Cited by 830Cancer survivorship and careChildhood Cancer Survivors' Quality of LifeWomen's cancer prevention and management

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Quality of Life, Fertility Concerns, and Behavioral Health Outcomes in Younger Breast Cancer Survivors: A Systematic Review

Howard-Anderson, J., Ganz, P. A., Bower, J. E., Stanton, A. L.·2012·JNCI Journal of the National Cancer Institute

DOI 10.1093/jnci/djr541

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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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Background
Erratum to: Fertility preservation with ovarian stimulation and time to treatment in women with stage II–III breast cancer receiving neoadjuvant therapy
Chien, A. J., Chambers, J., McAuley, F. M., Kaplan, T. M., Letourneau, J. M., Hwang, J., Kim, M., Melisko, M., Rugo, H. S., Esserman, L. J., et al. (2017) · Breast Cancer Research and Treatment · doi:10.1007/s10549-017-4350-1 · Cited by 42
NCCN Guidelines® Insights: Survivorship, Version 2.2024
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A highly-sensitive anti-Müllerian hormone assay improves analysis of ovarian function following chemotherapy for early breast cancer
Chai, J., Howie, A. F., Cameron, D., & Anderson, R. A. (2014) · European Journal of Cancer · doi:10.1016/j.ejca.2014.06.011 · Cited by 41
“bone health [18–20], thus its early and reliable diagnosis is central to the ongoing management of women with breast and other cancers.”
Background
Young patients and gastrointestinal (GI) tract malignancies - are we addressing the unmet needs?
Perl, G., Nordheimer, S., Lando, S., Benedict, C., Brenner, B., Perry, S., Shmoisman, G., Purim, O., Amit, L., Stemmer, S. M., et al. (2016) · BMC Cancer · doi:10.1186/s12885-016-2676-4 · Cited by 43
Health‐related quality of life and care satisfaction outcomes: Informing psychosocial oncology care among Latina and African‐American young breast cancer survivors
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“≥$60 K 30 (26) 7 (29) 21 (48) 2 (4) Education < High school 38 (33) 0 (0) 4 (9) 34 (72) 56.”
Method
Premature ovarian insufficiency
Kapoor, E. (2023) · Current Opinion in Endocrine and Metabolic Research · doi:10.1016/j.coemr.2023.100435 · Cited by 42
Cancer-related fatigue and depression in breast cancer patients postchemotherapy: Different associations with optimism and stress appraisals
Levkovich, I., Cohen, M. W., Pollack, S., Drumea, K. C., & Fried, G. (2014) · Palliative & Supportive Care · doi:10.1017/s147895151400087x · Cited by 44
“However, survivorship is often followed by long-term physical and psychological symptoms that may limit daily functioning and social relationship capabilities, which in turn may seriously reduce quality of life (QoL) (Howard-Anderson et al., 2012; Monga et al., 2007).”
Background
The PREgnancy and FERtility (PREFER) study: an Italian multicenter prospective cohort study on fertility preservation and pregnancy issues in young breast cancer patients
Lambertini, M., Anserini, P., Fontana, V., Poggio, F. B., Iacono, G., Abate, A., Levaggi, A., Miglietta, L., Bighin, C., Giraudi, S., et al. (2017) · BMC Cancer · doi:10.1186/s12885-017-3348-8 · Cited by 40
“nancy issues that may contribute to the great psychosocial distress seen in these patients [2].”
Relationships between health literacy and quality of life among survivors with breast cancer
Wei, C. S., Wu, M., & Tung, H. (2021) · International Journal of Nursing Practice · doi:10.1111/ijn.12922 · Cited by 40
Psychotherapy with Music Intervention Improves Anxiety, Depression and the Redox Status in Breast Cancer Patients Undergoing Radiotherapy: A Randomized Controlled Clinical Trial
Zeppegno, P., Krengli, M., Ferrante, D., Bagnati, M., Burgio, V., Farruggio, S., Rolla, R., Gramaglia, C. M., & Grossini, E. (2021) · Cancers · doi:10.3390/cancers13081752 · Cited by 48
An Internet-based cognitive behavioral therapy for treatment-induced menopausal symptoms in breast cancer survivors: results of a pilot study
Atema, V., van Leeuwen, M., Oldenburg, H. S. A., van Beurden, M., Hunter, M. S., & Aaronson, N. K. (2017) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0000000000000836 · Cited by 39
“Menopausal symptoms can cause discomfort and adversely affect health-related quality of life (HRQL).(1-7)”
Background
Perinatal risks in female cancer survivors: A population-based analysis
van der Kooi, A.-L., Brewster, D., Wood, R., Nowell, S., Fischbacher, C., van den Heuvel‐Eibrink, M. M., Laven, J. S. E., Wallace, W. H., & Anderson, R. A. (2018) · PLoS ONE · doi:10.1371/journal.pone.0202805 · Cited by 39
