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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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BackgroundInfluentialSearching for metastases in ovarian tissue before autotransplantation: a tailor-made approach
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BackgroundLife satisfaction of women of working age shortly after breast cancer surgery
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Fertility, sexuality and cancer in young adult women
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“For a patient diagnosed with breast cancer at a young age, fertility and pregnancy issues that might arise during treatment contribute to their emotional and psychological distress [7].”
BackgroundHow medical choices influence quality of life of women carrying a BRCA mutation
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The Quality and Readability of Online Consumer Information About Gynecologic Cancer
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“For women who were diagnosed with cancer during their reproductive years, resolving their fertility issues might be a salient part of the rehabilitation process.(9,10) In view of the existing literature, we decided to assess the quality and readability of the content of frequently accessed gynecologic cancer-related W…”
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Moderators of inflammation-related depression: a prospective study of breast cancer survivors
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“Younger survivors (<50) are at the highest risk for depression following breast cancer diagnosis and treatment [76], and the present results could serve to characterize this trend.”
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“Data Source and Study Population An institutional review board–approved study (18-202) was performed to evaluate patient-reported outcomes in postmastectomy reconstruction patients (a component of routine clinical care).”
MethodApproaches to Fertility Preservation for Young Women With Breast Cancer
Razeti, M. G., Soldato, D., Arecco, L., Levaggi, A., Puglisi, S., Solinas, C., Agostinetto, E., Spinaci, S., Lapuchesky, L. S., Genova, C., et al. (2023) · Clinical Breast Cancer · doi:10.1016/j.clbc.2023.01.006 · Cited by 35
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Advances in Fertility Preservation for Young Women With Cancer
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“Additionally, some studies have demonstrated that breast cancer patients under the age of 50 suffer a greater psychological burden than older patients, and that the psychological burden does not improve over time [21,22].”
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“In detail, premature menopause is a consequence of chemotherapy and/or hormonal treatment, and it is accompanied by physiologic changes that can affect energy balance, with a consequent increase in abdominal fat, reduction in lean mass, and worsening of MS parameters [21].”
BackgroundQuality of life in female cancer survivors: is it related to ovarian reserve?
Kondapalli, L. A., Dillon, K., Sammel, M. D., Ray, A., Prewitt, M., Ginsberg, J. P., & Gracia, C. R. (2013) · Quality of Life Research · doi:10.1007/s11136-013-0473-y · Cited by 27
“organs are impacted by cancer therapy, and may result in impaired psychosocial and sexual functioning [2, 3].”
BackgroundFergus, K. D., Ahmad, S., McLeod, D. L., Stephen, J. E., Gardner, S. L., Pereira, A., Warner, E., & Carter, W. (2015) · Trials · doi:10.1186/s13063-014-0534-8 · Cited by 28
“These unique challenges may include: the loss of fertility and therefore a loss of the choice to conceive children [2,4,11,13,14]; not having children because of the fear that pregnancy-related hormonal changes may provoke a cancer recurrence [15]; premature menopause with its associated hot flashes, and sleep and moo…”
BackgroundPost-treatment problems of African American breast cancer survivors
Barsevick, A. M., Leader, A. E., Bradley, P. K., Avery, T. P., Dean, L. T., DiCarlo, M. A., & Hegarty, S. (2016) · Supportive Care in Cancer · doi:10.1007/s00520-016-3359-z · Cited by 27
“With regard to age, a review of 28 studies of younger survivors (younger than age 51) identified menopause and infertility as key issues [16].”
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“Concerns about premature ovarian failure and infertility were common in younger breast cancer survivors and had a role in the level of distress after treatment [3].”
BackgroundCrane, T. E., Badger, T. A., O’Connor, P., Segrin, C. G., Alvarez, A. A., Freylersythe, S. G., Penaloza, I., Pace, T. W. W., & Sikorskii, A. E. (2020) · Journal of Cancer Survivorship · doi:10.1007/s11764-020-00954-z · Cited by 26
“Many symptoms last up to 10 years after completion of cancer treatment [26, 27].”
