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Quality of Life, Fertility Concerns, and Behavioral Health Outcomes in Younger Breast Cancer Survivors: A Systematic Review
Abstract
BACKGROUND: Breast cancer is the most common cancer in women younger than age 50 years. Cancer treatments in younger women may cause premature menopause, infertility, and negative psychosocial effects. In this systematic review, we examined three key domains of functioning that are particularly relevant for younger breast cancer survivors: health-related quality of life (QOL), menopausal symptoms and fertility concerns, and behavioral health outcomes. METHODS: We conducted a literature review using PubMed and secondary sources and examined 840 articles published between January 1990 and July 2010. Inclusion criteria for articles were 1) published in English after 1989; 2) exclusively analyzed female breast cancer survivors aged 50 years or younger or premenopausal at diagnosis, with baseline characteristics and/or quantitative or descriptive analyses for this age group; 3) investigated QOL (health-related QOL including physical functioning and mental health, depression, and anxiety), menopause- or fertility-related concerns, and weight gain or physical activity-related behavioral health outcomes. Data were extracted using a standardized table collecting the purpose, design, population, and results of each study. Extracted data were reviewed for accuracy by two investigators and presented as descriptive tables. RESULTS: A total of 28 articles met the inclusion criteria (15 cross-sectional studies, eight longitudinal studies, and five randomized trials). Regarding data review, no discordance between investigators was noted. Standardized measures of QOL and depressive symptoms identified worse outcomes as being more frequent or severe in breast cancer survivors aged 50 years or younger when compared with the general age-matched population of women without cancer and to older women (aged >50 years) with breast cancer. Concerns about premature menopause, menopausal symptoms, and infertility were common in younger women (aged ≤ 50 years) and had a role in the level of distress after treatment. Weight gain and physical inactivity were common health outcomes in younger women. CONCLUSIONS: Younger women with breast cancer were found to experience distinct psychosocial and menopause-related concerns, weight gain, and physical inactivity. A need for more longitudinal research, including efforts at intervention to manage these symptoms and adverse health outcomes, remains.
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“Frailty tends to be a concern in older women37 while fertility issues uniquely impact younger premenopausal survivors.38”
From Behavioral interventions to enhance adherence to hormone therapy in breast cancer survivors: a systematic literature review (2016) · cites this paper as [37]
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“Younger breast cancer survivors possibly have more mood distress and worse psychological adjustment than older survivors which may be due to reproductive disturbances [18] and impaired sexual partnership [10].”
BackgroundAn update on primary ovarian insufficiency
Jin, M., Yu, Y., & Huang, H. (2012) · Science China Life Sciences · doi:10.1007/s11427-012-4355-2 · Cited by 111
Goossens, J., Delbaere, I., Lancker, A. V., Beeckman, D., Verhaeghe, S. T. L., & Hecke, A. V. (2013) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2013.06.015 · Cited by 109
“The psychosocial impact of fertility loss comprised psychosocial concerns, distress and poor sexual functioning (Canada and Schover, 2012; Carter et al., 2010; Howard-Anderson et al., 2012; Wenzel et al., 2005).”
BackgroundInvestigation of antioxidant and anticancer potential of fucoidan from Sargassum polycystum
Palanisamy, S., Vinosha, M., Manikandakrishnan, M., Anjali, R., Rajasekar, P., Marudhupandi, T., Manikandan, R., Vaseeharan, B., & Prabhu, N. M. (2018) · International Journal of Biological Macromolecules · doi:10.1016/j.ijbiomac.2018.04.163 · Cited by 111
Imran, M., Al‐Wassia, R., Alkhayyat, S. S., Baig, M., & Al-Saati, B. A. (2019) · PLoS ONE · doi:10.1371/journal.pone.0219093 · Cited by 109
Treatment‐related amenorrhea and sexual functioning in young breast cancer survivors
Rosenberg, S. M., Tamimi, R. M., Gelber, S. I., Ruddy, K. J., Bober, S. L., Kereakoglow, S., Borges, V. F., Come, S. E., Schapira, L., & Partridge, A. H. (2014) · Cancer · doi:10.1002/cncr.28738 · Cited by 108
“This is crucial, because the onset of amenorrhea, whether temporary or permanent, can be especially distressing among young women.(3) Furthermore, there is a need to develop, test, and evaluate interventions to improve shortterm and long-term sexual outcomes and other dimensions of QOL in young women.”
