Volume 18, Issue 4 (Iranian Journal of Breast Diseases 2026)
ijbd 2026, 18(4): 102-122 |
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Sajadian A. Evaluation of long-term quality of life, anxiety, depression, and hope among Iranian breast cancer survivors: a prospective, multicenter, 5-year longitudinal study. ijbd 2026; 18 (4) :102-122
URL: http://ijbd.ir/article-1-1233-en.html
URL: http://ijbd.ir/article-1-1233-en.html
1- Quality of Life Department, Breast Cancer Research Center, Motamed Cancer Institute, Academic Center for Education, Culture, and Research (ACECR), Tehran, Iran , assajadi@yahoo.com
Abstract: (35 Views)
Introduction: Given the high prevalence and increasing survival rates of breast cancer in recent years, evaluating quality of life (QoL) in this population has become of growing importance. The objective of this study was to assess the quality of life, as well as depression, anxiety, and hope in breast cancer survivors (BCS).
Methods: A 5-year longitudinal prospective study was conducted among eligible breast cancer survivors referred to one of five referral medical centers in Tehran, Iran. Quality of life (SF-36), anxiety and depression (HADS), and hope (AHS) questionnaires at three time points (immediately, one year, and five years after treatment) were completed.
Results: Of the 1250 recruited patients, 1,115 BCS participated in the study, and finally 856 women (76.7%) remained in the study for five years. Improvements were observed in all SF-36 subscales, including the physical (PCS) and mental component summaries (MCS) (P<0.001). Mixed model analysis showed that anxiety was inversely associated with PCS (β=-0.35, P=0.01) and MCS (β=-0.29, P=0.01). An older age at diagnosis was associated with reduced physical functioning (β = -0.12, P < 0.001). Contrary to this, both hope (β=0.021, β=0.45, P<0.001, respectively for PCS and MCS) and higher education demonstrated positive associations with QoL (β=3.75, β=2.20, P<0.0, respectively for PCS and MCS). Depression, marital status, occupation, and disease stage had no significant effect on PCS and MCS.
Conclusion: The results demonstrated an improvement in quality of life among breast cancer survivors over five years. Anxiety and hope have been found to influence quality of life, underscoring the essential need for continuous attention to overall mental and physical health and regular psychosocial screening programs and hope-enhancing interventions, particularly in the first years following treatment.
Methods: A 5-year longitudinal prospective study was conducted among eligible breast cancer survivors referred to one of five referral medical centers in Tehran, Iran. Quality of life (SF-36), anxiety and depression (HADS), and hope (AHS) questionnaires at three time points (immediately, one year, and five years after treatment) were completed.
Results: Of the 1250 recruited patients, 1,115 BCS participated in the study, and finally 856 women (76.7%) remained in the study for five years. Improvements were observed in all SF-36 subscales, including the physical (PCS) and mental component summaries (MCS) (P<0.001). Mixed model analysis showed that anxiety was inversely associated with PCS (β=-0.35, P=0.01) and MCS (β=-0.29, P=0.01). An older age at diagnosis was associated with reduced physical functioning (β = -0.12, P < 0.001). Contrary to this, both hope (β=0.021, β=0.45, P<0.001, respectively for PCS and MCS) and higher education demonstrated positive associations with QoL (β=3.75, β=2.20, P<0.0, respectively for PCS and MCS). Depression, marital status, occupation, and disease stage had no significant effect on PCS and MCS.
Conclusion: The results demonstrated an improvement in quality of life among breast cancer survivors over five years. Anxiety and hope have been found to influence quality of life, underscoring the essential need for continuous attention to overall mental and physical health and regular psychosocial screening programs and hope-enhancing interventions, particularly in the first years following treatment.
Type of Study: Research |
Subject:
Nutrition, psychology, sport
Received: 2025/12/23 | Accepted: 2026/02/3 | Published: 2026/02/6
Received: 2025/12/23 | Accepted: 2026/02/3 | Published: 2026/02/6
References
1. Cancer [Internet]. 2025. Available from: https://www.who.int/news-room/fact-sheets/detail/cancer.
2. Sanaat Z, Dolatkhah R. Epidemiologic profile of breast cancer in Iran: a systematic review and meta-analysis. Clinical Epidemiology and Global Health. 2024;26:101537. [DOI:10.1016/j.cegh.2024.101537]
3. Amato O, Guarneri V, Girardi F. Epidemiology trends and progress in breast cancer survival: earlier diagnosis, new therapeutics. Current Opinion in Oncology. 2023;35(6):612-9. [DOI:10.1097/CCO.0000000000000991] [PMID] []
4. Nafissi N, Khayamzadeh M, Zeinali Z, Pazooki D, Hosseini M, Akbari MEJMEJoC. Epidemiology and histopathology of breast cancer in Iran versus other Middle Eastern countries. 2018;9(3):243-51.
