Sihan Song; Jiyoung Youn; Myungsook Park; Eunkyung Hwang; Hyeong-Gon Moon; Dong-Young Noh; Jung Eun Lee

doi:10.5720/kjcn.2015.20.2.129

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Research Article
The Association between the Adherence to Dietary Guidelines for Breast Cancer Survivors and Health-related Quality of Life among Korean Breast Cancer Survivors: Sihan Song, Jiyoung Youn, Myungsook Park, Eunkyung Hwang, Hyeong-Gon Moon, Dong-Young Noh, Jung Eun Lee; Korean Journal of Community Nutrition 2015;20(2):129-140.
DOI: https://doi.org/10.5720/kjcn.2015.20.2.129
Published online: April 30, 2015

¹Department of Food and Nutrition, Sookmyung Women's University, Seoul, Korea.

²Breast Care Center, Seoul National University Hospital, Seoul, Korea.

³Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.

Corresponding author: Jung Eun Lee. Department of Food and Nutrition, Sookmyung Women's University, Cheongpa-ro 47-gil 100, Yongsan-gu, Seoul 140-742, Korea. Tel: (02) 2077-7560, Fax: (02) 710-9479, junglee@sookmyung.ac.kr

• Received: March 16, 2015 • Revised: April 21, 2015 • Accepted: April 21, 2015

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
Acknowledgments
Acknowledgments
REFERENCES

Abstract

Objectives
We examined the association between the adherence to dietary guidelines for breast cancer survivors and health-related quality of life in a cross-sectional study of Korean breast cancer survivors.
Methods
A total of 157 women aged 21 to 79 years who had been diagnosed with stage I to III breast cancers according to the American Joint Committee on Cancer (AJCC) and had breast cancer surgery at least 6 months before the baseline were included. We used a Korean version of the Core 30 (C30) and Breast cancer 23 (BR23) module of the European Organization for Research and Treatment Cancer Quality of Life Questionnaire (EORTC-QLQ), both of which have been validated for Koreans. Participants were asked about their adherence to dietary guidelines for breast cancer survivors, suggested by the Korean breast cancer society, using a 5-point Likert scale. We summed dietary guideline adherence scores for each participant and calculated the least squares means of health-related quality of life according to dietary guideline adherence scores using the generalized linear model.
Results
Breast cancer survivors who had higher adherence to dietary guidelines for breast cancer survivors had lower constipation scores than those with lower adherence (p for trend=0.01). When we stratified by the stage at diagnosis, this association was limited to those who had been diagnosed with stage II or III breast cancers. Also, sexual functioning scores increased significantly with increasing adherence scores of dietary guidelines among those with stage II or III breast cancers (p for trend < 0.001). However, among those who had been diagnosed with stage I, higher scores of dietary guidelines were associated with higher scores of pain (p for trend=0.03) and breast symptoms (p for trend=0.05).
Conclusions
Our study suggested that the health-related quality of life levels of breast cancer survivors are associated with the adherence to dietary guidelines and may differ by the stage of the breast cancer.
Keywords: breast cancer survivors; dietary guideline adherence; health-related quality of life

Acknowledgments

This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (NRF-2014R1A2A2A01007794).