BackgroundGeue, K., Sender, A., Schmidt, R., Richter, D., Hinz, A., Schulte, T., Brähler, E., & Stöbel‐Richter, Y. (2013) · Quality of Life Research · doi:10.1007/s11136-013-0559-6 · Cited by 108
Depression in adolescents and young adults with cancer
Park, E. M., & Rosenstein, D. L. (2015) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2015.17.2/epark · Cited by 108
Faller, H., Brähler, E., Härter, M. C., Keller, M., Schulz, H., Wegscheider, K., Weis, J., Boehncke, A., Reuter, K., Richard, M., et al. (2017) · Patient Education and Counseling · doi:10.1016/j.pec.2017.05.031 · Cited by 110
Ávila, M. M., Platas, A., & Martínez-Cannon, B. A. (2017) · Revista de investigaci�n Cl�nica · doi:10.24875/ric.17002279 · Cited by 105
Lambertini, M., Campbell, C., Bines, J., Korde, L. A., Izquierdo, M. A., Fumagalli, D., Mastro, L. D., Ignatiadis, M., Pritchard, K. I., Wolff, A. C., et al. (2018) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djy094 · Cited by 102
Mechanisms of Aquaporin-Facilitated Cancer Invasion and Metastasis
Ieso, M. L. D., & Yool, A. J. (2018) · Frontiers in Chemistry · doi:10.3389/fchem.2018.00135 · Cited by 99
To preserve or not to preserve
Mersereau, J. E., Goodman, L. R., Deal, A. M., Gorman, J. R., Whitcomb, B. W., & Su, H.-C. I. (2013) · Cancer · doi:10.1002/cncr.28317 · Cited by 95
“For many female young adult survivors, the ability to have biological children is central to their quality of life.(2,3) Because many cancer treatments have the potential to be gonadotoxic, newly diagnosed cancer patients are advised to consider their desire for future fertility and fertility preservation (FP) options…”
BackgroundZavos, A., & Valachis, A. (2016) · Acta Oncologica · doi:10.3109/0284186x.2016.1155738 · Cited by 95
“One of the main issues that influence patients’ quality of life after adjuvant chemotherapy is the risk for infertility [4].”
BackgroundSexual Health Issues in Women with Cancer
Krychman, M., & Millheiser, L. S. (2013) · The Journal of Sexual Medicine · doi:10.1111/jsm.12034 · Cited by 92
Naik, H., Leung, B. O., Laskin, J. J., McDonald, M., Srikanthan, A., Wu, J., Bates, A. T., & Ho, C. (2019) · Breast Cancer Research and Treatment · doi:10.1007/s10549-019-05468-6 · Cited by 92
Partner support and anxiety in young women with breast cancer
Borstelmann, N. A., Rosenberg, S. M., Ruddy, K. J., Tamimi, R. M., Gelber, S. I., Schapira, L., Come, S. E., Borges, V. F., Morgan, E., & Partridge, A. H. (2015) · Psycho-Oncology · doi:10.1002/pon.3780 · Cited by 90
“As has been reported in prior studies, younger age at diagnosis of cancer was also an independent predictor of higher levels of anxiety [7].”
ResultVin‐Raviv, N., Hillyer, G. C., Hershman, D. L., Galea, S., Leoce, N., Bovbjerg, D. H., Kushi, L. H., Kroenke, C. H., Lamerato, L. E., Ambrosone, C. B., et al. (2013) · JNCI Journal of the National Cancer Institute · doi:10.1093/jnci/djt024 · Cited by 90
“Furthermore, a recent review that examined quality of life, depression, anxiety, and stress perception among young breast cancer survivors concluded that younger women with breast cancer experienced more emotional distress than their older counterparts or than the general age-matched population without cancer (36).”
BackgroundFertility and pregnancy issues in BRCA -mutated breast cancer patients
Lambertini, M., Goldrat, O., Toss, A., Azim, H. A., Peccatori, F. A., Ignatiadis, M., Mastro, L. D., & Demeestere, I. (2017) · Cancer Treatment Reviews · doi:10.1016/j.ctrv.2017.07.001 · Cited by 89
Avis, N. E., Levine, B. J., Naughton, M. J., Case, L. D., Naftalis, E. Z., & Zee, K. J. V. (2013) · Breast Cancer Research and Treatment · doi:10.1007/s10549-013-2513-2 · Cited by 95
“As with general psychological distress, younger age consistently has been shown to be associated with increased depression risk [8-14].”
