# Cancer Research Network

# 

**Prophylactic Mastectomy Outcomes Study Survey**

**[Notes for Potential Users]{.underline}**

The survey on the following pages was used for the study described in
the following publications:

-   Geiger AM, Nekhlyudov L, Herrinton LJ, Rolnick S, Greene SM, West
    CN, Harris E, Elmore JG, Altschuler A, Fletcher SW, Emmons K.
    Quality of life after bilateral prophylactic mastectomy. *Ann Surg
    Oncol* (in press).

-   Geiger AM, West CN, Nekhlyudov LN, Herrinton LJ, Liu AI, Altschuler
    A, Rolnick SJ, Harris EL, Greene SM, Elmore JG, Emmons K, Fletcher
    SW. Contentment with quality of life among breast cancer survivors
    with and without contralateral prophylactic mastectomy. *J Clin
    Oncol* 2006;24:1350-1356.

-   Greene SM, Geiger AM, Harris E, Altschuler A, Nekhlyudov L, Barton
    M, Rolnick SJ, Fletcher S. Impact of IRB requirements on a
    multi-site Cancer Research Network study. *Ann Epidemiol*
    2006;16:275-278.

-   Nekhlyudov L, Bower M, Herrinton L, Altschuler A, Greene S. Rolnick
    C, Elmore J, Harris E, Liu IA, Emmons KM, Fletcher SW, Geiger AM.
    Women's decision-making roles regarding contralateral prophylactic
    mastectomy. *J Natl Cancer Inst Monogr* 2005;35:55-60.

We offer the survey for review by interested parties. We caution any
potential users of any portions of the survey to consult the
documentation of question sources at the end of this file to ensure
appropriate use and attribution. Should any items developed or adapted
by our group be used in another survey, we would appreciate citation of
one or both of the first two publications listed above.

Any questions about the survey should be directed to Ann Geiger at
ageiger@wfubmc.edu.

# Living with Breast Cancer Risk: Survey of Experiences

We appreciate your taking time to participate in our research study by
completing and returning this survey. Remember that completing this
survey is voluntary. You may choose to skip questions that make you
uncomfortable. Your participation in this study does not affect your
medical care or coverage in any way. We will not share your specific
answers with anyone else and no information identifying you will appear
in study reports.

Please check or circle the one best answer to each of the following
questions, unless instructed otherwise.

Your Health

1.  In general, would you say your health is:

1 Poor

2 Fair

3 Good

4 Very Good

5 Excellent

2.  Has a doctor or other health care provider ever told you that you
    have: (check all that apply)

1 Cancer other than breast cancer

2 Depression or other psychological or mental condition

3 Diabetes

4 Hypertension/high blood pressure or heart disease

5 Osteoporosis

6 Overweight

9 Other, please specify:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

0 None

Your Breast Cancer Experience and Thoughts

3.  Have you ever been diagnosed with breast cancer including ductal
    carcinoma in situ (DCIS)?

0 No

1 Yes, please provide date of first diagnosis \_\_\_\_ / \_\_\_\_ /
\_\_\_\_

8 Not sure

4.  How would you describe your concern about developing breast cancer
    or, if you have had breast cancer, getting breast cancer again?

4 Very concerned

3 Concerned

2 Not very concerned

1 Not concerned at all

5.  Below is a list of statements that describe reactions some women
    have to thinking about breast cancer. Each woman's experience is
    different so you may or may not have these concerns.

