Women with Breast Cancer: Quality of Life and Diet Adherence

Institution: University of California, San Diego
Investigator(s): Wayne Bardwell, Ph.D. -
Award Cycle: 2001 (Cycle VII) Grant #: 7KB-0097 Award: $164,427
Award Type: New Investigator Awards
Research Priorities
Community Impact of Breast Cancer>Sociocultural, Behavioral, and Psychological Issues: the human side

Initial Award Abstract (2001)
The most common cancer in women, breast cancer, can be highly distressing and have a major effect on quality of life. Some studies have suggested that a diet that includes high amounts of vegetables, fruit and fiber, and less fat might protect women from recurrence of this disease. The Women’s Healthy Eating and Living (WHEL) Study is a 6-year research program to test the effectiveness of this diet in 3080 California women with breast cancer 2-4 years after completing medical treatment. Regular telephone counseling is included to help the women stick to their dietary plans. This proposal is designed to analyze and report findings based on demographic, psychological, social and quality of life information gathered from these women at the beginning of the study and 1 year later.

This proposal is designed to provide information about two major concepts. First is to determine which women will have difficulty sticking to their dietary plans. Second is to understand what effect maintaining these dietary plans for 1 year will have on how the participants feel and function in their daily lives and with their families and friends. In addition, the study will look at the use of dietary supplements and also the effect that hot flashes—a common problem after breast cancer treatment—have on how the women feel and function.

Women entering the study will be randomly assigned to the dietary intervention group or to a control group (which will be given a less-strict diet recommended by the American Cancer Society). Each woman will be scheduled for clinic visits at the beginning and annually for 6 years. At each visit they will be asked to report what they ate the previous day and to fill out some questionnaires which measure social support and difficulties, life problems, mood, optimism, hostility, willingness to express "negative emotions", quality of life, physical and mental concerns, sleep problems, and personal habits. Sophisticated statistical analysis programs will be used.

This proposal is innovative because it is one of the first to look at how personal characteristics might determine who will stick with the strict diet. It also looks to see if sticking with the diet will improve the womens’ mood, daily functioning, and relationships. Understanding how personal characteristics are related to the use of dietary supplements is a topic relatively new to breast cancer research. Finally, determining how hot flashes affect how women with breast cancer feel and function is important and understudied. All of these findings should help medical and mental health professionals be more effective in tailoring and delivering treatment programs.

Final Report (2005)
Introduction: final report documents progress for this 3-year BCRP grant for analysis of baseline and Yr 1 psycho-social data from the Women's Healthy Eating and Living (WHEL) Study. The WHEL Study is an 8-yr randomized trial of effects of a strict dietary intervention on breast cancer outcomes.

Progress: Aim 1 was to understand relationships between psychosocial/quality of life (QOL)/demographic variables and diet adherence, and to compare these to relationships observed in controls. We observed relationships between QOL and psychological symptoms, obesity, sleep quality, physical activity, stressful life events, pain, and GI symptoms. Findings were presented at the 2003 Society of Behavioral Medicine (SBM) Conference and published in Psycho-oncology.

Aim 2 was to determine if telephone counseling had a separate effect on Q0L. We concluded counseling did not result in changes in QOL or social support. Thus, any effects of this study on breast cancer outcomes can be attributed to diet. Findings were given in an oral presentation at the 2003 Society of Behavioral Medicine Conference and in a manuscript under revision for Health Psychology,

Aim 3 was to understand relationships between psychosocial/QOL/demographic variables and underreporting of dietary intake. We analyzed relationships between response bias (Marlowe-Crowne Social Desirability Scale), measures of dietary self-report, and serum biomarkers of dietary intake. Results suggest that, overall, self-report of dietary intake are not influenced by response bias. These findings were reported in our manuscript published in Psycho-oncology.

