The Association between the Adherence to Dietary Guidelines for Breast Cancer Survivors and Health-related Quality of Life among Korean Breast Cancer Survivors

한국 유방암 경험자들의 유방암 식사지침 수행 정도와 건강관련 삶의 질의 연관성

  • Song, Sihan (Department of Food and Nutrition, Sookmyung Women's University) ;
  • Youn, Jiyoung (Department of Food and Nutrition, Sookmyung Women's University) ;
  • Park, Myungsook (Department of Food and Nutrition, Sookmyung Women's University) ;
  • Hwang, Eunkyung (Breast Care Center, Seoul National University Hospital) ;
  • Moon, Hyeong-Gon (Breast Care Center, Seoul National University Hospital) ;
  • Noh, Dong-Young (Breast Care Center, Seoul National University Hospital) ;
  • Lee, Jung Eun (Department of Food and Nutrition, Sookmyung Women's University)
  • 송시한 (숙명여자대학교 식품영양학과) ;
  • 윤지영 (숙명여자대학교 식품영양학과) ;
  • 박명숙 (숙명여자대학교 식품영양학과) ;
  • 황은경 (서울대학교병원 유방센터) ;
  • 문형곤 (서울대학교병원 유방센터) ;
  • 노동영 (서울대학교병원 유방센터) ;
  • 이정은 (숙명여자대학교 식품영양학과)
  • Received : 2015.03.16
  • Accepted : 2015.04.21
  • Published : 2015.04.30


Objectives: We examined the association between the adherence to dietary guidelines for breast cancer survivors and health-related quality of life in a cross-sectional study of Korean breast cancer survivors. Methods: A total of 157 women aged 21 to 79 years who had been diagnosed with stage I to III breast cancers according to the American Joint Committee on Cancer (AJCC) and had breast cancer surgery at least 6 months before the baseline were included. We used a Korean version of the Core 30 (C30) and Breast cancer 23 (BR23) module of the European Organization for Research and Treatment Cancer Quality of Life Questionnaire (EORTC-QLQ), both of which have been validated for Koreans. Participants were asked about their adherence to dietary guidelines for breast cancer survivors, suggested by the Korean breast cancer society, using a 5-point Likert scale. We summed dietary guideline adherence scores for each participant and calculated the least squares means of health-related quality of life according to dietary guideline adherence scores using the generalized linear model. Results: Breast cancer survivors who had higher adherence to dietary guidelines for breast cancer survivors had lower constipation scores than those with lower adherence (p for trend=0.01). When we stratified by the stage at diagnosis, this association was limited to those who had been diagnosed with stage II or III breast cancers. Also, sexual functioning scores increased significantly with increasing adherence scores of dietary guidelines among those with stage II or III breast cancers (p for trend < 0.001). However, among those who had been diagnosed with stage I, higher scores of dietary guidelines were associated with higher scores of pain (p for trend=0.03) and breast symptoms (p for trend=0.05). Conclusions: Our study suggested that the health-related quality of life levels of breast cancer survivors are associated with the adherence to dietary guidelines and may differ by the stage of the breast cancer.


Supported by : National Research Foundation of Korea (NRF)


