Family Practice, 17, 159-66.
  16. Larsson J, Sandelin K, Forsberg C (2010). Health related quality of life and healthcare experiences in breast cancer patients in a study of Swedish women. Cancer Nurs, 33, 164-70.
  17. Letourneau JM, Ebbel EE, Katz PP, et al (2011). Pretreatment fertility counseling and fertility preservation improve quality of life in reproductive age women with cancer. Cancer, doi: 10.1002/cncr.26459.
  18. Martin M, Pienkowski T, Mackey J, et al (2005a). Adjuvant Docetaxel for Node-Positive Breast Cancer. N Engl J Med, 352, 2302-13.
  19. Martin M, Lluch A, Segui M, et al (2005b). Toxicity and healthrelated quality of life in node-negative breast cancer patients receiving adjuvant treatment with TAC or FAC: impact of adding prophylactic growth factors to TAC. J Clin Oncol, 23, 604.
  20. Montazeri A, Harirchi I, Vahdani M, et al (1999). The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30): translation and validation study of the Iranian version. Support Care Cancer, 7, 400-6.
  21. Mousavi SM, Gouya MM, Ramazani R et al (2009). Cancer incidence and mortality in Iran. Ann Oncol, 20, 556-63.
  22. Nguyen KH, Freedman GM, Hanlon AL, et al (2003). Smoking cessation confers survival advantage for breast cancer patients treated with conservative surgery and radiation. Int J Radiat Oncol Biol Phys, 57, S358-9.
  23. Perry S, Kowalski TL, Chang CH (2007). Quality of life assessment in women with breast cancer: benefits, acceptability and utilization. Health Qual Life Outcomes, 5, 24-37.
  24. Richardson LC, Wang W, Hartzema AG, et al (2007). The role of health-related quality of life in early discontinuation of chemotherapy for breast cancer. Breast J, 13, 581-7.
  25. Sadjadi A, Nouraie M, Mohagheghi MA, et al (2005). Cancer Occurrence in Iran in 2002, an International Perspective. Asian Pacific J Cancer Pre, 6, 359-63.
  26. Shi HY, Uen YH, Yen LC, et al (2011). Two-year quality of life after breast cancer surgery: A comparison of three surgical procedures. EJSO, 37, 695-702.
  27. StataCorp (2009). Stata Statistical Software: Release 11. College Station, TX: StataCorp LP.
  28. Walters SJ (2009). Quality of Life Outcomes in Clinical Trials and Health-Care Evaluation. John Wiley & Sons Ltd; United Kingdom.

Cited by

  1. Gender Differences in Marital Disruption among Patients with Cancer: Results from the Korean National Health and Nutrition Examination Survey (KNHANES) vol.15, pp.16, 2014,
  2. Health-related Quality of Life in Women with Breast Cancer: a Literature-based Review of Psychometric Properties of Breast Cancer-specific Measures vol.15, pp.8, 2014,
  3. Sense of coherence as a mediator of health-related quality of life dimensions in patients with breast cancer: a longitudinal study with prospective design vol.13, pp.1, 2015,