+------------------------------------------------+----+-----+-----+----+
| Please circle one number to indicate how       | [  |     |     |    |
| frequently each comment about breast cancer    | Fr |     |     |    |
| was true for you [during the past 30           | eq |     |     |    |
| days]{.underline} before you received this     | ue |     |     |    |
| survey.                                        | nc |     |     |    |
|                                                | y] |     |     |    |
|                                                | {. |     |     |    |
|                                                | sm |     |     |    |
|                                                | al |     |     |    |
|                                                | lc |     |     |    |
|                                                | ap |     |     |    |
|                                                | s} |     |     |    |
+------------------------------------------------+----+-----+-----+----+
|                                                | N  | Rar | S   | O  |
|                                                | ot | ely | ome | ft |
|                                                |    |     | -ti | en |
|                                                | at |     | mes |    |
|                                                | a  |     |     |    |
|                                                | ll |     |     |    |
+------------------------------------------------+----+-----+-----+----+
|                                                |    |     |     |    |
+------------------------------------------------+----+-----+-----+----+
| a.  I thought about breast cancer when I       | 1  | 2   | 3   | 4  |
|     didn't                                     |    |     |     |    |
|                                                |    |     |     |    |
| > expect to.                                   |    |     |     |    |
+------------------------------------------------+----+-----+-----+----+
|                                                |    |     |     |    |
+------------------------------------------------+----+-----+-----+----+
| b.  I had to keep myself from getting upset    | 1  | 2   | 3   | 4  |
|     when I thought about breast cancer or was  |    |     |     |    |
|     reminded of breast cancer.                 |    |     |     |    |
+------------------------------------------------+----+-----+-----+----+
|                                                |    |     |     |    |
+------------------------------------------------+----+-----+-----+----+
| c.  I had dreams about breast cancer.          | 1  | 2   | 3   | 4  |
+------------------------------------------------+----+-----+-----+----+
|                                                |    |     |     |    |
+------------------------------------------------+----+-----+-----+----+
| d.  I avoided things that remind me of breast  | 1  | 2   | 3   | 4  |
|     cancer.                                    |    |     |     |    |
+------------------------------------------------+----+-----+-----+----+
|                                                |    |     |     |    |
+------------------------------------------------+----+-----+-----+----+
| e.  I avoided conversations about breast       | 1  | 2   | 3   | 4  |
|     cancer.                                    |    |     |     |    |
+------------------------------------------------+----+-----+-----+----+
|                                                |    |     |     |    |
+------------------------------------------------+----+-----+-----+----+
| f.  I was aware that I have a lot of feelings  | 1  | 2   | 3   | 4  |
|     about breast cancer, but I didn't deal     |    |     |     |    |
|     with them.                                 |    |     |     |    |
+------------------------------------------------+----+-----+-----+----+
|                                                |    |     |     |    |
+------------------------------------------------+----+-----+-----+----+
| g.  I tried not to think about breast cancer.  | 1  | 2   | 3   | 4  |
+------------------------------------------------+----+-----+-----+----+

Your Life Right Now

4.  Below is a list of statements that describe aspects of women's
    lives, including thoughts about your body and sexuality.