“The impact on later health of survivors is high: quality of life is consistently lower in breast cancer survivors as compared to women without a history of cancer [2, 3], 75% of cancer survivors develop at least one health problem [4], and childhood cancer survivors are 8.”
Background
Long-term health-related quality of life of breast cancer survivors remains impaired compared to the age-matched general population especially in young women. Results from the prospective controlled BREX exercise study
Roine, E., Sintonen, H., Kellokumpu‐Lehtinen, P., Penttinen, H., Utriainen, M., Vehmanen, L., Huovinen, R., Kautiainen, H., Nikander, R., BLOMQVIST, C. P., et al. (2021) · The Breast · doi:10.1016/j.breast.2021.06.012 · Cited by 39
“…review concluded that lower HRQoL and depressive symptoms were more frequent or severe in younger ( (cid:1) 50 years) survivors when compared to older ( > 50 years) survivors and that the mental, as opposed to physical functioning domains, were most severely impacted in the younger survivors [6].”
BackgroundInfluential
Depression and vasomotor symptoms in young breast cancer survivors: the mediating role of sleep disturbance
Accortt, E. E., Bower, J. E., Stanton, A. L., & Ganz, P. A. (2015) · Archives of Women s Mental Health · doi:10.1007/s00737-015-0504-5 · Cited by 38
“Younger breast cancer survivors (BCS) are at elevated risk for depression (Howard-Anderson et al. 2012); indeed, their levels of depressive symptoms are approximately twice as high as those of older women in the months after diagnosis (Avis et al. 2013).”
BackgroundSelf-citation
Insurance Coverage, Employment Status, and Financial Well-Being of Young Women Diagnosed with Breast Cancer
Tangka, F. K. L., Subramanian, S., Jones, M., Edwards, P., Flanigan, T. S., Kaganova, Y., Smith, K. W., Thomas, C. C., Hawkins, N. A., Rodriguez, J., et al. (2020) · Cancer Epidemiology Biomarkers & Prevention · doi:10.1158/1055-9965.epi-19-0352 · Cited by 38
“Furthermore, younger women are more likely to be diagnosed with late-stage disease that requires more intensive treatments, and they may have additional concerns, such as preserving fertility (21, 22).”
Background
Couplelinks online intervention for young couples facing breast cancer: A randomised controlled trial
Fergus, K. D., Ahmad, S., Gardner, S. L., Ianakieva, I., McLeod, D. L., Stephen, J. E., Carter, W., Periera, A., Warner, E., & Panchaud, J. (2021) · Psycho-Oncology · doi:10.1002/pon.5836 · Cited by 41
Breast cancer and physical activity: A bibliometric analysis
Fresno-Alba, S., Denche-Zamorano, Á., Pastor-Cisneros, R., Pereira-Payo, D., Franco-García, J. M., & Jiménez-Castuera, R. (2023) · Frontiers in Oncology · doi:10.3389/fonc.2022.1051482 · Cited by 33
Medical Care Costs of Breast Cancer in Privately Insured Women Aged 18–44 Years
Allaire, B. T., Ekwueme, D. U., Guy, G. P., Li, C., Tangka, F. K. L., Trivers, K. F., Sabatino, S. A., Rodriguez, J. L., & Trogdon, J. G. (2016) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2015.08.035 · Cited by 37
“11 In addition, younger women with breast cancer are more likely to exhibit symptoms of depression than older breast cancer patients, 12 more prone to emotional distress and anxiety, 13 and are more likely to utilize mental health services.”
Improving Adjuvant Endocrine Treatment Tailoring in Premenopausal Women With Hormone Receptor–Positive Breast Cancer
Lambertini, M., Blondeaux, E., Perrone, F., & Mastro, L. D. (2019) · Journal of Clinical Oncology · doi:10.1200/jco.19.02242 · Cited by 37
A review of psychological impact of breast cancer in women below 50 years old
Martino, M. L., Lemmo, D., & Gargiulo, A. (2021) · Health Care For Women International · doi:10.1080/07399332.2021.1901901 · Cited by 37
Medical and information needs among young women with breast cancer in Mexico
Villarreal-Garza, C. M., Lopez-Martinez, E. A., Martínez-Cannon, B. A., Platas, A., Castro‐Sánchez, A., Ávila, M. M., Mohar, A., Monroy, A., Águila, C., & Gálvez‐Hernández, C. L. (2019) · European Journal of Cancer Care · doi:10.1111/ecc.13040 · Cited by 36
Employment trends in young women following a breast cancer diagnosis
Rosenberg, S. M., Vaz-Luís, I., Gong, J., Rajagopal, P. S., Ruddy, K. J., Tamimi, R. M., Schapira, L., Come, S. E., Borges, V. F., de Moor, J. S., et al. (2019) · Breast Cancer Research and Treatment · doi:10.1007/s10549-019-05293-x · Cited by 36
Cost-effectiveness of a pragmatic exercise intervention for women with breast cancer: results from a randomized controlled trial
Gordon, L. G., DiSipio, T., Battistutta, D., Yates, P. M., Bashford, J., Pyke, C., Eakin, E., & Hayes, S. C. (2016) · Psycho-Oncology · doi:10.1002/pon.4201 · Cited by 35