REFERENCES

1. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JCJM, Kaasa S, Klee M, Osoba D, Razavi D, Rofe PB, Schraub S, Sneeuw K, Sullivan M, Takeda F. The European Organization for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993; 85(5): 365-376.Article PubMed
2. Amecican Cancer Society. Cancer facts & figures 2014. Atlanta: American Cancer Society; 2014a. p. 9-11.
3. Amecican Cancer Society. Cancer treatment and survivorship facts & figures 2014-2015. Atlanta: American Cancer Society; 2014b. p. 26.
4. Blanchard CM, Courneya KS, Stein K. Cancer survivors' adherence to lifestyle behavior recommendations and associations with health-related quality of life: results from the American Cancer Society's SCS-II. J Clin Oncol 2008; 26(13): 2198-2204.Article PubMed
5. Boucher BA, Cotterchio M, Curca IA, Kreiger N, Harris SA, Kirsh VA, Goodwin PJ. Intake of phytoestrogen foods and supplements among women recently diagnosed with breast cancer in Ontario, Canada. Nutr Cancer 2012; 64(5): 695-703.Article PubMed
6. Brazier JE, Harper R, Jones NM, O'Cathain A, Thomas KJ, Usherwood T, Westlake L. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ 1992; 305(6846): 160-164.Article PubMed PMC
7. Centers for Disease Control and Prevention. Measuring healthy days. Atlanta: Centers for Disease Control and Prevention; 2000. p. 6-11.
8. Cho SW, Kim JH, Lee SM, Lee SM, Choi EJ, Jeong J, Park YK. Effect of 8-week nutrition counseling to increase phytochemical rich fruit and vegetable consumption in Korean breast cancer patients: a randomized controlled trial. Clin Nutr Res 2014; 3(1): 39-47.Article PubMed PMC
9. Dashti HS, Follis JL, Smith CE, Tanaka T, Cade BE, Gottlieb DJ, Hruby A, Jacques PF, Lamon-Fava S, Richardson K, Saxena R, Scheer FAJL, Kovanen L, Bartz TM, Perala MM, Jonsson A, Frazier-Wood AC, Kalafati IP, Mikkila V, Partonen T, Lemaitre RN, Lahti J, Hernandez DG, Toft U, Johnson WC, Kanoni S, Raitakari OT, Perola M, Psaty BM, Ferrucci L, Grarup N, Highland HM, Rallidis L, Kahonen M, Havulinna AS, Siscovick DS, Raikkonen K, Jorgensen T, Rotter JI, Deloukas P, Viikari JSA, Mozaffarian D, Linneberg A, Seppala I, Hansen T, Salomaa V, Gharib SA, Eriksson JG, Bandinelli S, Pedersen O, Rich SS, Dedoussis G, Lehtimaki T, Ordovas JM. Habitual sleep duration is associated with BMI and macronutrient intake and may be modified by CLOCK genetic variants. Am J Clin Nutr 2015; 101(1): 135-143.Article PubMed
10. Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM. Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol 2005; 23(24): 5814-5830.Article PubMed
11. Edge SB, Byrd DR, Carducci M, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC cancer staging manual. 7th ed. New York: Springer; 2009. p. 419-460.
12. Eslick GD. Gastrointestinal symptoms and obesity: a metaanalysis. Obes Rev 2012; 13(5): 469-479.Article PubMed
13. Fayers PM, Aaronson NK, Bjordal K, Groenvold M, Curran D, Bottomley A; on behalf of the EORTC Quality of Life Group. The EORTC QLQ-C30 Scoring Manual. 3rd ed. Brussels: EORTC; 2001. p. 55-58.
14. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015; 136(5): E359-E386.Article PubMed
15. Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012. GLOBOCAN; 2012; cited March 12, 2015]. Available from http://globocan.iarc.fr/.
16. Hann D, Winter K, Jacobsen P. Measurement of depressive symptoms in cancer patients: Evaluation of the center for epidemiological studies depression scale (Ces-d). J Psychosom Res 1999; 46(5): 437-443.PubMed
17. Hays RD, Morales LS. The RAND-36 measure of health-related quality of life. Ann Med 2001; 33(5): 350-357.Article PubMed
18. Holmes S, Dickerson J. The quality of life: design and evaluation of a self-assessment instrument for use with cancer patients. Int J Nurs Stud 1987; 24(1): 15-24.Article PubMed
19. Inoue-Choi M, Lazovich D, Prizment AE, Robien K. Adherence to the World Cancer Research Fund/American Institute for Cancer Research recommendations for cancer prevention is associated with better health-related quality of life among elderly female cancer survivors. J Clin Oncol 2013; 31(14): 1758-1766.Article PubMed PMC
