Qualité de vie et communication entre soignant et soignée auprès de femmes atteintes de cancer du sein : approche longitudinale

Introduction: Nowadays, women with breast cancer can have a longer survival and many of these women can even foresee a cure.  While early screening and aggressive medical treatment offer hope to more women, researchers and clinicians must now look into the quality of life of these women at each clinical phase of the disease’s trajectory.  The physical, functional, psychological and social difficulties that women treated for cancer experience can compromise their quality of life, hence the importance to evaluate it.  Few researchers were interested in examining the longitudinal change of the quality of life of these women at the various phases of the disease’s trajectory in oncology: diagnosis, treatment and follow-up.  Also, few researchers wondered if the perception women have of their communication with healthcare providers influence their quality of life throughout the trajectory of the disease.  Main objectives: 1) Describe the evolution of the health-related quality of life of women suffering from breast cancer during diagnosis, radiation therapy and follow-up; 2) Describe the evolution of the women’s perception of their communication with the doctors, nurses and the technicians in radio-oncology during the same clinical phases; 3) Examine the evolution of the association between the perceived communication the women have with healthcare providers and their health-related quality of life during the three phases described above.  Methods: The sample consisted of 120 French-speaking women with early breast cancer (stage I or II), aged 18 years and over (55 years ± 9,5) who underwent a lumpectomy.  The women have filled out questionnaires around the diagnosis period ( on average six weeks from diagnostic), during half-way of radiation therapy (on average 27 weeks from diagnostic), and between three and four months after the end of radiation therapy (on average 48 weeks after diagnostic).  At each measurement time, they completed five questionnaires of 60 minutes of total length at the hospital or at home : One pertaining to demographic data, one on medical data, the MOS SSS, the EORTC QLQ-C30/BR23 and the MCCS.  Results: The GEE analyses indicate that the health-related quality of life of breast cancer women changes with time.  It diminishes during radiotherapy, except for the emotional and the cognitive functioning.  The analyses also show that certain clinical, intrapersonal and interpersonal factors influence their quality of life.  Precisely, with age and with a better perceived social support along the disease’s trajectory, better is the women’s quality of life for the generic and specific dimensions of functioning.  Moreover, those with stage II cancer and those who received radiotherapy and hormonotherapy have better scores for some quality of life dimensions compared to those who had a stage I cancer and those who were treated with chimiotherapy, radiotherapy and hormonotherapy.  The results also revealed an interaction between the factor “time” and one interpersonal factor for the role functioning and the sexual functioning of these women.  The perception the women have of their communication with doctors and other healthcare providers changed a little with time.  Hence, the women perceived themselves more competent regarding the seeking of information with radio-oncologists during radiotherapy than with surgeons at diagnosis.  They also perceived the verification and the seeking of information provided by the radio-oncologists during radiotherapy more satisfying compared to those of surgeons during diagnosis.  The women perceived better their overall communication with the radio-oncologists and the surgeons during radiotherapy and at follow-up than during diagnosis with the surgeons.  The GEE analyses indicate as well that some clinical (type of treatment), intrapersonal and interpersonal factors (age, education, and perceived social support) are factors that seems to influence the way they perceive their communication with healthcare providers.  Finally, women’s perceptions of their competence with regards to their communication skills towards doctors and other healthcare providers explain more their health-related quality of life than their perception of the competence of healthcare providers.  Therefore, women have better role and emotional functioning as well as fewer side effects and symptoms during radiotherapy and at follow-up when they perceive themselves as competent communicators for the seeking of information and the socio-emotional aspect of a relation at preceding phases towards doctors (surgeons and radio-oncologists).  Moreover, women’s age, their perceived social support, the stage of their cancer and the type of treatments received influence the association between their quality of life and their communication with healthcare providers.  Finally, an interaction exists between the factor “time” and one interpersonal or intrapersonal factor for the following quality of life dimensions : role, emotional, and sexual functioning.  Conclusion and repercussions:  The results of the present thesis underscore the importance to assess longitudinally the health-related quality of life of women with breast cancer at various times along the disease’s trajectory, especially during radiotherapy and for psychosocial specialists to take care of younger women diagnosed with breast cancer and those who do not perceive receiving social support.  Thus, better psychosocial ressources can be developed to help those groups of women.  The results illustrate as well that it is important to inform surgeons the importance of establishing a satisfactory communication with breast cancer women during diagnosis in order for them to have a positive perception of their communication with surgeons.  Finally, the results obtained underscore the benefits for breast cancer women to be proactive and feel competent with regards to seeking information and the socio-emotional aspect of the relation between them and the surgeons and radio-oncologists in order to maintain a good health-related quality of life.

Keyphrases: Health-related quality of life, Breast cancer, Disease's trajectory, Communication between patient and healthcare providers