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Health-related quality of life in Asian patients with breast cancer: a systematic review
  1. Peh Joo Ho1,
  2. Sofie A M Gernaat2,
  3. Mikael Hartman1,3,
  4. Helena M Verkooijen2,4
  1. 1 Saw Swee Hock School of Public Health, National University of Singapore, Singapore
  2. 2 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
  3. 3 Department of Surgery, National University of Singapore, Singapore
  4. 4 Imaging Division, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
  1. Correspondence to Dr Mikael Hartman; mikael_hartman{at}


Objective To summarise the evidence on determinants of health-related quality of life (HRQL) in Asian patients with breast cancer.

Design Systematic review conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations and registered with PROSPERO (CRD42015032468).

Methods According to the PRISMA guidelines, databases of MEDLINE (PubMed), Embase and PsycINFO were systematically searched using the following terms and synonyms: breast cancer, quality of life and Asia. Articles reporting on HRQL using EORTC-QLQ-C30, EORTC-QLQ-BR23, FACT-G and FACT-B questionnaires in Asian patients with breast cancer were eligible for inclusion. The methodological quality of each article was assessed using the quality assessment scale for cross-sectional studies or the Newcastle-Ottawa Quality Assessment Scale for cohort studies.

Results Fifty-seven articles were selected for this qualitative synthesis, of which 43 (75%) were cross-sectional and 14 (25%) were longitudinal studies. Over 75 different determinants of HRQL were studied with either the EORTC or FACT questionnaires. Patients with comorbidities, treated with chemotherapy, with less social support and with more unmet needs have poorer HRQL. HRQL improves over time. Discordant results in studies were found in the association of age, marital status, household income, type of surgery, radiotherapy and hormone therapy and unmet sexuality needs with poor global health status or overall well-being.

Conclusions In Asia, patients with breast cancer, in particular those with other comorbidities and those treated with chemotherapy, with less social support and with more unmet needs, have poorer HRQL. Appropriate social support and meeting the needs of patients may improve patients’ HRQL.

  • breast cancer
  • health-related quality of life
  • patient-reported outcomes

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  • Contributors HMV, PJH and SAMG designed the study. PJH and SAMG performed the systematic review. PJH wrote the manuscript. All authors discussed and revised the manuscript.

  • Funding The study was carried out with the support from the National University Hospital, Singapore, Clinician Scientist Award, National Medical Research Council R-608-000-093-511 and Asian Breast Cancer Research Fund N-176-000-023-091 awarded to MH.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No dataset was used in this systematic review.

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