20. Jung KW, Won YJ, Kong HJ, Oh CM, Lee DH, Lee JS. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2011. Cancer Res Treat 2014; 46(2): 109-123.Article PubMed PMC
21. Kennedy ET, Ohls J, Carlson S, Fleming K. The healthy eating index: Design and applications. J Am Diet Assoc 1995; 95(10): 1103-1108.PubMed
22. Dietary guideline for breast cancer survivors. Korea Breast Cancer Society; 2012; cited July 31, 2012]. Available from http://www.kbcs.or.kr/journal/common_sense_14.html.
23. Kushi LH, Doyle C, McCullough M, Rock CL, Demark-Wahnefried W, Bandera EV, Gapstur S, Patel AV, Andrews K, Gansler T, American Cancer, Physical Activity. American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin 2012; 62(1): 30-67.Article PubMed
24. Lee MK, Yun YH, Park HA, Lee ES, Jung KH, Noh DY. A Web-based self-management exercise and diet intervention for breast cancer survivors: pilot randomized controlled trial. Int J Nurs Stud 2014; 51(12): 1557-1567.Article PubMed
25. McTiernan A, Irwin M, Vongruenigen V. Weight, physical activity, diet, and prognosis in breast and gynecologic cancers. J Clin Oncol 2010; 28(26): 4074-4080.Article PubMed PMC
26. Mols F, Vingerhoets AJ, Coebergh JW, van de Poll-Franse LV. Quality of life among long-term breast cancer survivors: A systematic review. Eur J cancer 2005; 41(17): 2613-2619.Article PubMed
27. Mosher CE, Sloane R, Morey MC, Snyder DC, Cohen HJ, Miller PE, Demark-Wahnefried W. Associations between lifestyle factors and quality of life among older long-term breast, prostate, and colorectal cancer survivors. Cancer 2009; 115(17): 4001-4009.Article PubMed
28. Neugarten BL, Kraines RJ. "Menopausal symptoms" in women of various ages. Obstet Gynecol Surv 1965; 20(6): 994-1001.Article
29. Patterson RE, Haines PS, Popkin BM. Diet quality index: capturing a multidimensional behavior. J Am Diet Assoc 1994; 94(1): 57-64.Article PubMed
30. Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL, Bandera EV, Hamilton KK, Grant B, McCullough M, Byers T, Gansler T. Nutrition and Physical Activity Guidelines for Cancer Survivors. CA Cancer J Clin 2012; 62(4): 242-274.Article
31. Stamatakis KA, Brownson RC. Sleep duration and obesity-related risk factors in the rural Midwest. Prev Med 2008; 46(5): 439-444.Article PubMed
32. Swisher AK, Abraham J, Bonner D, Gilleland D, Hobbs G, Kurian S, Yanosik MA, Vona-Davis L. Exercise and dietary advice intervention for survivors of triple-negative breast cancer: effects on body fat, physical function, quality of life, and adipokine profile. Support Care Cancer 2015; 2015: 1-9.Article PDF
33. Tangney CC, Young JA, Murtaugh MA, Cobleigh MA, Oleske DM. Self-reported dietary habits, overall dietary quality and symptomatology of breast cancer survivors: a cross-sectional examination. Breast Cancer Res Treat 2002; 71(2): 113-123.Article PubMed
34. Toles M, Demark-Wahnefried W. Nutrition and the cancer survivor: evidence to guide oncology nursing practice. Semin Oncol Nurs 2008; 24(3): 171-179.Article PubMed PMC
35. Velentzis LS, Keshtgar MR, Woodside JV, Leathem AJ, Titcomb A, Perkins KA, Mazurowska M, Anderson V, Wardell K, Cantwell MM. Significant changes in dietary intake and supplement use after breast cancer diagnosis in a UK multicentre study. Breast Cancer Res Treat 2011; 128(2): 473-482.Article PubMed PDF
36. Wayne SJ, Baumgartner K, Baumgartner RN, Bernstein L, Bowen DJ, Ballard-Barbash R. Diet quality is directly associated with quality of life in breast cancer survivors. Breast Cancer Res Treat 2006; 96(3): 227-232.Article PubMed PDF
37. Wiseman M. The second World Cancer Research Fund/American Institute for Cancer Research expert report. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Proc Nutr Soc 2008; 67(3): 253-256.Article PubMed
38. Yun YH, Bae SH, Kang IO, Shin KH, Lee R, Kwon SI, Park YS, Lee ES. Cross-cultural application of the Korean version of the European Organization for Research and Treatment of Cancer (EORTC) Breast-Cancer-Specific Quality of Life Questionnaire (EORTC QLQ-BR23). Support Care Cancer 2004a; 12(6): 441-445.Article PubMed PDF
39. Yun YH, Park YS, Lee ES, Bang SM, Heo DS, Park SY, You CH, West K. Validation of the Korean version of the EORTC QLQ-C30. Qual Life Res 2004b; 13(4): 863-868.Article PubMed