5. Koch L, Jansen L, Herrmann A, Stegmaier C, Holleczek B, Singer S, et al. Quality of life in long-term breast cancer survivors-a 10-year longitudinal population-based study. Acta oncologica. 2013;52(6):1119-28. [DOI:10.3109/0284186X.2013.774461] [PMID]
6. Montagnese C, Porciello G, Vitale S, Palumbo E, Crispo A, Grimaldi M, et al. Quality of life in women diagnosed with breast cancer after a 12-month treatment of lifestyle modifications. Nutrients. 2020;13(1):136. [DOI:10.3390/nu13010136] [PMID] []
7. Maurer T, Thöne K, Obi N, Jung AY, Behrens S, Becher H, et al. Health-related quality of life in a cohort of breast cancer survivors over more than 10 years post-diagnosis and in comparison to a control cohort. Cancers. 2021;13(8):1854. [DOI:10.3390/cancers13081854] [PMID] []
8. Rahimzadeh M, Pourhoseingholi MA, Kavehie B. Survival rates for breast cancer in Iranian patients: a meta-analysis. Asian Pacific Journal of Cancer Prevention. 2016;17(4):2223-7. [DOI:10.7314/APJCP.2016.17.4.2223] [PMID]
9. Akbari ME, Akbari A, Khayamzadeh M, Salmanian R, Akbari M. Ten-year survival of breast cancer in Iran: a national study (Retrospective cohort study). Breast Care. 2023;18(1):12-21. [DOI:10.1159/000526746] [PMID] []
10. Alvarez-Pardo S, Romero-Pérez EM, Camberos-Castañeda N, de Paz JA, Horta-Gim MA, González-Bernal JJ, et al. Quality of life in Breast Cancer survivors in relation to Age, type of Surgery and length of Time since First Treatment. International Journal of Environmental Research and Public Health. 2022;19(23):16229. [DOI:10.3390/ijerph192316229] [PMID] []
11. Salafia C, Adamsons K. Quality of life in breast cancer survivors: An ambiguous loss perspective. Journal of Family Theory & Review. 2025. [DOI:10.1111/jftr.12612] [PMID] []
12. Aljadani FF, Nughays RO, Alharbi GE, Almazroy EA, Elyas SK, Danish HE, et al. Quality of Life in Breast Cancer Patients in Saudi Arabia: A Systematic Review. Breast Cancer: Targets and Therapy. 2025:171-86. [DOI:10.2147/BCTT.S505725] [PMID] []
13. Hack C, Voiß P, Lange S, Paul A, Conrad S, Dobos G, et al. Local and systemic therapies for breast cancer patients: reducing short-term symptoms with the methods of integrative medicine. Geburtshilfe und Frauenheilkunde. 2015;75(07):675-82. [DOI:10.1055/s-0035-1557748] [PMID] []
14. Tommasi C, Balsano R, Corianò M, Pellegrino B, Saba G, Bardanzellu F, et al. Long-term effects of breast cancer therapy and care: calm after the storm? Journal of clinical medicine. 2022;11(23):7239. [DOI:10.3390/jcm11237239] [PMID] []
15. Vuong S, Warner E. Breast cancer survivorship among younger patients: Challenges and opportunities-Narrative review. Annals of Palliative Medicine. 2024;13(5):1246257-1257. [DOI:10.21037/apm-24-64] [PMID]
16. Schmidt ME, Goldschmidt S, Hermann S, Steindorf K. Late effects, long‐term problems and unmet needs of cancer survivors. International Journal of Cancer. 2022;151(8):1280-90. [DOI:10.1002/ijc.34152] [PMID]
17. Trentham-Dietz A, Sprague BL, Klein R, Klein BE, Cruickshanks KJ, Fryback DG, et al. Health-related quality of life before and after a breast cancer diagnosis. Breast cancer research and treatment. 2008;109:379-87. [DOI:10.1007/s10549-007-9653-1] [PMID] []
18. Chu W-o, Dialla PO, Roignot P, Bone-Lepinoy M-C, Poillot M-L, Coutant C, et al. Determinants of quality of life among long-term breast cancer survivors. Quality of Life Research. 2016;25:1981-90. [DOI:10.1007/s11136-016-1248-z] [PMID]
19. Peuckmann V, Ekholm O, Rasmussen NK, Møller S, Groenvold M, Christiansen P, et al. Health-related quality of life in long-term breast cancer survivors: nationwide survey in Denmark. Breast cancer research and treatment. 2007;104:39-46. [DOI:10.1007/s10549-006-9386-6] [PMID]
