What matters most? Predictors of quality of life and life satisfaction among young breast cancer survivors

This study tested a literature-based model of psychosocial adjustment among young breast cancer (BC) survivors. The model included biological factors (BRCA positive, stage of cancer, premature menopause, medical comorbidities, time in remission), psychological factors (psychological diagnoses, cognitive functioning), and social/practical factors (social support, parenting, finances, fertility). Factors were hypothesized to impact distressing reactions (depression, anxiety, fear of recurrence, and traumatic distress), and adaptive reactions (hope, benefit finding) to survivorship. Reactions to survivorship were hypothesized to impact quality of life (QoL) and satisfaction with life (SWL). Young BC survivors (N = 284) were recruited via social media to complete a web-based survey. The self-report items in the survey assessed demographic and biopsychosocial factors, and self-report measures including the Functional Assessment of Cancer Therapy for breast cancer (FACT-B) and Satisfaction with Life Scale (SWLS). Latent variables were created for Adaptive and Distressing Reactions. Structural Equation Modeling (SEM) was performed in MPlus to test the hypothesized relationships between biopsychosocial factors, Adaptive and Distressing Reactions, and the outcomes of QoL and SWL. The hypothesized model fit the observed data adequately well: chi2 (100) = 332.92, p < .001, CFI = .86, RMSEA = .09, SRMR = .05. The final model accounted for 86% and 62% of the variance in QoL and SWL, respectively. Support, parenting, and fertility concerns were the only significant predictors of adjustment. Adaptive Reactions was associated with SWLS (Beta = .58, p < .0001), but not QoL. Distressing Reactions was associated with SWL (Beta = - .26, p = .01) QoL (Beta = - .87, p <.001). QoL and SWL were significantly associated (Beta = .19, p < .05). The biopsychosocial factors that predicted Adaptive and Distressing Reactions to survivorship were social support, parenting concerns, and fertility concerns. Stage of cancer, time in remission, comorbidities, premature menopause, psychiatric diagnoses, and cognitive functioning were not related to psychosocial adjustment. Depression, anxiety, fear of recurrence, and traumatic distress (Distressing Reactions) were strongly associated with lower levels of QoL and SWL whereas hope and benefit finding (Adaptive Reactions) were only associated with higher levels of SWL.