Table 1

The mean score of dietary guideline components among 157 breast cancer survivors¹⁾

1) Each component was rated on a 5-point Likert scale.

Table 2

The characteristics of study participants according to dietary guideline adherence scores

1) Analysis of variance was used for continuous variables and chi-square test was used for categorical variables.

2) Total number of participants was not equal to 157 because of some did not provide information.

3) Fisher's exact test was used.

4) American Joint Committee on Cancer

5) not available

Table 3

Health-related quality of life (HRQOL) scores¹⁾ according to dietary guideline adherence scores among breast cancer survivors with stage I to III breast cancers (n=157)

1) Adjusted for age (year; continuous), energy intake (kcal/day; continuous), body mass index (kg/m²; continuous), marital status (married or cohabitation, unmarried or divorced or widowed), education level (high school or less, college or more), breast cancer stage (I, II, III), and survival time (6 month-1 year, 1 year-5 years, ≥ 5 years).

2) P for trend was calculated using the median value of each tertile category as a continuous variable.

3) European Organization for Research and Treatment of Cancer Quality of life Questionnaire Core 30

4) Least-squares

5) 95% confidence interval

6) European Organization for Research and Treatment of Cancer Quality of life Questionnaire Breast Cancer Module 23

Table 4

Health-related quality of life (HRQOL) scores¹⁾ according to dietary guideline adherence scores among breast cancer survivors with stage I breast cancers (n=70)

1) Adjusted for age (year; continuous), energy intake (kcal/day; continuous), body mass index (kg/m²; continuous), marital status (married or cohabitation, unmarried or divorced or widowed), education level (high school or less, college or more), and survival time (6 month-1 year, 1 year-5 years, ≥ 5 years).

2) P for trend was calculated using the median value of each tertile category as a continuous variable.

3) European Organization for Research and Treatment of Cancer Quality of life Questionnaire Core 30

4) Least-squares

5) 95% confidence interval

6) European Organization for Research and Treatment of Cancer Quality of life Questionnaire Breast Cancer Module 23

Table 5

Health-related quality of life (HRQOL) scores¹⁾ according to dietary guideline adherence scores among breast cancer survivors with stage II to III breast cancers (n=87)

1) Adjusted for age (year; continuous), energy intake (kcal/day; continuous), body mass index (kg/m²; continuous), marital status (married or cohabitation, unmarried or divorced or widowed), education level (high school or less, college or more), breast cancer stage III (yes, no), and survival time (6 month-1 year, 1 year-5 years, ≥ 5 years)

2) P for trend was calculated using the median value of each tertile category as a continuous variable.

3) European Organization for Research and Treatment of Cancer Quality of life Questionnaire Core 30

4) Least-squares

5) 95% confidence interval

6) European Organization for Research and Treatment of Cancer Quality of life Questionnaire Breast Cancer Module 23

Figure & Data

Table 1

The mean score of dietary guideline components among 157 breast cancer survivors¹⁾

1) Each component was rated on a 5-point Likert scale.

Table 2

The characteristics of study participants according to dietary guideline adherence scores

1) Analysis of variance was used for continuous variables and chi-square test was used for categorical variables.

2) Total number of participants was not equal to 157 because of some did not provide information.

3) Fisher's exact test was used.

4) American Joint Committee on Cancer

5) not available

Table 3

Health-related quality of life (HRQOL) scores¹⁾ according to dietary guideline adherence scores among breast cancer survivors with stage I to III breast cancers (n=157)

2) P for trend was calculated using the median value of each tertile category as a continuous variable.

