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Association between Socioeconomic Status and Altered Appearance Distress, Body Image, and Quality of Life Among Breast Cancer Patients

  • Chang, Oliver (Krieger School of Arts and Sciences, Johns Hopkins University) ;
  • Choi, Eun-Kyung (Cancer Education Center, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Im-Ryung (Cancer Education Center, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Nam, Seok-Jin (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Jeong Eon (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Se Kyung (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Im, Young-Hyuck (Department of Hematology and Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Yeon Hee (Department of Hematology and Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Cho, Juhee (Cancer Education Center, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Published : 2014.11.06

Abstract

Background: Breast cancer patients experience a variety of altered appearance - such as loss or disfigurement of breasts, discolored skin, and hair loss - which result in psychological distress that affect their quality of life. This study aims to evaluate the impact of socioeconomic status on the altered appearance distress, body image, and quality of life among Korean breast cancer patients. Materials and Methods: A cross-sectional survey was conducted at advocacy events held at 16 different hospitals in Korea. Subjects were eligible to participate if they were 18 years of age or older, had a histologically confirmed diagnosis of breast cancer, had no evidence of recurrence or metastasis, and had no psychological problems at the time of the survey. Employment status, marital status, education, and income were assessed for patient socioeconomic status. Altered appearance distress was measured using the NCI's cancer treatment side effects scale; body image and quality of life were measured by the EORTC QLC-C30 and BR23. Means and standard deviations of each outcome were compared by socioeconomic status and multivariate linear regression models for evaluating the association between socioeconomic status and altered appearance distress, body image, and quality of life. Results: A total of 126 breast cancer patients participated in the study; the mean age of participants was 47.7 (SD=8.4). Of the total, 83.2% were married, 85.6% received more than high school education, 35.2% were employed, and 41% had more than $3000 in monthly household income. About 46% had mastectomy, and over 30% were receiving either chemotherapy or radiation therapy at the time of the survey. With fully adjusted models, the employed patients had significantly higher altered appearance distress (1.80 vs 1.48; p<0.05) and poorer body image (36.63 vs 51.69; p<0.05) compared to the patients who were unemployed. Higher education (10.58, standard error (SE)=7.63) and family income (12.88, SE=5.08) was positively associated with better body image after adjusting for age, disease stage at diagnosis, current treatment status, and breast surgery type. Similarly, patients who were married and who had higher education had better quality of life were statistically significant in the multivariate models. Conclusions: Socioeconomic status is significantly associated with altered appearance distress, body image, and quality of life in Korean women with breast cancer. Patients who suffer from altered appearance distress or lower body image are much more likely to experience psychosocial, physical, and functional problems than women who do not, therefore health care providers should be aware of the changes and distresses that these breast cancer patients go through and provide specific information and psychosocial support to socioeconomically more vulnerable patients.

