Model of Health-Related Quality of Life in Breast Cancer Patients Using Cross-Sectional Data: The Role of Resilience

Abstract

Katarina Velickovic,1 Ulrika Olsson Möller,1– 3 Lisa Ryden,4,5 Pär-Ola Bendahl,4 Marlene Malmström1,3 1Department of Health Sciences, Lund University, Lund, Sweden; 2Department of Nursing and Integrated Health Sciences, Kristianstad University, Kristianstad, Sweden; 3Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden; 4Department of Clinical Sciences Lund, Lund University, Lund, Sweden; 5Department of Surgery and Gastroenterology, Skåne University Hospital, Lund, SwedenCorrespondence: Katarina Velickovic, Department of Health Sciences, Lund University, Sölvegatan 19, Lund, 223 62, Sweden, Email [email protected]: Resilience has been suggested as an important predictor of both physical and mental health-related quality of life in breast cancer patients. However, it is unclear why resilient women handle their diagnosis better, not only mentally, but also physically. The aim of this study was to investigate paths between resilience, physical activity, and mental, physical, and global health-related quality of life in breast cancer patients.Patients and Methods: Structural equation modeling was conducted to evaluate the proposed structural paths using a sample of 638 women with newly diagnosed breast cancer patients from Sweden.Results: Resilience was directly associated with physical activity and mental health-related quality of life. It was indirectly associated with physical functioning, through mental health-related quality of life and physical activity. Resilience was also indirectly associated with global quality of life, through mental health-related quality of life.Conclusion: Mental health support and encouraging physical activity may be especially relevant to enhance all aspects of health-related quality of life early in the breast cancer process. Results should be replicated longitudinally.Plain Language Summary: Receiving a breast cancer diagnosis can be highly disruptive to one’s worldview and sense of normalcy. Many women with breast cancer describe the diagnostic period as even more stressful than receiving treatment. However, some women handle their breast cancer diagnosis better than others. Resilience is a psychological trait that refers to one’s ability to cope with highly stressful events and maintain good wellbeing despite adversity. More resilient women were shown to handle a breast cancer diagnosis better, not only mentally, but also physically. They also describe their quality of life as higher than low resilient women. However, it is unclear why resilient women have not only better mental health, but also physical health. In this study, we addressed this question by examining the relationships between resilience, mental health, physical functioning, physical activity, and patients’ self-reported quality of life. We found that mental health and physical activity explained the relationship between resilience and physical functioning and self-reported quality of life. This suggests that highly resilient women experience less psychological distress following a breast cancer diagnosis and are more inclined to maintain physical activity during this stressful period. Consequently, they may manage to have better physical functioning and evaluate their quality of life as better. This study highlights the importance of psychosocial support and encouraging physical activity in women with breast cancer who may struggle to cope with their diagnosis. This study implies that this can not only alleviate psychological distress, but also aid one’s physical functioning and overall quality of life.Keywords: structural equation modeling, psychological distress, physical activity, newly diagnosed breast cancer, health-related quality of life

Keywords

• structural equation modeling
• psychological distress
• physical activity
• newly diagnosed breast cancer
• health-related quality of life