3) European Organization for Research and Treatment of Cancer Quality of life Questionnaire Core 30

4) Least-squares

5) 95% confidence interval

6) European Organization for Research and Treatment of Cancer Quality of life Questionnaire Breast Cancer Module 23

Table 4

Health-related quality of life (HRQOL) scores¹⁾ according to dietary guideline adherence scores among breast cancer survivors with stage I breast cancers (n=70)

1) Adjusted for age (year; continuous), energy intake (kcal/day; continuous), body mass index (kg/m²; continuous), marital status (married or cohabitation, unmarried or divorced or widowed), education level (high school or less, college or more), and survival time (6 month-1 year, 1 year-5 years, ≥ 5 years).

2) P for trend was calculated using the median value of each tertile category as a continuous variable.

3) European Organization for Research and Treatment of Cancer Quality of life Questionnaire Core 30

4) Least-squares

5) 95% confidence interval

6) European Organization for Research and Treatment of Cancer Quality of life Questionnaire Breast Cancer Module 23

Table 5

Health-related quality of life (HRQOL) scores¹⁾ according to dietary guideline adherence scores among breast cancer survivors with stage II to III breast cancers (n=87)

1) Adjusted for age (year; continuous), energy intake (kcal/day; continuous), body mass index (kg/m²; continuous), marital status (married or cohabitation, unmarried or divorced or widowed), education level (high school or less, college or more), breast cancer stage III (yes, no), and survival time (6 month-1 year, 1 year-5 years, ≥ 5 years)

2) P for trend was calculated using the median value of each tertile category as a continuous variable.

3) European Organization for Research and Treatment of Cancer Quality of life Questionnaire Core 30

4) Least-squares

5) 95% confidence interval

6) European Organization for Research and Treatment of Cancer Quality of life Questionnaire Breast Cancer Module 23