Aim 4 was to understand how psychological distress patterns vary by demographics. We observed that predictors of depression in breast cancer survivors are similar to those for women in the general population. Psychosocial variables and physical symptoms-not cancer variables-predict depression in these women, Findings were given in a talk at the Academy of Psychosomatic Medicine 2003 Conference and are currently being written up for publication.

Aim 5 was to understand relationships between participant characteristics and use of dietary supplements. We have identified 5 clusters of use of complementary and alternative medicine, including supplements, and are in the process of developing an algorithm to characterize women in these clusters, Data will then be written up for publication.

Aim 6 was to understand predictors of hot flashes in these women. Preliminary results show that vasomotor symptoms were associated with sleep disturbance and psychological symptoms. Results will be submitted for presentation to the American Psychosomatic Society 2005 Conference and will be written up and submitted for publication later this year.

Future Directions/Impact: We are continuing to document and publish findings resulting from this highly productive project, with another manuscript currently being revised for Health Psychology and two other manuscripts currently being written. Findings from this study have contributed and are expected to continue to contribute significantly to the understanding of psychological and dietary aspects of breast cancer, with potential application to the understanding of adherence to other health behavior change interventions. Results from thus BCRP-funded study are fueling new applications to NCI and other agencies to examine longitudinal quality of life and overall psychological functioning in breast cancer survivors.

Symposium Abstract (2003)
The WHEL Study is a randomized trial of the effects of a major change in dietary pattern in 3088 women with early stage breast cancer on breast cancer recurrence and survival. Breast cancer patients are thought to be vulnerable to depression for many reasons associated with the impact of diagnosis, treatment, metabolic and endocrine changes, and psychological/social factors. We were interested in identifying predictors of depressive symptoms in women 0-4 years after diagnosis of stage I, II, or IIIA breast cancer who had completed treatment but had not yet begun participation in the WHEL Study.

Statistical analyses were conducted on data from 2617 women for whom complete data was available. Depressive symptoms were measured using the 8-item short form of the Center for Epidemiological Studies-Depression Scale. The following predictor variables were included in the analysis: cancer-related variables (type of treatment, current tamoxifen use, years since diagnosis, cancer stage at diagnosis, menopausal status), demographics (age, relationship status, body size, ethnicity, education), health behaviors (physical activity, current smoking, diet, alcohol consumption), physical symptoms (pain, menopausal, genitourinary, gastrointestinal), and, psychological/social variables (social support, social strain, optimism, expression of negative emotions, ambivalence about expressing negative emotions, hostility, sleep disturbance).

Overall, the predictor variables accounted for 42% of depressive symptoms. The percentage accounted for by the each of the above blocks of variables was as follows: cancer-related variables=1.3%; demo-graphics=2.9%; health behaviors=1.0%; physical symptoms=11.3%; psychological/social vari-ables=25.6%. Higher levels of depressive symptoms were associated with being pre-menopausal, fewer years since diagnosis, younger age, more pain and menopausal symptoms, less social support, more social strain, less optimism, more ambivalence about expressing negative emotions, and more sleep disturbance. Psychological/social variables and physical symptoms were strongly predictive of depressive symptoms even after considering the effects of cancer severity, demographics, and health behaviors.

These findings suggest that predictors of depressive symptoms in women treated for early stage breast cancer are similar to those found in the general population. Psychological/social variables and physical symptoms—not cancer-related variables— were important predictors of mood.

Quality of life (QOL) and diet in breast cancer.
Periodical:Annals of Behavioral Medicine
Index Medicus: Ann Behav Med
Authors: Bardwell WA, Rock CL, Pierce JP
Yr: 2002 Vol: 24 Nbr: Abs: Pg:S175

Health-related quality of life in women previously treated for early-stage breast cancer.
Index Medicus:
Authors: Bardwell WA, Major JM, Rock CL, Newman VA, Thomson CA, Chilton JA, Dimsdale JE, Pierce JP.
Yr: 2004 Vol: 13 Nbr: 9 Abs: Pg:595-604