+------------------------------------------+----+----+-----+-----+----+
| Please circle one number to indicate how | [  |    |     |     |    |
| true each statement has been for you     | Fr |    |     |     |    |
| [during the past 30 days]{.underline}.   | eq |    |     |     |    |
|                                          | ue |    |     |     |    |
|                                          | nc |    |     |     |    |
|                                          | y] |    |     |     |    |
|                                          | {. |    |     |     |    |
|                                          | sm |    |     |     |    |
|                                          | al |    |     |     |    |
|                                          | lc |    |     |     |    |
|                                          | ap |    |     |     |    |
|                                          | s} |    |     |     |    |
+==========================================+====+====+=====+=====+====+
|                                          | N  | A  | So  | Qu  | Ve |
|                                          | ot |    | me- | ite | ry |
|                                          |    | Li |     |     |    |
|                                          | At | tt | w   | A   | Mu |
|                                          |    | le | hat | Bit | ch |
|                                          | A  |    |     |     |    |
|                                          | ll | B  |     |     |    |
|                                          |    | it |     |     |    |
+------------------------------------------+----+----+-----+-----+----+
|                                          |    |    |     |     |    |
+------------------------------------------+----+----+-----+-----+----+
| a.  I am able to enjoy life.             | 1  | 2  | 3   | 4   | 5  |
+------------------------------------------+----+----+-----+-----+----+
|                                          |    |    |     |     |    |
+------------------------------------------+----+----+-----+-----+----+
| b.  I am content with the quality of my  | 1  | 2  | 3   | 4   | 5  |
|     life right now.                      |    |    |     |     |    |
+------------------------------------------+----+----+-----+-----+----+
|                                          |    |    |     |     |    |
+------------------------------------------+----+----+-----+-----+----+
| c.  I feel self-conscious about my       | 1  | 2  | 3   | 4   | 5  |
|     appearance.                          |    |    |     |     |    |
+------------------------------------------+----+----+-----+-----+----+
|                                          |    |    |     |     |    |
+------------------------------------------+----+----+-----+-----+----+
| d.  I am happy with my current weight.   | 1  | 2  | 3   | 4   | 5  |
+------------------------------------------+----+----+-----+-----+----+
|                                          |    |    |     |     |    |
+------------------------------------------+----+----+-----+-----+----+
| e.  I am satisfied with my appearance    | 1  | 2  | 3   | 4   | 5  |
|     when dressed.                        |    |    |     |     |    |
+------------------------------------------+----+----+-----+-----+----+
|                                          |    |    |     |     |    |
+------------------------------------------+----+----+-----+-----+----+
| f.  I find it difficult to look at       | 1  | 2  | 3   | 4   | 5  |
|     myself naked.                        |    |    |     |     |    |
+------------------------------------------+----+----+-----+-----+----+
|                                          |    |    |     |     |    |
+------------------------------------------+----+----+-----+-----+----+
| g.  I am embarrassed for others to see   | 1  | 2  | 3   | 4   | 5  |
|     my body.                             |    |    |     |     |    |
+------------------------------------------+----+----+-----+-----+----+
|                                          |    |    |     |     |    |
+------------------------------------------+----+----+-----+-----+----+
| h.  I am able to feel like a woman.      | 1  | 2  | 3   | 4   | 5  |
+------------------------------------------+----+----+-----+-----+----+
|                                          |    |    |     |     |    |
+------------------------------------------+----+----+-----+-----+----+
| i.  I feel sexually attractive.          | 1  | 2  | 3   | 4   | 5  |
+------------------------------------------+----+----+-----+-----+----+
|                                          |    |    |     |     |    |
+------------------------------------------+----+----+-----+-----+----+
| j.  I am satisfied with my sex life.     | 1  | 2  | 3   | 4   | 5  |
+------------------------------------------+----+----+-----+-----+----+