REFERENCES

1. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JCJM, Kaasa S, Klee M, Osoba D, Razavi D, Rofe PB, Schraub S, Sneeuw K, Sullivan M, Takeda F. The European Organization for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993; 85(5): 365-376.Article PubMed
2. Amecican Cancer Society. Cancer facts & figures 2014. Atlanta: American Cancer Society; 2014a. p. 9-11.
3. Amecican Cancer Society. Cancer treatment and survivorship facts & figures 2014-2015. Atlanta: American Cancer Society; 2014b. p. 26.
4. Blanchard CM, Courneya KS, Stein K. Cancer survivors' adherence to lifestyle behavior recommendations and associations with health-related quality of life: results from the American Cancer Society's SCS-II. J Clin Oncol 2008; 26(13): 2198-2204.Article PubMed
5. Boucher BA, Cotterchio M, Curca IA, Kreiger N, Harris SA, Kirsh VA, Goodwin PJ. Intake of phytoestrogen foods and supplements among women recently diagnosed with breast cancer in Ontario, Canada. Nutr Cancer 2012; 64(5): 695-703.Article PubMed
6. Brazier JE, Harper R, Jones NM, O'Cathain A, Thomas KJ, Usherwood T, Westlake L. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ 1992; 305(6846): 160-164.Article PubMed PMC
7. Centers for Disease Control and Prevention. Measuring healthy days. Atlanta: Centers for Disease Control and Prevention; 2000. p. 6-11.
8. Cho SW, Kim JH, Lee SM, Lee SM, Choi EJ, Jeong J, Park YK. Effect of 8-week nutrition counseling to increase phytochemical rich fruit and vegetable consumption in Korean breast cancer patients: a randomized controlled trial. Clin Nutr Res 2014; 3(1): 39-47.Article PubMed PMC
9. Dashti HS, Follis JL, Smith CE, Tanaka T, Cade BE, Gottlieb DJ, Hruby A, Jacques PF, Lamon-Fava S, Richardson K, Saxena R, Scheer FAJL, Kovanen L, Bartz TM, Perala MM, Jonsson A, Frazier-Wood AC, Kalafati IP, Mikkila V, Partonen T, Lemaitre RN, Lahti J, Hernandez DG, Toft U, Johnson WC, Kanoni S, Raitakari OT, Perola M, Psaty BM, Ferrucci L, Grarup N, Highland HM, Rallidis L, Kahonen M, Havulinna AS, Siscovick DS, Raikkonen K, Jorgensen T, Rotter JI, Deloukas P, Viikari JSA, Mozaffarian D, Linneberg A, Seppala I, Hansen T, Salomaa V, Gharib SA, Eriksson JG, Bandinelli S, Pedersen O, Rich SS, Dedoussis G, Lehtimaki T, Ordovas JM. Habitual sleep duration is associated with BMI and macronutrient intake and may be modified by CLOCK genetic variants. Am J Clin Nutr 2015; 101(1): 135-143.Article PubMed
10. Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM. Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol 2005; 23(24): 5814-5830.Article PubMed
11. Edge SB, Byrd DR, Carducci M, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC cancer staging manual. 7th ed. New York: Springer; 2009. p. 419-460.
12. Eslick GD. Gastrointestinal symptoms and obesity: a metaanalysis. Obes Rev 2012; 13(5): 469-479.Article PubMed
13. Fayers PM, Aaronson NK, Bjordal K, Groenvold M, Curran D, Bottomley A; on behalf of the EORTC Quality of Life Group. The EORTC QLQ-C30 Scoring Manual. 3rd ed. Brussels: EORTC; 2001. p. 55-58.
14. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray F. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer 2015; 136(5): E359-E386.Article PubMed
15. Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012. GLOBOCAN; 2012; cited March 12, 2015]. Available from http://globocan.iarc.fr/.
16. Hann D, Winter K, Jacobsen P. Measurement of depressive symptoms in cancer patients: Evaluation of the center for epidemiological studies depression scale (Ces-d). J Psychosom Res 1999; 46(5): 437-443.PubMed
17. Hays RD, Morales LS. The RAND-36 measure of health-related quality of life. Ann Med 2001; 33(5): 350-357.Article PubMed
18. Holmes S, Dickerson J. The quality of life: design and evaluation of a self-assessment instrument for use with cancer patients. Int J Nurs Stud 1987; 24(1): 15-24.Article PubMed
19. Inoue-Choi M, Lazovich D, Prizment AE, Robien K. Adherence to the World Cancer Research Fund/American Institute for Cancer Research recommendations for cancer prevention is associated with better health-related quality of life among elderly female cancer survivors. J Clin Oncol 2013; 31(14): 1758-1766.Article PubMed PMC
