The purpose of this study was to describe the impact of two interventions on the quality of life (QOL) and the role of social support. Its aim was to generate new knowledge about QOL and social support and in this way to help health care professionals achieve a deeper understanding of QOL and social support issues. The outcome measures were QOL and social support.
The data for the research were collected by questionnaires one week and six months after breast cancer surgery. In the first phase 120 breast cancer patients took part in the telephone intervention and 108 patients were recruited into the control group. In the second phase 112 breast cancer patients took part in the face-to-face intervention and 92 patients were recruited into the control group. The third dataset comprised those breast cancer patients who were involved in both phases, i.e. in the telephone intervention and in the face-to-face intervention. The population consisted of 85 women in the intervention group and 79 women in the control group. QOL was assessed using two instruments, viz the Quality of Life Index-Cancer Version (QLI-CV) and the European Organization for Research and Treatment of Cancer Breast Cancer-Specific Quality of Life (EORTC QLQ-BR23).
The results showed that the breast cancer patients benefited from the telephone support and counselling provided by the physiotherapist one week after surgery as well as from the face-to-face counselling six months after surgery. The breast cancer patients who took part in the telephone intervention had a statistically (p=.036) and clinically better body image, less postoperative side-effects (p=.004) and they had a better future outlook (p=.010) than the breast cancer patients in the control group. The breast cancer patients who took part in the face-to-face support and education intervention had statistically (p=.011) and clinically less arm symptoms than women in the control group. In a clinical analysis patients in the control group were not as distressed by hair loss as the patients in the intervention group. In both phases the breast cancer patients in the intervention group reported clinically better sexual functioning than those in the control group.
During the six-month follow-up body image deteriorated (intervention group p?.001, control group p=.007) and treatment side-effects increased statistically (intervention group p?.001, control group p=.003) and clinically significantly in both groups, breast and arm symptoms decreased in both groups both statistically (p?.001) and clinically significantly. Future outlook improved significantly (p?.001) over six months among patients in the control group, but not among patients in the intervention group. The improvement in future outlook was greater in the control group (p=.014).
Age, education, type of surgery and axillary treatment were associated with QOL and predicted poor QOL at both stages of the study. In both phases membership of the control group and at follow-up adjuvant therapies predicted poor QOL. Negative QOL changes were best predicted by education, employment status, having underage children and adjuvant therapies, as well as by support received from the social network. The patients who received more affect from the support network were at greater risk of reduced global QOL and health and functional capacity. Increased aid from nurses increased the likelihood of improved sexual functioning.
The interventions designed and tested in this study can be put to use in the care and treatment of breast cancer patients with relatively low resource input. Even short-term support and counselling after breast cancer surgery and during treatment can help to improve patients’ QOL. Postoperative support and counselling should be incorporated as an integral part of the care of breast cancer patients and implemented on the basis of the existing research evidence. Early intervention after a short hospital stay is the most effective way of supporting and helping breast cancer patients cope and of enhancing their physical, psychological and social QOL. Breast cancer patients with poor QOL and at greatest risk of declining QOL during the treatment process are in greatest need of support and counselling. This must be taken into account in planning treatment interventions and in the allocation of support to breast cancer patients.