  1. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JCJM, Kaasa S, Klee M, Osoba D, Razavi D, Rofe PB, Schraub S, Sneeuw K, Sullivan M, Takeda F (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(5): 365-376
  2. Amecican Cancer Society (2014a): Cancer facts & figures 2014, American Cancer Society, Atlanta, pp. 9-11
  3. Amecican Cancer Society (2014b): Cancer treatment and survivorship facts & figures 2014-2015, American Cancer Society, Atlanta, pp. 26
  4. Blanchard CM, Courneya KS, Stein K (2008): Cancer survivors' adherence to lifestyle behavior recommendations and associations with health-related quality of life: results from the American Cancer Society's SCS-II. J Clin Oncol 26(13): 2198-2204
  5. Boucher BA, Cotterchio M, Curca IA, Kreiger N, Harris SA, Kirsh VA, Goodwin PJ (2012): Intake of phytoestrogen foods and supplements among women recently diagnosed with breast cancer in Ontario, Canada. Nutr Cancer 64(5): 695-703
  6. Brazier JE, Harper R, Jones NM, O'Cathain A, Thomas KJ, Usherwood T, Westlake L (1992): Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ 305(6846): 160-164
  7. Centers for Disease Control and Prevention (2000): Measuring healthy days, Centers for Disease Control and Prevention, Atlanta, pp. 6-11
  8. Cho SW, Kim JH, Lee SM, Lee SM, Choi EJ, Jeong J, Park YK (2014): Effect of 8-week nutrition counseling to increase phytochemical rich fruit and vegetable consumption in Korean breast cancer patients: a randomized controlled trial. Clin Nutr Res 3(1): 39-47
  9. Dashti HS, Follis JL, Smith CE, Tanaka T, Cade BE, Gottlieb DJ, Hruby A, Jacques PF, Lamon-Fava S, Richardson K, Saxena R, Scheer FAJL, Kovanen L, Bartz TM, Perala MM, Jonsson A, Frazier-Wood AC, Kalafati IP, Mikkila V, Partonen T, Lemaitre RN, Lahti J, Hernandez DG, Toft U, Johnson WC, Kanoni S, Raitakari OT, Perola M, Psaty BM, Ferrucci L, Grarup N, Highland HM, Rallidis L, Kahonen M, Havulinna AS, Siscovick DS, Raikkonen K, Jorgensen T, Rotter JI, Deloukas P, Viikari JSA, Mozaffarian D, Linneberg A, Seppala I, Hansen T, Salomaa V, Gharib SA, Eriksson JG, Bandinelli S, Pedersen O, Rich SS, Dedoussis G, Lehtimaki T, Ordovas JM (2015): Habitual sleep duration is associated with BMI and macronutrient intake and may be modified by CLOCK genetic variants. Am J Clin Nutr 101(1): 135-143
  10. Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM (2005): Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol 23(24): 5814-5830
  11. Edge SB, Byrd DR, Carducci M, Compton CC, Fritz AG, Greene FL, Trotti A (2009): AJCC cancer staging manual, 7th ed, Springer, New York, pp.419-460
  12. Eslick GD (2012): Gastrointestinal symptoms and obesity: a metaanalysis. Obes Rev 13(5): 469-479
  13. Fayers PM, Aaronson NK, Bjordal K, Groenvold M, Curran D, Bottomley A, on behalf of the EORTC Quality of Life Group (2001): The EORTC QLQ-C30 Scoring Manual, 3rd ed, EORTC, Brussels, pp.55-58
  14. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F (2015): Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 136(5): E359-386
  15. GLOBOCAN (2012): Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012. Available from [cited March 12, 2015]
  16. Hann D, Winter K, Jacobsen P (1999): Measurement of depressive symptoms in cancer patients: Evaluation of the center for epidemiological studies depression scale (Ces-d). J Psychosom Res 46(5): 437-443
  17. Hays RD, Morales LS (2001): The RAND-36 measure of healthrelated quality of life. Ann Med 33(5): 350-357
  18. Holmes S, Dickerson J (1987): The quality of life: design and evaluation of a self-assessment instrument for use with cancer patients. Int J Nurs Stud 24(1): 15-24
  19. Inoue-Choi M, Lazovich D, Prizment AE, Robien K (2013): Adherence to the World Cancer Research Fund/American Institute for Cancer Research recommendations for cancer prevention is associated with better health-related quality of life among elderly female cancer survivors. J Clin Oncol 31(14): 1758-1766