20. Jung KW, Won YJ, Kong HJ, Oh CM, Lee DH, Lee JS. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2011. Cancer Res Treat 2014; 46(2): 109-123.Article PubMed PMC
21. Kennedy ET, Ohls J, Carlson S, Fleming K. The healthy eating index: Design and applications. J Am Diet Assoc 1995; 95(10): 1103-1108.PubMed
22. Dietary guideline for breast cancer survivors. Korea Breast Cancer Society; 2012; cited July 31, 2012]. Available from http://www.kbcs.or.kr/journal/common_sense_14.html.
23. Kushi LH, Doyle C, McCullough M, Rock CL, Demark-Wahnefried W, Bandera EV, Gapstur S, Patel AV, Andrews K, Gansler T, American Cancer, Physical Activity. American Cancer Society Guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin 2012; 62(1): 30-67.Article PubMed
24. Lee MK, Yun YH, Park HA, Lee ES, Jung KH, Noh DY. A Web-based self-management exercise and diet intervention for breast cancer survivors: pilot randomized controlled trial. Int J Nurs Stud 2014; 51(12): 1557-1567.Article PubMed
25. McTiernan A, Irwin M, Vongruenigen V. Weight, physical activity, diet, and prognosis in breast and gynecologic cancers. J Clin Oncol 2010; 28(26): 4074-4080.Article PubMed PMC
26. Mols F, Vingerhoets AJ, Coebergh JW, van de Poll-Franse LV. Quality of life among long-term breast cancer survivors: A systematic review. Eur J cancer 2005; 41(17): 2613-2619.Article PubMed
27. Mosher CE, Sloane R, Morey MC, Snyder DC, Cohen HJ, Miller PE, Demark-Wahnefried W. Associations between lifestyle factors and quality of life among older long-term breast, prostate, and colorectal cancer survivors. Cancer 2009; 115(17): 4001-4009.Article PubMed
28. Neugarten BL, Kraines RJ. "Menopausal symptoms" in women of various ages. Obstet Gynecol Surv 1965; 20(6): 994-1001.Article
29. Patterson RE, Haines PS, Popkin BM. Diet quality index: capturing a multidimensional behavior. J Am Diet Assoc 1994; 94(1): 57-64.Article PubMed
30. Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL, Bandera EV, Hamilton KK, Grant B, McCullough M, Byers T, Gansler T. Nutrition and Physical Activity Guidelines for Cancer Survivors. CA Cancer J Clin 2012; 62(4): 242-274.Article
31. Stamatakis KA, Brownson RC. Sleep duration and obesity-related risk factors in the rural Midwest. Prev Med 2008; 46(5): 439-444.Article PubMed
32. Swisher AK, Abraham J, Bonner D, Gilleland D, Hobbs G, Kurian S, Yanosik MA, Vona-Davis L. Exercise and dietary advice intervention for survivors of triple-negative breast cancer: effects on body fat, physical function, quality of life, and adipokine profile. Support Care Cancer 2015; 2015: 1-9.Article PDF
33. Tangney CC, Young JA, Murtaugh MA, Cobleigh MA, Oleske DM. Self-reported dietary habits, overall dietary quality and symptomatology of breast cancer survivors: a cross-sectional examination. Breast Cancer Res Treat 2002; 71(2): 113-123.Article PubMed
34. Toles M, Demark-Wahnefried W. Nutrition and the cancer survivor: evidence to guide oncology nursing practice. Semin Oncol Nurs 2008; 24(3): 171-179.Article PubMed PMC
35. Velentzis LS, Keshtgar MR, Woodside JV, Leathem AJ, Titcomb A, Perkins KA, Mazurowska M, Anderson V, Wardell K, Cantwell MM. Significant changes in dietary intake and supplement use after breast cancer diagnosis in a UK multicentre study. Breast Cancer Res Treat 2011; 128(2): 473-482.Article PubMed PDF
36. Wayne SJ, Baumgartner K, Baumgartner RN, Bernstein L, Bowen DJ, Ballard-Barbash R. Diet quality is directly associated with quality of life in breast cancer survivors. Breast Cancer Res Treat 2006; 96(3): 227-232.Article PubMed PDF
37. Wiseman M. The second World Cancer Research Fund/American Institute for Cancer Research expert report. Food, nutrition, physical activity, and the prevention of cancer: a global perspective. Proc Nutr Soc 2008; 67(3): 253-256.Article PubMed
38. Yun YH, Bae SH, Kang IO, Shin KH, Lee R, Kwon SI, Park YS, Lee ES. Cross-cultural application of the Korean version of the European Organization for Research and Treatment of Cancer (EORTC) Breast-Cancer-Specific Quality of Life Questionnaire (EORTC QLQ-BR23). Support Care Cancer 2004a; 12(6): 441-445.Article PubMed PDF
39. Yun YH, Park YS, Lee ES, Bang SM, Heo DS, Park SY, You CH, West K. Validation of the Korean version of the EORTC QLQ-C30. Qual Life Res 2004b; 13(4): 863-868.Article PubMed