20. Kapur R. The Role of Women in Promoting Well-being of their Families. 2021.
21. Sajadian A, Raji LM, Hashemi E, Montazeri A, Anbiaee R, Omranipour R, et al. A prospective, multicenter, longitudinal study to evaluate the long-term quality of life and associated factors in breast cancer survivors, 5-year follow-up: A study protocol. 2024. [DOI:10.61186/ijbd.17.2.26]
22. Framework IC. The MOS 36-item short-form health survey (SF-36). Med Care. 1992;30(6):473-83. [DOI:10.1097/00005650-199206000-00002]
23. Montazeri A, Goshtasebi A, Vahdaninia M, Gandek B. The Short Form Health Survey (SF-36): translation and validation study of the Iranian version. Quality of life research. 2005;14:875-82. [DOI:10.1007/s11136-004-1014-5] [PMID]
24. Apolone G, Filiberti A, Cifani S, Ruggiata R, Mosconi PJAoO. Evaluation of the EORTC QLQ-C30 questionnaire: a comparison with the SF-36 Health Survey in a cohort of Italian long-survival cancer patients. 1998;9(5):549-57. [DOI:10.1023/A:1008264412398] [PMID]
25. Porzsolt F, Wölpl CP, Rist CE, Kosa R, Büchele G, Gaus WJPO. Comparison of three instruments (QLQ‐C30, SF‐36, QWB‐7) measuring health‐related quality of life/quality of well‐being. 1996;5(2):103-17.
https://doi.org/10.1002/(SICI)1099-1611(199606)5:2<103::AID-PON221>3.3.CO;2-N [DOI:10.1002/(SICI)1099-1611(199606)5:23.3.CO;2-N]
26. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica. 1983;67(6):361-70. [DOI:10.1111/j.1600-0447.1983.tb09716.x] [PMID]
27. Montazeri A, Vahdaninia M, Ebrahimi M, Jarvandi S. The Hospital Anxiety and Depression Scale (HADS): translation and validation study of the Iranian version. Health and quality of life outcomes. 2003;1:1-5.
https://doi.org/10.1186/1477-7525-1-19
https://doi.org/10.1186/1477-7525-1-14 [DOI:10.1186/1477-7525-1-66] [PMID] []
28. Snyder CR, Sympson SC, Ybasco FC, Borders TF, Babyak MA, Higgins RL. Development and validation of the State Hope Scale. Journal of personality and social psychology. 1996;70(2):321. [DOI:10.1037/0022-3514.70.2.321] [PMID]
29. Vakili Y, Ghanbari N, Nooripour R, Mansournia MA, Ilanloo H, Matacotta JJ. Validity of the snyder's adult hope scale (AHS) among Iranian women with breast cancer. Archives of Breast Cancer. 2022:96-103. [DOI:10.32768/abc.20229196-103]
30. Al-Karni MA, Omar MT, Al Dhwayan NM, Ajarim D, Idreess MJ, Gwada RF. Factors associated with health-related quality of life among breast cancer survivors in Saudi Arabia: cross-sectional study. Asian Pacific Journal of Cancer Prevention: APJCP. 2024;25(3):951. [DOI:10.31557/APJCP.2024.25.3.951] [PMID] []
31. Vaca-Cartagena BF, Guajardo ASF, Azim Jr HA, Rotolo F, Olivas-Martinez A, Platas A, et al. Describing quality of life trajectories in young Hispanic women with breast cancer: 5-year results from a large prospective cohort. 2025;79:103866. [DOI:10.1016/j.breast.2024.103866] [PMID] []
32. Park J-H, Jung YS, Kim JY, Bae SH. Determinants of quality of life in women immediately following the completion of primary treatment of breast cancer: A cross-sectional study. PloS one. 2021;16(10):e0258447. [DOI:10.1371/journal.pone.0258447] [PMID] []
33. Sharma N, Purkayastha A. Factors affecting quality of life in breast cancer patients: a descriptive and cross-sectional study with review of literature. Journal of mid-life health. 2017;8(2):75-83. [DOI:10.4103/jmh.JMH_15_17] [PMID] []
34. Kim SHJIJoNS. Survivorship concerns among posttreatment cancer survivors in South Korea: A secondary analysis of a cross-sectional survey. 2025;162:104982. [DOI:10.1016/j.ijnurstu.2024.104982] [PMID]