5.  Below is a list of statements that describe moods.

+--------------------------------------+-------+-------+-------+-------+
| Please circle the number for each    | [Fr   |       |       |       |
| statement which best describes how   | equen |       |       |       |
| often you felt or behaved this way   | cy]{. |       |       |       |
| [during the past 30                  | small |       |       |       |
| days]{.underline}.                   | caps} |       |       |       |
+======================================+=======+=======+=======+=======+
|                                      | R     | Some  | Oc    | Most  |
|                                      | arely | or    | casio | or    |
|                                      | or    | L     | nally | All   |
|                                      | None  | ittle | or a  | of    |
|                                      | of    | of    | Mod   | the   |
|                                      | the   | the   | erate | Time  |
|                                      | Time  | Time  | A     |       |
|                                      |       |       | mount |       |
|                                      |       |       | of    |       |
|                                      |       |       | the   |       |
|                                      |       |       | Time  |       |
+--------------------------------------+-------+-------+-------+-------+
|                                      |       |       |       |       |
+--------------------------------------+-------+-------+-------+-------+
| a.  I was bothered by things that    | 1     | 2     | 3     | 4     |
|     usually don't bother me.         |       |       |       |       |
+--------------------------------------+-------+-------+-------+-------+
|                                      |       |       |       |       |
+--------------------------------------+-------+-------+-------+-------+
| b.  I did not feel like eating; my   | 1     | 2     | 3     | 4     |
|     appetite was poor.               |       |       |       |       |
+--------------------------------------+-------+-------+-------+-------+
|                                      |       |       |       |       |
+--------------------------------------+-------+-------+-------+-------+
| c.  I felt that I could not shake    | 1     | 2     | 3     | 4     |
|     off the blues even with help     |       |       |       |       |
|     from my family or friends.       |       |       |       |       |
+--------------------------------------+-------+-------+-------+-------+
|                                      |       |       |       |       |
+--------------------------------------+-------+-------+-------+-------+
| d.  I felt that I was just as good   | 1     | 2     | 3     | 4     |
|     as other people.                 |       |       |       |       |
+--------------------------------------+-------+-------+-------+-------+
|                                      |       |       |       |       |
+--------------------------------------+-------+-------+-------+-------+
| e.  I had trouble keeping my mind on | 1     | 2     | 3     | 4     |
|     what I was doing.                |       |       |       |       |
+--------------------------------------+-------+-------+-------+-------+
|                                      |       |       |       |       |
+--------------------------------------+-------+-------+-------+-------+
| f.  I felt depressed.                | 1     | 2     | 3     | 4     |
+--------------------------------------+-------+-------+-------+-------+
|                                      |       |       |       |       |
+--------------------------------------+-------+-------+-------+-------+
| g.  I felt that everything I did was | 1     | 2     | 3     | 4     |
|     an effort.                       |       |       |       |       |
+--------------------------------------+-------+-------+-------+-------+
|                                      |       |       |       |       |
+--------------------------------------+-------+-------+-------+-------+
| h.  I felt hopeful about the future. | 1     | 2     | 3     | 4     |
+--------------------------------------+-------+-------+-------+-------+
|                                      |       |       |       |       |
+--------------------------------------+-------+-------+-------+-------+
| i.  I thought my life had been a     | 1     | 2     | 3     | 4     |
|     failure.                         |       |       |       |       |
+--------------------------------------+-------+-------+-------+-------+
|                                      |       |       |       |       |
+--------------------------------------+-------+-------+-------+-------+
| j.  I felt fearful.                  | 1     | 2     | 3     | 4     |
+--------------------------------------+-------+-------+-------+-------+
|                                      |       |       |       |       |
+--------------------------------------+-------+-------+-------+-------+
| k.  My sleep was restless.           | 1     | 2     | 3     | 4     |
+--------------------------------------+-------+-------+-------+-------+
|                                      |       |       |       |       |
+--------------------------------------+-------+-------+-------+-------+
| l.  I was happy.                     | 1     | 2     | 3     | 4     |
+--------------------------------------+-------+-------+-------+-------+
|                                      |       |       |       |       |
+--------------------------------------+-------+-------+-------+-------+
| m.  I talked less than usual.        | 1     | 2     | 3     | 4     |
+--------------------------------------+-------+-------+-------+-------+
|                                      |       |       |       |       |
+--------------------------------------+-------+-------+-------+-------+
| n.  I felt lonely.                   | 1     | 2     | 3     | 4     |
+--------------------------------------+-------+-------+-------+-------+
|                                      |       |       |       |       |
+--------------------------------------+-------+-------+-------+-------+
| o.  People were unfriendly.          | 1     | 2     | 3     | 4     |
+--------------------------------------+-------+-------+-------+-------+
|                                      |       |       |       |       |
+--------------------------------------+-------+-------+-------+-------+
| p.  I enjoyed life.                  | 1     | 2     | 3     | 4     |
+--------------------------------------+-------+-------+-------+-------+
|                                      |       |       |       |       |
+--------------------------------------+-------+-------+-------+-------+
| q.  I had crying spells.             | 1     | 2     | 3     | 4     |
+--------------------------------------+-------+-------+-------+-------+
|                                      |       |       |       |       |
+--------------------------------------+-------+-------+-------+-------+
| r.  I felt sad.                      | 1     | 2     | 3     | 4     |
+--------------------------------------+-------+-------+-------+-------+
|                                      |       |       |       |       |
+--------------------------------------+-------+-------+-------+-------+
| s.  I felt that people disliked me.  | 1     | 2     | 3     | 4     |
+--------------------------------------+-------+-------+-------+-------+
|                                      |       |       |       |       |
+--------------------------------------+-------+-------+-------+-------+
| t.  I could not "get going.\"        | 1     | 2     | 3     | 4     |
+--------------------------------------+-------+-------+-------+-------+

