Experience and predictors of symptoms, distress and health-related quality of life over time in postmenopausal women with recurrent breast cancer

The purpose of this study was to explore the symptom experience and predictors of distress and quality of life over time in women with recurrent breast cancer. Fifty-six women completed questionnaires at the diagnosis of recurrence, 1 month, 3 and 6 months after recurrence. A majority of women reported multiple, concurrent and distressing symptoms such as lack of energy, difficulty sleeping, pain, worry and problems with sexual interest or activity during the recurrent breast cancer trajectory. The highest level of symptom burden and distress and decreased quality of life was reported 3 months after recurrence. Although distress declined and quality of life improved over time, patients reported persistent symptoms. Of the patients at increased risk of vulnerability to distress were women who experienced multiple and concurrent symptoms. Other risk factors were co-morbidity, prehistory of anxiety and depression and progressive or terminal disease. Fatigue, pain and depression explained 68-72% of the variance in distress. Distress explained 44-46% of the variance in quality of life. These findings suggest that symptoms are important contributors to the distress experience, and that distress has a severe impact on quality of life. The care of women with recurrent breast cancer must be based upon the awareness of critical factors that exacerbate the vulnerability to distress throughout the disease trajectory.