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The Association between the Adherence to Dietary Guidelines for Breast Cancer Survivors and Health-related Quality of Life among Korean Breast Cancer Survivors

Korean J Community Nutr. 2015;20(2):129-140. Published online April 30, 2015

DOI: https://doi.org/10.5720/kjcn.2015.20.2.129

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The Association between the Adherence to Dietary Guidelines for Breast Cancer Survivors and Health-related Quality of Life among Korean Breast Cancer Survivors

Table 1

The mean score of dietary guideline components among 157 breast cancer survivors¹⁾

1) Each component was rated on a 5-point Likert scale.

Table 2

The characteristics of study participants according to dietary guideline adherence scores

1) Analysis of variance was used for continuous variables and chi-square test was used for categorical variables.

2) Total number of participants was not equal to 157 because of some did not provide information.

3) Fisher's exact test was used.

4) American Joint Committee on Cancer

5) not available

Table 3

Health-related quality of life (HRQOL) scores¹⁾ according to dietary guideline adherence scores among breast cancer survivors with stage I to III breast cancers (n=157)

2) P for trend was calculated using the median value of each tertile category as a continuous variable.

3) European Organization for Research and Treatment of Cancer Quality of life Questionnaire Core 30

4) Least-squares

5) 95% confidence interval

6) European Organization for Research and Treatment of Cancer Quality of life Questionnaire Breast Cancer Module 23

Table 4

Health-related quality of life (HRQOL) scores¹⁾ according to dietary guideline adherence scores among breast cancer survivors with stage I breast cancers (n=70)

1) Adjusted for age (year; continuous), energy intake (kcal/day; continuous), body mass index (kg/m²; continuous), marital status (married or cohabitation, unmarried or divorced or widowed), education level (high school or less, college or more), and survival time (6 month-1 year, 1 year-5 years, ≥ 5 years).

2) P for trend was calculated using the median value of each tertile category as a continuous variable.

3) European Organization for Research and Treatment of Cancer Quality of life Questionnaire Core 30

4) Least-squares

5) 95% confidence interval

6) European Organization for Research and Treatment of Cancer Quality of life Questionnaire Breast Cancer Module 23

Table 5

Health-related quality of life (HRQOL) scores¹⁾ according to dietary guideline adherence scores among breast cancer survivors with stage II to III breast cancers (n=87)

1) Adjusted for age (year; continuous), energy intake (kcal/day; continuous), body mass index (kg/m²; continuous), marital status (married or cohabitation, unmarried or divorced or widowed), education level (high school or less, college or more), breast cancer stage III (yes, no), and survival time (6 month-1 year, 1 year-5 years, ≥ 5 years)

2) P for trend was calculated using the median value of each tertile category as a continuous variable.

3) European Organization for Research and Treatment of Cancer Quality of life Questionnaire Core 30

4) Least-squares

5) 95% confidence interval

6) European Organization for Research and Treatment of Cancer Quality of life Questionnaire Breast Cancer Module 23

Table 1 The mean score of dietary guideline components among 157 breast cancer survivors1)

1) Each component was rated on a 5-point Likert scale.

Table 2 The characteristics of study participants according to dietary guideline adherence scores

1) Analysis of variance was used for continuous variables and chi-square test was used for categorical variables.

2) Total number of participants was not equal to 157 because of some did not provide information.

3) Fisher's exact test was used.

4) American Joint Committee on Cancer

5) not available

Table 3 Health-related quality of life (HRQOL) scores1) according to dietary guideline adherence scores among breast cancer survivors with stage I to III breast cancers (n=157)

2) P for trend was calculated using the median value of each tertile category as a continuous variable.

3) European Organization for Research and Treatment of Cancer Quality of life Questionnaire Core 30

4) Least-squares

5) 95% confidence interval

6) European Organization for Research and Treatment of Cancer Quality of life Questionnaire Breast Cancer Module 23

Table 4 Health-related quality of life (HRQOL) scores1) according to dietary guideline adherence scores among breast cancer survivors with stage I breast cancers (n=70)

1) Adjusted for age (year; continuous), energy intake (kcal/day; continuous), body mass index (kg/m²; continuous), marital status (married or cohabitation, unmarried or divorced or widowed), education level (high school or less, college or more), and survival time (6 month-1 year, 1 year-5 years, ≥ 5 years).

2) P for trend was calculated using the median value of each tertile category as a continuous variable.

3) European Organization for Research and Treatment of Cancer Quality of life Questionnaire Core 30

4) Least-squares

5) 95% confidence interval

6) European Organization for Research and Treatment of Cancer Quality of life Questionnaire Breast Cancer Module 23

Table 5 Health-related quality of life (HRQOL) scores1) according to dietary guideline adherence scores among breast cancer survivors with stage II to III breast cancers (n=87)

1) Adjusted for age (year; continuous), energy intake (kcal/day; continuous), body mass index (kg/m²; continuous), marital status (married or cohabitation, unmarried or divorced or widowed), education level (high school or less, college or more), breast cancer stage III (yes, no), and survival time (6 month-1 year, 1 year-5 years, ≥ 5 years)

2) P for trend was calculated using the median value of each tertile category as a continuous variable.

3) European Organization for Research and Treatment of Cancer Quality of life Questionnaire Core 30

4) Least-squares

5) 95% confidence interval

6) European Organization for Research and Treatment of Cancer Quality of life Questionnaire Breast Cancer Module 23