A Few Details About You

6.  What is your age?

\_\_\_ \_\_\_ years

7.  To what race/ethnic group do you belong? Please check all that
    apply.

1 Asian or Pacific Islander, please specify:

2 Black or African American

3 Hispanic/Latino, please specify:

4 Native American or Alaskan Native

5 White or Caucasian

9 Other, please specify:

8.  What is the highest level of education you have completed?

1 Less than or some high school

2 High school or GED

3 Trade or technical school

4 Junior college, or some college

5 College graduate

6 Postgraduate work or degree

9.  What is your current marital status?

1 Married

2 Living together but unmarried

3 Separated or divorced

4 Widowed

5 Single, never married

10. What is your current height?

\_\_\_ feet \_\_\_ inches or 888 Not sure

11. What is your current weight?

\_\_\_\_\_ pounds or 888 Not sure

12. On what date did you complete this questionnaire?

\_\_\_\_/\_\_\_\_/\_\_\_\_ (month/day/year)

  -------------------------------- ----- ---------------------------------
  If you **have** had one or both        If you **have** **not** had one
  breasts surgically removed to          or both breasts removed to
  **prevent** breast cancer,             **prevent** breast cancer, or
  [please continue with the              have only had one or both breasts
  questions below]{.underline}.          removed to **treat** breast
  Removal of a breast to treat           cancer, [please go to question 24
  cancer does not qualify.               on the last page]{.underline}.

                                         
  -------------------------------- ----- ---------------------------------

For Women who Have Had Surgery to Prevent Breast Cancer\
(Prophylactic Mastectomy)

Throughout this section we use the phrase **prophylactic mastectomy** to
describe the removal of one or both breasts to prevent breast cancer.

13. Before your prophylactic mastectomy, how would you have described
    your concern about developing breast cancer?

4 Very concerned

3 Concerned

2 Not very concerned

1 Not concerned at all

14. What were your reasons for having a prophylactic mastectomy? Please
    check all that apply.

1 Uncomfortably large breasts

2 Concerns about appearance

3 Unclear mammogram results

4 Unclear pathology results

5 Breast cancer or ductal carcinoma in situ (DCIS) in one breast

6 Lobular carcinoma in situ (LCIS)

7 Fibrocystic breasts

8 Family history of breast cancer

9 Prevent breast cancer

0 Other, please specify:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

15. At the time of your prophylactic mastectomy, what was your marital
    status?

1 Married

2 Living together but unmarried

3 Separated or divorced

4 Widowed

5 Single, never married

16. Which one statement best describes the decision about your
    prophylactic mastectomy?

1 I made the final decision to have surgery.

2 I made the final decision to have surgery after seriously considering
my doctor\'s opinion.

3 My doctor and I shared responsibility for the final decision to have
surgery.

4 My doctor made the final decision about my surgery, but seriously
considered my opinion.

5 My doctor made the final decision about my surgery.

17. Thinking back to [six months after]{.underline} your prophylactic
    mastectomy, how satisfied were you with your decision to have the
    surgery?

> 1 Very dissatisfied
>
> 2 Dissatisfied
>
> 3 Satisfied
>
> 4 Very satisfied

18. Did you have breast reconstruction after your prophylactic
    mastectomy? Breast reconstruction is a surgical procedure in which
    the breasts are recreated using implants or tissue from the body.

0 No. Please skip to question 21.

1 Yes, done in a separate surgery after the prophylactic mastectomy

2 Yes, done along with prophylactic mastectomy

20a.How satisfied were you with the timing of your reconstruction
relative to your prophylactic mastectomy?

> 1 Very dissatisfied
>
> 2 Dissatisfied
>
> 3 Satisfied
>
> 4 Very satisfied

20b. Have you had surgery to revise or repair your reconstruction?

> 0 No
>
> 1 Yes, one or two times
>
> 2 Yes, multiple times

19. All things considered, how satisfied are you with the medical care
    you received at the time of your prophylactic mastectomy?