BackgroundNew onset of type 2 diabetes as a complication after cancer diagnosis: A systematic review
Jo, A., Scarton, L. J., O’Neal, L. J., Larson, S. A., Schafer, N., George, T. J., & Pena, J. M. M. (2020) · Cancer Medicine · doi:10.1002/cam4.3666 · Cited by 26
“The study included: (1) cohort studies, (2) cancer diagnosis by a doctor, (3) incidence”
MethodAnxiety and depression after breast cancer: The predictive role of monoamine levels
Pérez-Tejada, J., Labaka, A., Vegas, Ó., Larraioz, A., Pescador, A., & Arregi, A. (2021) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2021.101953 · Cited by 33
Caleça, T., Ribeiro, P., Vitorino, M. M., Menezes, M., Sampaio-Alves, M., Mendes, A. D., Vicente, R. S., Negreiros, I., Faria, A., & Costa, D. A. (2023) · Cancers · doi:10.3390/cancers15030594 · Cited by 26
Chemotherapy-Related Amenorrhea and Quality of Life Among Premenopausal Women With Breast Cancer
Kabirian, R., Franzoi, M. A., Havas, J., Coutant, C., Trédan, O., Lévy, C., Cottu, P. H., Mérimèche, A. D., Guillermet, S., Ferrero, J.-., et al. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.43910 · Cited by 26
Barua, A., Ram, S., & Narayanasamy, R. (2013) · Indian Journal of Palliative Care · doi:10.4103/0973-1075.110234 · Cited by 26
“Howard‑Anderson et al ., [35] found self-esteem significantly affected the quality of life of young breast cancer women.”
Brédart, A., Kop, J., Fiszer, C., Sigal‐Zafrani, B., & Dolbeault, S. (2015) · Psycho-Oncology · doi:10.1002/pon.3836 · Cited by 37
“Moreover, their quality of life is often more severely impaired compared with older (>50 years old) BCS [43].”
BackgroundTrogdon, J. G., Ekwueme, D. U., Chamiec‐Case, L., & Guy, G. P. (2016) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2015.09.026 · Cited by 26
Review of fertility preservation issues for young women with breast cancer
Gonçalves, V., & Quinn, G. P. (2016) · Human Fertility · doi:10.1080/14647273.2016.1193228 · Cited by 26
“…fertility issues are particularly important and pertinent for these young women (Avis, Crawford, & Manuel, 2004; Gonçalves, Sehovic, & Quinn, 2014; Howard-Anderson et al., 2012; Morrow et al., 2014; Partridge et al., 2004; Peate, Meiser, Hickey, & Friedlander, 2009; Senkus et al., 2014) and…”
Identifying distinct trajectories of change in young breast cancer survivors' sexual functioning
von Hippel, C. D., Rosenberg, S. M., Austin, S. B., Sprunck‐Harrild, K., Ruddy, K. J., Schapira, L., Come, S. E., Borges, V. F., & Partridge, A. H. (2019) · Psycho-Oncology · doi:10.1002/pon.5047 · Cited by 26
“Young women treated with chemotherapy and endocrine therapy often face early menopausal symptoms like hot flashes and distressing concerns about infertility.(10,11,18) These effects may make sex emotionally or physically painful and cause many young women to lose interest in sexual activity, decrease activity, and dev…”
BackgroundRasch Analysis of the 9-Item Shared Decision Making Questionnaire in Women With Breast Cancer
Wu, T., Chen, C.-T., Huang, Y., Hou, W., Wang, J., & Hsieh, C. (2018) · Cancer Nursing · doi:10.1097/ncc.0000000000000607 · Cited by 26
Differences in symptom clusters before and twelve months after breast cancer surgery
Mazor, M. B., Cataldo, J. K., Lee, K. A., Dhruva, A., Cooper, B. A., Paul, S. M., Topp, K. S., Smoot, B. J., Dunn, L. B., Levine, J. D., et al. (2017) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2017.12.003 · Cited by 25
“Prior to and following breast cancer treatment women experience multiple co-occurring menopausal-related symptoms (Barton and Ganz, 2015; Howard-Anderson et al., 2012).”
