Abstract Background: Evidence comparing patients' health-related quality of life (HRQOL) pre- and post-breast cancer diagnosis, and factors influencing these trajectories, is limited due to unpredictable onset. We analyzed predictors of HRQOL change in elderly breast cancer patients across two transitions: pre- to post-diagnosis, and at diagnosis versus two years later. Methods: Using SEER-MHOS linkage, we analyzed breast cancer patients 65 years who completed two HRQOL surveys. Two cohorts were examined: patients with surveys pre- and within one-year post-diagnosis (cohort 1) and those with surveys within one year of diagnosis and two years post-diagnosis (cohort 2). Bayesian regression identified predictors of physical (PCS) and mental (MCS) score changes. Results: In cohort 1 (n=1,546), advanced stage was associated with greater HRQOL decline, with mean PCS changes ranging from −2.1 to −6.5 and MCS from −2.0 to −5.1. Baseline activities of daily living (ADL) limitations were associated with mean PCS declines ranging from −2.0 to −2.6 and mean MCS decline of −2.0. Better baseline health perception was protective with mean PCS increases ranging from +1.4 to +3.4. In cohort 2 (n=891), baseline ADL limitations were associated with mean PCS declines ranging from −1.6 to −5.5 and mean MCS decline of −2.5, while poor health perception was associated with mean PCS decline of −3.2. Excellent health perception was protective (mean MCS:+4.1). Surgery, chemotherapy, and radiation had no HRQOL impact. Conclusion: Baseline health perception and ADL limitations are critical determinants of HRQOL trajectories, outweighing treatments. Impact: Early intervention strategies based on baseline assessments may improve survivorship.
Moheb et al. (2025) studied this question.