> 1 Very dissatisfied
>
> 2 Dissatisfied
>
> 3 Satisfied
>
> 4 Very satisfied

20. Overall, how satisfied are you [now]{.underline} with your decision
    to have prophylactic mastectomy?

> 1 Very dissatisfied
>
> 2 Dissatisfied
>
> 3 Satisfied
>
> 4 Very satisfied

21. What one thing do you wish you had known before your prophylactic
    mastectomy?

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Final Questions for Everyone

22. Is there anything else you would like to share with us?

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

23. Please check here if you would like a copy of the results when
    available (approximately one year). 1

Thank you very much for completing the survey!

**Please mail it to the coordinating center in the envelope we provided,
or to:**

\[ADDRESS INFORMATION REMOVED\]

Please refer to your cover letter for contact people who can answer
questions about this study.

# Cancer Research Network

# 

**Prophylactic Mastectomy Outcomes Study Survey**

**[Documentation of Question Sources]{.underline}**

  ------------ -----------------------------------------------------------
  **Question   **Source**
  \#**         

  1            MOS SF-36^1^

  2            Created by our team

  3            Used in prior survey^2^

  4, 15        Created by our team

  5a-g         Revised Impact of Event Scale^3^ (time reference modified
               from 7 to 30 days, number of statements reduced, some
               statements reworded)

  6a,b,g       FACT-B^4^ (question g modified)

  6c,d,e       Hopwood^5^ (questions on original instrument modified to
               statements)

  6f           CARES^6^ (modified to remove reference to breast cancer)

  6h           FACT-B^4^

  6j           MOS^7^

  7a-t         CES-D^8^

  8--11        BRFSS^9^ (modified for self-administration and to combine
               race/ethnicity into one question)

  12-13        Used in prior survey^2^

  14, 16       Created by our team

  17           BRFSS^9^ (modified for retrospective use)

  18           Degner and Sloan^10^ (modified to pertain to prophylactic
               mastectomy surgery)

  19, 21, 22   Used in prior survey^11^ (modified to pertain to
               prohpylactic mastectomy surgery)

  20a-b        Created by our team

  21           Created by our team

  23 -- 25     Created by our team
  ------------ -----------------------------------------------------------

^1^Ware JE, Sherbourne CD. The MOS 36-item short-form health survey
(SF-36): I. Conceptual framework and item selection. *Med Care*
1992;30:473-83.

^2^Geiger AM. Do Breast Cancer Risk Factors Vary by Dual Receptor
Status? KPSC IRB #2134.

^3^Horowitz M, Wilner N, Alvarez W. Impact of event scale: a measure of
subjective stress. *Psychosom Med* 1979;41:209-18.

^4^Brady MJ, Cella DF, Mo F, Bonomi AE, Tulsky DS, Lloyd SR, Deasy S,
Cobleigh M, Shiomoto G. Reliability and validity of the Functional
Assessment of Cancer Therapy-Breast quality-of-life instrument. *J Clin
Oncol* 1997;15:974-86.

^5^Hopwood P, Fletcher I, Lee A, Al Ghazal S. A body image scale for use
with cancer patients. *Eur J Can*cer 2001;37:189-97.

^6^Ganz PA, Schag CA, Lee JJ, Sim MS. The CARES: a generic measure of
health-related quality of life for patients with cancer. *Qual Life Res*
1992;1:19-29.

^7^Sherbourne CD. Social functioning: sexual problems measures. In:
Stewart AL, Ware JE, eds. Measuring functioning and well-being: the
Medical Outcomes Study approach. Durham, NC: Duke University Press,
1992:194-204.

^8^Radloff LS. The CES-D scale: A self-report depression scale for
research in the general population. *Applied* *Psychological
Measurement* 1977; 1: 385-401.

^9^Behavioral Risk Factor Surveillance System, 2000 Questionnaire. At
http://www.cdc.gov/brfss/.

^10^Degner LF, Sloan JA. Decision making during serious illness: what
role do patients really want to play? *J Clin* *Epidemiol*
1992;45:941-50.

^11^Geiger AM, Mullen ES, Sloman PA, Edgerton BW, Petitti DB. Evaluation
of a breast cancer patient information and support program. *Eff Clin
Pract* 2000;3:157-65. KPSC IRB #2126.