BackgroundInfluentialRadiation therapy for young women with early breast cancer: Current state of the art
Meattini, I., Lambertini, M., Desideri, I., Caluwé, A. D., Kaidar‐Person, O., & Livi, L. (2019) · Critical Reviews in Oncology/Hematology · doi:10.1016/j.critrevonc.2019.02.014 · Cited by 25
The TMK-Group (Tumour Registry Breast Cancer), Marschner, N. W., Trarbach, T., Rauh, J., Meyer, D., Müller‐Hagen, S., Harde, J., Dille, S., Kruggel, L., & Jänicke, M. (2019) · Breast Cancer Research and Treatment · doi:10.1007/s10549-019-05197-w · Cited by 25
Song, S., Hwang, E., Moon, H., Noh, D., & Lee, J. E. (2015) · Nutrients · doi:10.3390/nu7125532 · Cited by 25
“However, we do not have information on the comorbidity status at diagnosis, which has been suggested as a predictor of impaired overall quality of life as well as functional status [42,43], and we could not determine the causal relationship between the ACS guideline and WCRF/AICR recommendation adherence and HRQoL bec…”
BackgroundChow, L. W. C., Biganzoli, L., Leo, A. D., Kuroi, K., Han, H. S., Patel, J., Huang, C., Lu, Y., Zhu, L., Chow, C. Y. C., et al. (2017) · Asia-Pacific Journal of Clinical Oncology · doi:10.1111/ajco.12682 · Cited by 25
A qualitative study of work and early menopause: ‘On-the job’ experiences and career trajectories
Vincent, A. J., Johnston‐Ataata, K., Flore, J., Kokanović, R., Hickey, M., Boyle, J. A., & Teede, H. J. (2024) · Maturitas · doi:10.1016/j.maturitas.2024.107920 · Cited by 24
Liu, K., Wu, Y., Yang, W., Li, T., Wang, Z., Xiao, S., Peng, Z., Li, M., Xiong, W., Li, M., et al. (2024) · Molecular Nutrition & Food Research · doi:10.1002/mnfr.202300784 · Cited by 24
Experiencing menopause in the context of cancer: Women’s constructions of gendered subjectivities
Parton, C., Ussher, J. M., & Perz, J. (2017) · Psychology and Health · doi:10.1080/08870446.2017.1320799 · Cited by 24
da Silva, T. L. (2016) · Cancer Treatment Communications · doi:10.1016/j.ctrc.2016.03.004 · Cited by 25
“Psychological and functional management and support are key components of treatment for FBC patients [66,67], including for their romantic partners [88,89], and related interventions have been well investigated in these populations [90].”
InfluentialMartino, M. L., Gargiulo, A., Lemmo, D., Dolce, P., Barberio, D., Abate, V., Avino, F., & Tortoriello, R. (2019) · Health Psychology Open · doi:10.1177/2055102919844501 · Cited by 24
“Although the literature presents women under the age of 50 with breast cancer as a more vulnerable target (Howard-Anderson et al., 2012), showing specific needs (Ruddy et al., 2013) and clinical aspects (Ribnikar et al., 2015), nowadays, only few studies are trying to improve knowledge regarding…”
BackgroundKorde, L. A., Partridge, A. H., Esser, M., Lewis, S., Simha, J., & Johnson, R. H. (2015) · Journal of Adolescent and Young Adult Oncology · doi:10.1089/jayao.2014.0049 · Cited by 23
“60 Future research to clarify these unique concerns should focus on describing long-term psychosocial outcomes, implementing age-appropriate psychosocial screening during and after cancer therapy, and designing and validating interventions to prevent and manage negative psychosocial outcomes.”
