In recent years there has been a growing realization of the importance of considering quality, as well as length, of survival in cancer patients. The extended survival that has resulted from more effective cancer treatments couple with the sometimes debilitating and distressing impacts of those treatments has led to considerable concern regarding the long term quality of life for patients with experience extended remissions or cure and for patients who experience recurrence of disease. The proposed research is designed: (1) to assess longitudinally the quality of life of breast cancer patients who do and do not experience relapse during the first two years following initial surgery; and (2) to identify early predictors of ongoing problems and of rapid recovery among patients. Possible predictors to be explored include earlier quality of life, type and extent of information received, expectations regarding the future, and nature of medical follow-up. Subjects will be approximately 1500 Stage I and Stage II breast cancer patients who are participating in a clinical trial being conducted in 40 hospitals throughout northern Italy. In addition to demographic and medical data, self-reported quality of life data and physician-reported functional status will be obtained at time of initial treatment and at six months, one year, and two years post-surgery. The approximately 200 respondents who are expected to experience a recurrence of disease will also be tested at time of relapse and at six months post-relapse. Comparison data will be gathered from physically healthy northern Italian women and from women who are receiving noncancer-related surgeries at participating hospitals. Repeated measure multivariate analyses of variance and multiple regression analyses will be used to compare quality of life longitudinally for women receiving different medical treatments and to identify predictors of quality of life. Possible causal links among variables will be examined using path analysis.