BackgroundCancer-Related Worry in Canadian Thyroid Cancer Survivors
Bresner, L., Banach, R., Rodin, G., Thabane, L., Ezzat, S., & Sawka, A. M. (2014) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2014-3169 · Cited by 88
“In a systematic review examining quality of life and behavioral outcomes in breast cancer survivors, Howard-Anderson et al (18) reported that premenopausal women experienced greater depressive symptoms (both incidence risk and severity), stress and anxiety, poorer health-related quality of life, and more menopausal an…”
Online support groups for women with breast cancer
McCaughan, E., Parahoo, K., Hueter, I., Northouse, L., & Bradbury, I. (2017) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011652.pub2 · Cited by 90
Hurtado-de-Mendoza, A., Cabling, M. L., Lobo, T., Dash, C., & Sheppard, V. B. (2016) · Clinical Breast Cancer · doi:10.1016/j.clbc.2016.03.006 · Cited by 79
“Frailty tends to be a concern in older women,(36) while fertility issues uniquely affect younger premenopausal survivors.(37) Thus, designing interventions that also take into account the unique needs of premenopausal survivors is warranted.”
Resilience in women with breast cancer: A systematic review
Aizpurua-Perez, I., & Perez-Tejada, J. (2020) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2020.101854 · Cited by 86
Corney, R., & Swinglehurst, J. (2013) · Psycho-Oncology · doi:10.1002/pon.3365 · Cited by 83
Young Women with Breast Cancer: A Focus Group Study of Unmet Needs
Ruddy, K. J., Greaney, M. L., Sprunck‐Harrild, K., Meyer, M. E., Emmons, K. M., & Partridge, A. H. (2013) · Journal of Adolescent and Young Adult Oncology · doi:10.1089/jayao.2013.0014 · Cited by 82
“A systematic review of 28 studies of survivors p50 years of age found that anxiety, depression, and impaired quality of life were common, as were concerns about weight gain, premature menopause, menopausal symptoms, and infertility.(4) However, little previous research has focused on how to relieve distress and improv…”
BackgroundBantema-Joppe, E. J., de Bock, G. H., Iersel, M. W.-V., Busz, D. M., Ranchor, A., Langendijk, J. A., Maduro, J. H., & van den Heuvel, E. R. (2015) · British Journal of Cancer · doi:10.1038/bjc.2014.632 · Cited by 80
“Published data suggest that breast cancer has a greater impact on HRQoL in younger patients than in older ones (Schroevers et al , 2004; Howard-Anderson et al , 2012; Koch et al , 2013; Champion et al , 2014; Morrow et al , 2014) and a reduction in impact is seen with increasing age (Schroevers et…”
Sekse, R. J. T., Hufthammer, K. O., & Vika, M. E. (2014) · Journal of Clinical Nursing · doi:10.1111/jocn.12647 · Cited by 81
“Furthermore, in a systematic review on health-related QoL in younger breast cancer survivors (Howard-Anderson et al. 2012) and, more specifically, in a longitudinal study on gynaecological cancers (Chan et al.”
BackgroundDi Meglio, A., Havas, J., Gbenou, A. S., Martin, E., El-Mouhebb, M., Pistilli, B., Menvielle, G., Dumas, A., Everhard, S., Martin, A.-L., et al. (2022) · Journal of Clinical Oncology · doi:10.1200/jco.21.00277 · Cited by 76
“Downstream effects of adjuvant BC treatments include substantial impact on general well-being, physical functioning, and vitality, and alterations in cognition, metabolism, and sexuality.(7-9) Chemotherapy is associated with poorer emotional and social functioning, body-image issues, increased likelihood of unemployme…”
BackgroundSelf-citationBower, J. E., Partridge, A. H., Wolff, A. C., Thorner, E. D., Irwin, M. R., Joffe, H., Petersen, L., Crespi, C. M., & Ganz, P. A. (2021) · Journal of Clinical Oncology · doi:10.1200/jco.21.00279 · Cited by 81
“Exclusion criteria were (1) recurrent or metastatic breast cancer; (2) another interval cancer diagnosis following breast cancer diagnosis (excluding nonmelanoma skin cancer); (3) current mindfulness practice; (4) pregnancy; and (5) a serious chronic medical or psychiatric condition that could detract from interventio…”
BackgroundMethodSelf-citationCarroll, J., Bower, J. E., & Ganz, P. A. (2021) · Nature Reviews Clinical Oncology · doi:10.1038/s41571-021-00580-3 · Cited by 81
Self-citationPosttraumatic growth in breast cancer survivors: does age matter?
