Quality of life during the COVID-19 pandemic and survival outcomes among breast cancer survivors.

Background: Health-related quality of life (HRQoL) has long been recognized as a critical area of cancer research as it reflects patients' well-being, but less is known if HRQoL predicts survival outcomes in survivors of early stage breast cancer.

Aims: We assessed racial disparities in HRQoL and the impact of HRQoL on survival outcomes in breast cancer survivors.

Methods: This study included a total of 721 breast cancer survivors from the Chicago Multiethnic Epidemiologic Breast Cancer Cohort who completed the Functional Assessment of Cancer Therapy-Breast (FACT-B) instrument in 2020. We examined racial differences in FACT-B scores and patient characteristics correlated with FACT-B and its subscales using multiple linear regression. We used Cox regression to assess the associations between HRQoL assessments and survival outcomes.

Results: Functional well-being score was lower in Black survivors than in White survivors (mean score: 19.6 vs. 20.9, P = 0.003). Being married was associated with a higher HRQoL score. Having a recurrence before interview and comorbidities worsened physical and emotional well-being. The total FACT-B score were significant predictors of both all-cause [hazard ratio (HR) = 0.68 per standard deviation, 95% CI 0.48-0.95] and breast cancer-specific mortality (HR = 0.57, 95% CI 0.37-0.88). Physical and functional well-being subscales were found to be associated with all-cause and breast cancer-specific mortality, and recurrence-free survival. Emotional well-being predicted breast cancer-specific mortality.

Conclusions: Our findings highlighted racial disparities in HRQoL and HRQoL associated with survival outcomes in breast cancer, suggesting the need to reduce the disparities and examine the long-term impact of HRQoL on health outcomes in future studies.