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February 2, 2026International Journal of Cancer0 citationsOpen Access

Longitudinal changes in health‐related quality of life after a breast cancer diagnosis in sub‐Saharan Africa: Evidence from the prospective ABC ‐ DO cohort

SMShamsudeen Mohammed MGMoses GalukandeMakerere University ANAllen Naamala

Key Points

The study aims to analyze the changes in health-related quality of life after a breast cancer diagnosis among women in sub-Saharan Africa.
Longitudinal study design with interviews every 3 months over 7 years.
Participants included newly diagnosed women aged ≥18 from five sub-Saharan African countries.
Quality of Life was assessed using the EORTC QLQ-C30 questionnaire.
Multilevel mixed-effects models were used to analyze factors influencing Global Health Status.
Health-related quality of life was lowest in the first 6 months post-diagnosis but improved over time.
Higher levels of education and family support were positively associated with improved Global Health Status.
GHS decreased with increasing age at diagnosis and advanced tumor stage.
Women reported higher health quality during COVID-19 lockdowns compared to before/post lockdown.

Abstract

Abstract Breast cancer and its treatments impact on women's health‐related quality of life, but few studies have assessed these outcomes among survivors in sub‐Saharan Africa (SSA). We investigated longitudinal changes in Global Health Status (GHS) and their correlates within the African Breast Cancer‐Disparities in Outcomes cohort. Newly diagnosed women (≥18 years) across five SSA countries were recruited in 2014–2017. In four countries, follow‐up interviews were conducted 3‐monthly over 7 years using the European Organisation for Research and Treatment of Cancer Quality of Life 30‐item core questionnaire version 3. Multilevel mixed‐effects models identified correlates of GHS. Overall, 1358 women from Namibia, Nigeria, Uganda and Zambia were included, with a mean age of 50.6 (SD = 13.7) years. Median follow‐up time was 3 (IQR = 2–5) years, with a median of 18 GHS assessments per woman (IQR = 10–23). GHS was lowest in the first 6 months post‐diagnosis but improved gradually thereafter. GHS increased with increasing education ( p ‐value for linear trend p t < .0001), breast cancer awareness (adjusted‐odds ratio: 1.32; 95% confidence interval 1.22–1.42), surgical treatment (1.90; 1.53–2.37), family support (1.46; 1.24–1.71) and maintaining pre‐diagnosis employment (1.54; 1.41–1.68). In contrast, GHS decreased with increasing age at diagnosis ( p t <.0001), rural residence (0.76; 0.70–0.82), advanced tumour stage at diagnosis ( p t <.0001) and having non‐HIV comorbidities (0.74; 0.60–0.92). GHS was not affected by HIV status, but it was higher during COVID‐19 lockdowns than pre‐/post‐lockdown (1.27; 1.09–1.49). These patterns were similar at young and older ages, and in the short‐ and long‐term. The potentially modifiable factors associated with GHS are known to influence breast cancer survival in SSA. Addressing them could improve survivorship and survival from this cancer in the region.

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