35. Browall M ÖU, Henoch I, Wengström Y. The course of Health Related Quality of Life in postmenopausal women with breast cancer from breast surgery and up to five years post-treatment. The Breast. 2013;22(5):952-7. [DOI:10.1016/j.breast.2013.05.002] [PMID]
36. Cespedes P, Martinez-Arnau FM, Torregrosa MD, Cauli O, Buigues C. Impact of a Physical Exercise and Health Education Program on Metabolic Syndrome and Quality of Life in Postmenopausal Breast Cancer Women Undergoing Adjuvant Treatment with Aromatase Inhibitors. Medicina. 2024;60(11):1893. [DOI:10.3390/medicina60111893] [PMID] []
37. Lopes C, Lopes-Conceição L, Fontes F, Ferreira A, Pereira S, Lunet N, et al. Prevalence and persistence of anxiety and depression over five years since breast cancer diagnosis-the NEON-BC prospective study. Current oncology. 2022;29(3):2141-53. [DOI:10.3390/curroncol29030173] [PMID] []
38. Li K, Chadha M, Moshier E, Rosenstein BS, Jandu HK, Veal CD, et al. Age-stratified analysis of health-related quality of life in patients with early-stage breast cancer receiving adjuvant radiation therapy and endocrine therapy. 2025;16(2):102195. [DOI:10.1016/j.jgo.2025.102195] [PMID]
39. Kitashita MJSCiC. Structural equation modeling of hope, psychological distress, quality of life, and influencing factors in advanced cancer patients undergoing cancer pharmacotherapy in Japan. 2025;33(3):189. [DOI:10.1007/s00520-025-09160-y] [PMID]
40. Cáceres MC, Nadal-Delgado M, López-Jurado C, Pérez-Civantos D, Guerrero-Martín J, Durán-Gómez N. Factors related to anxiety, depressive symptoms and quality of life in breast cancer. International Journal of Environmental Research and Public Health. 2022;19(6):3547. [DOI:10.3390/ijerph19063547] [PMID] []
41. Lueboonthavatchai P. Prevalence and psychosocial factors of anxiety and depression in breast cancer patients. Journal-Medical Association of Thailand. 2007;90(10):2164.
42. Reyes-Gibby CC, Anderson KO, Morrow PK, Shete S, Hassan S. Depressive symptoms and health-related quality of life in breast cancer survivors. Journal of women's health. 2012;21(3):311-8. [DOI:10.1089/jwh.2011.2852] [PMID] []
43. Muzzatti B, Bomben F, Flaiban C, Piccinin M, Annunziata MA. Quality of life and psychological distress during cancer: a prospective observational study involving young breast cancer female patients. BMC Cancer. 2020;20(1):758. [DOI:10.1186/s12885-020-07272-8] [PMID] []
44. Shen A, Qiang W, Wang Y, Chen Y. Quality of life among breast cancer survivors with triple negative breast cancer--role of hope, self-efficacy and social support. European Journal of Oncology Nursing. 2020;46:101771. [DOI:10.1016/j.ejon.2020.101771] [PMID]
45. Garduño-Ortega O, Morales-Cruz J, Hunter-Hernández M, Gany F, Costas-Muñiz R. Spiritual well-being, depression, and quality of life among Latina breast cancer survivors. Journal of religion and health. 2021;60:1895-907. [DOI:10.1007/s10943-020-01147-9] [PMID] []
46. Wonghongkul T, Moore SM, Musil C, Schneider S, Deimling G. The influence of uncertainty in illness, stress appraisal, and hope on coping in survivors of breast cancer. Cancer Nursing. 2000;23(6):422-9. [DOI:10.1097/00002820-200012000-00004] [PMID]
47. Husain FNA. Hope, meaning in life and religious/spiritual struggle predicts the quality of life in cancer patients with early and advanced malignancy: a structural equation modeling approach. HEALTH PSYCHOLOGY AND BEHAVIORAL MEDICINE. 2024;12: 1, 2351936. [DOI:10.1080/21642850.2024.2351936] [PMID] []
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