Depression and quality of life before and after breast cancer diagnosis in older women from the Women's Health Initiative

J Cancer Surviv. 2015 Dec;9(4):620-9. doi: 10.1007/s11764-015-0438-y. Epub 2015 Feb 24.


Purpose: Distress and reduced quality of life (QOL) are common among people with cancer. No study has compared these variables after breast cancer diagnosis to pre-cancer diagnosis levels.

Methods: Data on women with breast cancer 50 years of age or older (n = 6949) were analyzed from the Women's Health Initiative (1993-2013). Health-related QOL (physical function, mental health) was measured using Rand-36. Depressive symptoms were measured with the six-item Center for Epidemiologic Studies Depression scale. Assessments occurred before and after the cancer diagnosis. Hierarchical linear modeling compared pre-cancer QOL and depressive symptoms to levels post-diagnosis and tested whether pre-cancer physical activity, stressful life events, sleep disturbance, and pain predicted post-diagnosis outcomes.

Results: Compared with pre-cancer levels, depressive symptoms increased (20.0% increase at 0-6 months, 12.9% increase at 6-12 months), while physical function (-3.882 points at 0-6 months, -3.545 at 6-12 months) and mental health decreased (-2.899 points at 0-6 months, -1.672 at 6-12 months) in the first year after diagnosis (all p < .01). Depressive symptoms returned to pre-cancer levels after 10 years, but QOL remained significantly lower. At more than 10 years post-diagnosis, physical function was 2.379 points lower than pre-cancer levels (p < 0.01) while mental health was 1.922 points lower (p < 0.01). All pre-cancer predictors were associated with all outcomes. Pain predicted uniquely greater decreases in physical function post-diagnosis.

Conclusions: Depressive symptoms increased and QOL decreased following breast cancer diagnosis compared with pre-cancer levels, particularly in the first year.

Implications for cancer survivors: QOL may remain lower for years after breast cancer diagnosis, although decreases are small.

Keywords: Breast cancer; Depression; Distress; Health-related quality of life; Neoplasm; Women’s health.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Age Factors
  • Aged
  • Breast Neoplasms / diagnosis
  • Breast Neoplasms / epidemiology*
  • Breast Neoplasms / psychology*
  • Depression / epidemiology*
  • Depression / psychology
  • Female
  • Humans
  • Mental Health / statistics & numerical data
  • Middle Aged
  • Pain / epidemiology
  • Quality of Life* / psychology
  • Sleep Wake Disorders / epidemiology
  • Surveys and Questionnaires
  • Survivors / psychology
  • Women's Health