Contraceptive utilization and counseling among breast cancer survivors
Mody, S. K., Gorman, J. R., Oakley, L. P., Layton, T. M., Parker, B. A., & Panelli, D. M. (2019) · Journal of Cancer Survivorship · doi:10.1007/s11764-019-00765-x · Cited by 23
Brown, K., Armstrong, N., & Potdar, N. (2021) · Human Fertility · doi:10.1080/14647273.2021.1933219 · Cited by 23
Family size and duration of fertility in female cancer survivors: a population-based analysis
Anderson, R. A., Kelsey, T., Morrison, D. S., & Wallace, W. H. (2021) · Fertility and Sterility · doi:10.1016/j.fertnstert.2021.11.011 · Cited by 23
Passildas, J., Collard, O., Savoye, A.-M., Dohou, J., Ginzac, A., Thivat, É., Durando, X., Kwiatkowski, F., Penault-Llorca, F. M., Abrial, C., et al. (2018) · Clinical Breast Cancer · doi:10.1016/j.clbc.2018.10.003 · Cited by 23
Corter, A. L., Speller, B., Sequeira, S., Campbell, C., Facey, M. E., & Baxter, N. N. (2019) · Journal of Adolescent and Young Adult Oncology · doi:10.1089/jayao.2018.0125 · Cited by 23
The Effectiveness of the Sport “Dragon Boat Racing” in Reducing the Risk of Lymphedema Incidence
Iacorossi, L., Gambalunga, F., Molinaro, S., Domenico, R. D., Giannarelli, D., & Fabi, A. (2018) · Cancer Nursing · doi:10.1097/ncc.0000000000000615 · Cited by 23
“The most common symptoms of depression, related to change in one"s body image, fear of early menopause, infertility, and/or recurrence occur in women who have had breast cancer at a young age.(38) In our study, the women in group A were found to have a higher level of emotional well-being than those in group B, despit…”
BackgroundMeasuring the Multidimensional Reproductive Concerns of Young Adult Male Cancer Survivors
Gorman, J. R., Drizin, J. H., Malcarne, V. L., & Hsieh, T. (2020) · Journal of Adolescent and Young Adult Oncology · doi:10.1089/jayao.2019.0146 · Cited by 22
Vo, K., & Kawamura, K. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10235690 · Cited by 22
Weiner, L. S., Nagel, S., Su, H.-C. I., Hurst, S., Levy, S. S., Arredondo, E. M., Hekler, E. B., & Hartman, S. J. (2022) · Journal of Behavioral Medicine · doi:10.1007/s10865-022-00381-8 · Cited by 21
“Key psychosocial concerns include body image disturbances due to physical changes (e.g., hair loss, weight gain, surgical scars), sexual dysfunction, and fatigue (Howard-Anderson et al., 2012; Ruddy et al., 2013).”
BackgroundManagement of menopause in women with breast cancer
Vincent, A. J. (2014) · Climacteric · doi:10.3109/13697137.2014.996749 · Cited by 22
“Menopause/menopausal symptoms, with signifi cant negative effects on quality of life and potential long-term health impacts, may in women with breast cancer be associated with: (1) natural menopause occurring concurrently with a breast cancer diagnosis; (2) recurrence of menopausal symptoms following cessation of horm…”
BackgroundMethodInfluentialIssues of ovarian cancer survivors in the USA: a literature review
Trivers, K. F., Patterson, J. R., Roland, K. B., & Rodriguez, J. L. (2013) · Supportive Care in Cancer · doi:10.1007/s00520-013-1893-5 · Cited by 22
“In one study, 25 % of survivors reported enteringmenopause as a result of treatment and 27% reported distress related to this transition [24], which is lower than similar estimates in young women with breast cancer [36], but the ovarian cancer study included older women (mean age, 56 years) and did not stratify result…”
ResultLindberg, P., Netter, P., Koller, M. T., Steinger, B., & Klinkhammer‐Schalke, M. (2017) · PLoS ONE · doi:10.1371/journal.pone.0171519 · Cited by 24
Konara Mudiyanselage, S. P., Wu, Y.-L., Kukreti, S., Chen, C.-C., Lin, C.-N., Tsai, Y.-T., Ku, H.-C., Fang, S.-Y., Wang, J.-D., & Ko, N.-Y. (2023) · Breast Cancer · doi:10.1007/s12282-022-01413-6 · Cited by 22
“Because younger women are very body conscious and long term QoL status to keep their daily lifestyle more friendly than older women [15, 62].”
BackgroundCoping Among Breast Cancer Survivors: A Confirmatory Factor Analysis of the Brief COPE
Rand, K. L., Cohee, A. A., Monahan, P. O., Wagner, L. I., Shanahan, M. L., & Champion, V. L. (2019) · Journal of Nursing Measurement · doi:10.1891/1061-3749.27.2.259 · Cited by 32
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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