Patterns of Change in Emotional and Functional Well-Being Following Breast Cancer Diagnosis

Understanding the change in emotional well-being (EWB) and functional well-being (FWB) in breast cancer survivors can facilitate targeted support for unmet needs.

Among 2,767 women with breast cancer in the Carolina Breast Cancer Study Phase 3, we assessed EWB and FWB with the Functional Assessment of Cancer Therapy - Breast instrument at 5 (baseline), 25, and 84 months after diagnosis. We identified well-being trajectories using latent class growth analysis, and relative frequency differences (RFD) with 95% confidence intervals (CI) were estimated for associations between trajectory group membership and demographic or clinical characteristics.

Five trajectory groups were identified for both EWB and FWB. Most participants (∼70%) were classified into "good well-being" ("stable high" or "stable medium"). A small percentage (∼10%) fell into "very low baseline" or "early decrease", and the rest were "stable low" (∼20%). Overall, younger vs. older age was associated with "stable low" EWB (25.4% vs. 19.3%; RFD 6.1%; 95% CI, 3.0%-9.2%). Black participants more frequently had "stable low" FWB (24.2% vs. 16.6%; RFD 7.6%; 95% CI, 4.6%-10.6%). Breast cancer recurrence was strongly associated with "stable low" EWB (28.7% vs. 21.3%; RFD 7.3%; 95% CI, 2.3%-12.3%) and FWB (28.7% vs. 19.2%; RFD 8.6%; 95% CI, 3.7%-13.5%). Being unmarried, lower income, having nonprivate insurance, advanced stage, mastectomy vs. breast conservation surgery, and chemotherapy were also predictors of poor well-being trajectories.

Demographics and clinical features are associated with sustained poor well-being after breast cancer.

Improvements in long-term well-being may warrant targeted support.