  20. Jung KW, Won YJ, Kong HJ, Oh CM, Lee DH, Lee JS (2014): Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2011. Cancer Res Treat 46(2): 109-123
  21. Kennedy ET, Ohls J, Carlson S, Fleming K (1995): The healthy eating index: Design and applications. J Am Diet Assoc 95(10): 1103-1108
  22. Korea Breast Cancer Society (2012): Dietary guideline for breast cancer survivors. Available from [cited July 31, 2012]
  23. Kushi LH, Doyle C, McCullough M, Rock CL, Demark-Wahnefried W, Bandera EV, Gapstur S, Patel AV, Andrews K, Gansler T, American Cancer Society Nutrition, Physical Activity Guidelines Advisory Committee (2012): American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin 62(1): 30-67
  24. Lee MK, Yun YH, Park HA, Lee ES, Jung KH, Noh DY (2014): A Web-based self-management exercise and diet intervention for breast cancer survivors: pilot randomized controlled trial. Int J Nurs Stud 51(12): 1557-1567
  25. McTiernan A, Irwin M, Vongruenigen V (2010): Weight, physical activity, diet, and prognosis in breast and gynecologic cancers. J Clin Oncol 28(26): 4074-4080
  26. Mols F, Vingerhoets AJ, Coebergh JW, van de Poll-Franse LV (2005): Quality of life among long-term breast cancer survivors: A systematic review. Eur J cancer 41(17): 2613-2619
  27. Mosher CE, Sloane R, Morey MC, Snyder DC, Cohen HJ, Miller PE, Demark-Wahnefried W (2009): Associations between lifestyle factors and quality of life among older long-term breast, prostate, and colorectal cancer survivors. Cancer 115(17): 4001-4009
  28. Neugarten BL, Kraines RJ (1965): "Menopausal symptoms" in women of various ages. Obstet Gynecol Surv 20(6): 994-1001
  29. Patterson RE, Haines PS, Popkin BM (1994): Diet quality index: capturing a multidimensional behavior. J Am Diet Assoc 94(1): 57-64
  30. Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL, Bandera EV, Hamilton KK, Grant B, McCullough M, Byers T, Gansler T (2012): Nutrition and Physical Activity Guidelines for Cancer Survivors. CA Cancer J Clin 62(4): 242-274
  31. Stamatakis KA, Brownson RC (2008): Sleep duration and obesityrelated risk factors in the rural Midwest. Prev Med 46(5): 439-444
  32. Swisher AK, Abraham J, Bonner D, Gilleland D, Hobbs G, Kurian S, Yanosik MA, Vona-Davis L (2015): Exercise and dietary advice intervention for survivors of triple-negative breast cancer: effects on body fat, physical function, quality of life, and adipokine profile. Support Care Cancer 2015: 1-9
  33. Tangney CC, Young JA, Murtaugh MA, Cobleigh MA, Oleske DM (2002): Self-reported dietary habits, overall dietary quality and symptomatology of breast cancer survivors: a cross-sectional examination. Breast Cancer Res Treat 71(2): 113-123
  34. Toles M, Demark-Wahnefried W (2008): Nutrition and the cancer survivor: evidence to guide oncology nursing practice. Semin Oncol Nurs 24(3): 171-179
  35. Velentzis LS, Keshtgar MR, Woodside JV, Leathem AJ, Titcomb A, Perkins KA, Mazurowska M, Anderson V, Wardell K, Cantwell MM (2011): Significant changes in dietary intake and supplement use after breast cancer diagnosis in a UK multicentre study. Breast Cancer Res Treat 128(2): 473-482
  36. Wayne SJ, Baumgartner K, Baumgartner RN, Bernstein L, Bowen DJ, Ballard-Barbash R (2006): Diet quality is directly associated with quality of life in breast cancer survivors. Breast Cancer Res Treat 96(3): 227-232
  37. Wiseman M (2008): The second World Cancer Research Fund/American Institute for Cancer Research expert report. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Proc Nutr Soc 67(3): 253-256
  38. Yun YH, Bae SH, Kang IO, Shin KH, Lee R, Kwon SI, Park YS, Lee ES (2004a): 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(6): 441-445
  39. Yun YH, Park YS, Lee ES, Bang SM, Heo DS, Park SY, You CH, West K (2004b): Validation of the Korean version of the EORTC QLQ-C30. Qual Life Res 13(4): 863-868