Keywords

References

  1. Abu-Helalah M, Al-Hanaqta M, Alshraideh H, Abdulbaqi, N, Hijazeen J (2014). Quality of life and psychological wellbeing of breast cancer survivors in jordan. Asian Pac J Cancer Prev, 15, 5927-36. https://doi.org/10.7314/APJCP.2014.15.14.5927
  2. Ahn E, Cho J, Shin DW, et al (2009). Impact of breast cancer diagnosis and treatment on work-related life and factors affecting them. Breast Cancer Res Treat, 116, 609-16. https://doi.org/10.1007/s10549-008-0209-9
  3. Ashing-Giwa KT, Lim JW (2009). Examining the impact of socioeconomic status and socioecologic stress on physical and mental health quality of life among breast cancer survivors. Oncol Nurs Forum, 36, 79-88. https://doi.org/10.1188/09.ONF.79-88
  4. Beatty L, Oxlad M, Koczwara B, Wade TD (2008). The psychosocial concerns and needs of women recently diagnosed with breast cancer: a qualitative study of patient, nurse and volunteer perspectives. Health Expect, 11, 331-42. https://doi.org/10.1111/j.1369-7625.2008.00512.x
  5. Cho J, Choi EK, Kim IR, et al (2014). Development and validation of Chemotherapy-induced alopecia distress scale (CADS) for breast cancer patients. Ann Oncol, 25, 346-51. https://doi.org/10.1093/annonc/mdt476
  6. Cho J, Choi EK, Kim SY, et al (2013) (a). Association between cancer stigma and depression among cancer survivors: a nationwide survey in Korea. Psychooncology, 22, 2372-8.
  7. Cho J, Smith K, Choi EK, et al (2013) (b). Public attitudes toward cancer and cancer patients: a national survey in Korea. Psychooncology, 22, 605-13. https://doi.org/10.1002/pon.3041
  8. Choi EK, Kim IR, Chang O, et al (2014). Impact of chemotherapyinduced alopecia distress on body image, psychosocial well-being, and depression in breast cancer patients. Psychooncology, 23, 1103-10. https://doi.org/10.1002/pon.3531
  9. Fayers PM, Aaronson NK, Bjordal K, et al (2001). The EORTC QLQ-C30 Scoring Manual 3rd edition, European Organization for Research and Treatment of Cancer: Brussels, Belgium.
  10. Fobair P, Stewart SL, Chang S, et al (2006). Body image and sexual problems in young women with breast cancer. Psychooncology, 15, 579-94. https://doi.org/10.1002/pon.991
  11. Frith H, Harcourt D, Fussell A (2007). Anticipating an altered appearance: women undergoing chemotherapy treatment for breast cancer. Eur J Oncol Nurs, 11, 385-91. https://doi.org/10.1016/j.ejon.2007.03.002
  12. Harcourt NR (2005). The Psychology of Appearance. Health Psychology, McGraw-Hill International.
  13. Janz NK, Mujahid M, Lantz PM, et al (2005). Population-based study of the relationship of treatment and sociodemographics on quality of life for early stage breast cancer. Qual Life Res, 14, 1467-79. https://doi.org/10.1007/s11136-005-0288-6
  14. Karakoyun-Celik O, Gorken I, Sahin S, et al (2010). Depression and anxiety levels in woman under follow-up for breast cancer: relationship to coping with cancer and quality of life. Med Oncol, 27, 108-13. https://doi.org/10.1007/s12032-009-9181-4
  15. Kim IR, Cho J, Choi EK, et al (2012) (a). Perception, attitudes, preparedness and experience of chemotherapy-induced alopecia among breast cancer patients: a qualitative study. Asian Pac J Cancer Prev, 13, 1383-8. https://doi.org/10.7314/APJCP.2012.13.4.1383
  16. Kim KR, Chung HC, Lee E, Kim SJ, Namkoong K (2012) (b). Body image, sexual function and depression in Korean patients with breast cancer: modification by 5-HTT polymorphism. Support Care Cancer, 20, 2177-82. https://doi.org/10.1007/s00520-011-1329-z
  17. King MT, Kenny P, Shiell A, Hall J, Boyages J (2000). Quality of life three months and one year after first treatment for early stage breast cancer: influence of treatment and patient characteristics. Qual Life Res, 9, 789-800. https://doi.org/10.1023/A:1008936830764
  18. Lemieux J, Maunsell E, Provencher L (2008). Chemotherapyinduced alopecia and effects on quality of life among women with breast cancer: a literature review. Psychooncology, 17, 317-28. https://doi.org/10.1002/pon.1245
  19. Maunsell E, Brisson C, Dubois L, Lauzier S, Fraser A (1999). Work problems after breast cancer: an exploratory qualitative study. Psychooncology, 8, 467-73. https://doi.org/10.1002/(SICI)1099-1611(199911/12)8:6<467::AID-PON400>3.0.CO;2-P
  20. Moorey S (2007). The female body in mind : the interface between the female body and mental health. Breast Cancer and Body Image, Routledge, 72-88.
  21. Ogden J, Lindridge L (2008). The impact of breast scarring on perceptions of attractiveness: an experimental study. J Health Psychol, 13, 303-10. https://doi.org/10.1177/1359105307088132
  22. Preston MM (2010). An exploration of appearance-relat ed issues of breast cancer treatment on sense of self, self esteem, and social functioning in women with breast cancer. (University of Pennsylvania Scholarly Commons (5-17-2010)).
  23. Rosenberg SM, Tamimi RM, Gelber S, et al (2013). Body image in recently diagnosed young women with early breast cancer. Psychooncology, 22, 1849-55. https://doi.org/10.1002/pon.3221
  24. Rumsey N, Clarke A, White P, Wyn-Williams M, Garlick W (2004). Altered body image: appearance-related concerns of people with visible disfigurement. J Adv Nurs, 48, 443-53. https://doi.org/10.1111/j.1365-2648.2004.03227.x
  25. Salonen P, Tarkka MT, Kellokumpu-Lehtinen PL, et al (2009). Telephone intervention and quality of life in patients with breast cancer. Cancer Nurs, 32, 177-90. https://doi.org/10.1097/NCC.0b013e31819b5b65
  26. Schmid-Buchi S, Halfens RJ, Muller M, Dassen T, van den Borne B (2013). Factors associated with supportive care needs of patients under treatment for breast cancer. Eur J Oncol Nurs, 17, 22-9.
  27. Schover LR, Yetman RJ, Tuason, LJ, et al (1995). Partial mastectomy and breast reconstruction. A comparison of their effects on psychosocial adjustment, body image, and sexuality. Cancer, 75, 54-64. https://doi.org/10.1002/1097-0142(19950101)75:1<54::AID-CNCR2820750111>3.0.CO;2-I
  28. Tan FL, Loh S, Su TT, Veloo VW, Ng LL (2012). Return to work in multi-ethnic breast cancer survivors- a qualitative inquiry. Asian Pac J Cancer Prev, 13, 5791-7. https://doi.org/10.7314/APJCP.2012.13.11.5791
  29. Tiedtke C, de Rijk A, Dierckx de Casterle B, Christiaens MR, Donceel P (2010). Experiences and concerns about 'returning to work' for women breast cancer survivors: a literature review. Psychooncology, 19, 677-83.
  30. Wang K, Li X, Zhou C, et al (2013). Socio-economic factors influencing tumor presentation and treatment options in Chinese breast cancer patients. Asian Pac J Cancer Prev, 14, 267-74. https://doi.org/10.7314/APJCP.2013.14.1.267
  31. Yun YH, Bae SH, Kang IO, et al (2004). Cross-cultural application of the korean version of the european organization for research and treatment of cancer (EORTC) breast-cancer specific quality of life questionnaire (EORTC QLQ-BR23). Support Care Cancer, 12, 441-5. https://doi.org/10.1007/s00520-004-0632-3

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