“Younger women can experience premature menopause, bone density loss, infertility, and associated distress.(2) With increasing numbers of women diagnosed with breast cancer each”
Background
Symptoms of depression and anxiety as predictors of physical functioning in breast cancer patients. A prospective study using path analysis
Faller, H., Strahl, A., Richard, M., Niehues, C., & Meng, K. (2017) · Acta Oncologica · doi:10.1080/0284186x.2017.1333630 · Cited by 35
Social inequalities in quality of life in a cohort of women diagnosed with breast cancer in Barcelona (DAMA Cohort)
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Breast cancer in pregnant patients: A review of the literature
Martínez, M. T., Bermejo, B., Hernándo, C., Gambardella, V., Cejalvo, J. M., & Lluch, A. M. (2018) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2018.04.029 · Cited by 35
Opportunities for personalised follow‐up care among patients with breast cancer: A scoping review to identify preference‐sensitive decisions
de Ligt, K. M., van Egdom, L. S. E., Koppert, L. B., Siesling, S., & van Til, J. A. (2019) · European Journal of Cancer Care · doi:10.1111/ecc.13092 · Cited by 34
Mutational landscape differences between young-onset and older-onset breast cancer patients
Mealey, N. E., O'Sullivan, D. E., Pader, J., Ruan, Y., Wang, E., Quan, M. L., & Brenner, D. R. (2020) · BMC Cancer · doi:10.1186/s12885-020-6684-z · Cited by 36
“Negative psychosocial effects such as anxiety, depressive symptoms, and lower energy were observed to be worse among younger breast cancer survivors [2, 48, 49].”
Background
How to Protect Ovarian Function before and during Chemotherapy?
Arecco, L., Ruelle, T., Martelli, V., Boutros, A., Latocca, M. M., Spinaci, S., Marrocco, C., Massarotti, C., & Lambertini, M. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10184192 · Cited by 35
“Developing premature ovarian insufficiency (POI) and infertility are of high concern to many patients [3].”
Background
Worry about one's own children, psychological well‐being, and interest in psychosocial intervention
Kollberg, K. S., Thorsteinsdóttir, T., Wilderäng, U., & Steineck, G. (2013) · Psycho-Oncology · doi:10.1002/pon.3266 · Cited by 41
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BackgroundMethod
Non-BRCA Early-Onset Breast Cancer in Young Women
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Impact of hormone therapy side effects on health-related quality of life, distress, and well-being of breast cancer survivors
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Breast Cancer Survivors’ Contribution to Psychosocial Adjustment of Newly Diagnosed Breast Cancer Patients in a Computer-Mediated Social Support Group
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Ovarian Function and Fertility Preservation in Breast Cancer: Should Gonadotropin-Releasing Hormone Agonist be administered to All Premenopausal Patients Receiving Chemotherapy?
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Menopausal symptoms in relationship to breast cancer-specific quality of life after adjuvant cytotoxic treatment in young breast cancer survivors
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“Younger women that develop breast cancer often suffer prolonged psychological and physical issues including menopause-related concerns, weight gain and physical inactivity [23].”
Background
Gonadotropin-releasing hormone analogs: Mechanisms of action and clinical applications in female reproduction
Wu, H., Chang, H., & Leung, P. C. K. (2020) · Frontiers in Neuroendocrinology · doi:10.1016/j.yfrne.2020.100876 · Cited by 37
Hormone replacement therapy after breast cancer: Yes, No or maybe?
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Pomegranate peel extract inhibits expression of β-catenin, epithelial mesenchymal transition, and metastasis in triple negative breast cancer cells
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“Unfortunately, current therapeutic strategies are not appropriate because of their high cost, many side effects and no guarantee against metastasis and cancer recurrence (3).”
Background

Authors: Howard-Anderson, J., Ganz, P. A., Bower, J. E., & Stanton, A. L.
Affiliations: University of California, Los Angeles (US)
ORCID: Howard-Anderson, J.
Ganz, P. A.
Bower, J. E.
Stanton, A. L.
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
DOI: 10.1093/jnci/djr541
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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Quality of Life, Fertility Concerns, and Behavioral Health Outcomes in Younger Breast Cancer Survivors: A Systematic Review

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