Effects of inpatient rehabilitation on health-related quality of life in breast cancer patients

Background: Major endpoint for the assessment of a complex inpatient rehabilitation program is the health-related quality of life. In a prospective longitudinal study we evaluated the subjective well-being of breast cancer patients by different methods. Patients and Methods: 183 breast cancer patients were asked to complete six different questionnaires at three different time points: t1: start of treatment, t2: end of treatment, t3: 3 months after t2. Results: In the Hospital Anxiety and Depression Scale (HADS-D) we observed high mean scores for anxiety (8.73) and depression (5.55), as compared to a healthy control population (5.8 and 3.34, respectively). There was a significant improvement for both scores at t2 (6.84 and 4.77, respectively) and for anxiety at t3 (7.68). This was confirmed by the FBK questionnaire showing a significant decrease of the psychological distress in the t1/t2 and t1/t3 time periods as well. The global health score of the QLQ-C30 instrument increased significantly at the end of the rehabilitation and was maintained at the 3-month follow-up. This was true for most of the functional subscales as well. Older widowed women with 3-4 accompanying diseases had the most profit from the program. Using the Perceived Adjustment to Chronic Illness Scale (PACTS), we observed significantly less effort of coping with the illness at t2 and t3. Conclusions: At the end of a complex rehabilitation program for breast cancer patients, the health-related quality of life improved in several domains. While after a 3-month follow-up the scores were still better than before the treatment, anxiety and depression increased again. Therefore, the good results of the rehabilitation program should be maintained by continuous ambulatory treatment.