Boyle, C. C., Stanton, A. L., Ganz, P. A., & Bower, J. E. (2016) · Psycho-Oncology · doi:10.1002/pon.4091 · Cited by 88
“Indeed, research indicates that the experience of cancer is different for younger and older women, with younger women evidencing greater distress throughout the cancer trajectory [2,3].”
BackgroundSelf-citationPremature menopause in young breast cancer: effects on quality of life and treatment interventions.
Rosenberg, S. M., & Partridge, A. H. (2013) · Europe PMC (PubMed Central) · doi:10.3978/j.issn.2072-1439.2013.06.20 · Cited by 78
Letourneau, J. M., Sinha, N., Wald, K., Harris, E., Quinn, M. M., Imbar, T., Mok-Lin, E. Y., Chien, A. J., & Rosen, M. P. (2017) · Human Reproduction · doi:10.1093/humrep/dex276 · Cited by 75
Acquati, C., & Kayser, K. (2019) · Frontiers in Psychology · doi:10.3389/fpsyg.2019.00404 · Cited by 76
“These findings are consistent, despite the small sample size, with results from larger studies on the quality of life of younger women with breast cancer (Avis et al., 2004, 2005; Kroenke et al., 2004; Baucom et al., 2005; Luutonen et al., 2011; Howard-Anderson et al., 2012).”
ResultBreast Cancer Survivorship Issues
Stan, D. L., Loprinzi, C. L., & Ruddy, K. J. (2013) · Hematology/Oncology Clinics of North America · doi:10.1016/j.hoc.2013.05.005 · Cited by 75
Unmet Information Needs and Quality of Life in Young Breast Cancer Survivors in Japan
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Quality of Life Determinants in Breast Cancer Patients in Central Rural India
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“(Duijts et al., 2014, Howard- Anderson et al., 2012) Additionally, better QOL has been associated with longer survival of patients with cancer.”
BackgroundBoyle, C. C., Cole, S. W., Dutcher, J. M., Eisenberger, N. I., & Bower, J. E. (2019) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2019.01.024 · Cited by 75
Self-citationCognitive impairment following breast cancer treatments: an umbrella review
Oliva, G., Giustiniani, A., Danesin, L., Burgio, F., Arcara, G., & Conte, P. (2024) · The Oncologist · doi:10.1093/oncolo/oyae090 · Cited by 72
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Maly, R., Liu, Y.-H., Liang, L.-J., & Ganz, P. A. (2014) · Cancer · doi:10.1002/cncr.29150 · Cited by 79
Self-citationExplaining age-related differences in depression following breast cancer diagnosis and treatment
Avis, N. E., Levine, B. J., Naughton, M. J., Case, D., Naftalis, E. Z., & Zee, K. J. V. (2012) · Breast Cancer Research and Treatment · doi:10.1007/s10549-012-2277-0 · Cited by 71
“As with general psychological distress, younger age has been shown to be associated with increased depression risk [5, 6, 8, 13, 20, 21].”
Metadata
- Authors
- Howard-Anderson, J., Ganz, P. A., Bower, J. E., & Stanton, A. L.
- Affiliations
- University of California, Los Angeles (US)
- Venue
- JNCI Journal of the National Cancer Institute
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-01-23
- Volume
- 104
- Issue
- 5
- Pages
- 386-405
- ISSN
- 0027-8874 (ISSN-L)
- 1460-2105
- OpenAlex
- W2109496096
- Cited by
- 830
- References
- 99
- Citations by year
- 2026: 35 · 2025: 44 · 2024: 38 · 2023: 49 · 2022: 55 · 2021: 69 · 2020: 125 · 2019: 62 · 2018: 75 · 2017: 67 · 2016: 60 · 2015: 51 · 2014: 46 · 2013: 43 · 2012: 10
- FWCI
- 5.00
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JNCI Journal of the National Cancer Institute (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Breast Cancer Research Foundation
- Jonsson Comprehensive Cancer Center
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
- Keywords
- breast cancer survivors, young women, health-related quality of life, fertility concerns, premature menopause, menopausal symptoms, infertility, depression, anxiety, weight gain, physical inactivity, psychosocial distress, cancer treatment side effects
- MeSH terms
- Adult, Age Factors, Anxiety, Breast Neoplasms, Depression, Female, Fertility, Humans, Menopause, Premature, Motor Activity, Quality of Life, Risk Factors, Stress, Psychological, United States, Weight Gain, Health Behavior, Exercise, Age Distribution, Survivors
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