National Cancer Institute
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Outcomes Research Branch
Cancer Control and Population Sciences


Health, Eating, Activities, and Lifestyle Study of Quality of Life Among Breast Cancer Survivors (HEAL-QOL)

HEAL-QOL is an ancillary study to the Health, Eating, Activity and Lifestyle (HEAL) Study of breast cancer prognosis. HEAL is a collaborative, multicenter, longitudinal cohort study of breast cancer patients, stage 0-IIIa, in New Mexico, Southern California, and Western Washington. HEAL's overall objective is to examine the effects of various factors related to anthropometrics, diet, physical activity, and endogenous hormones on prognosis in women with breast cancer.

HEAL-QOL was designed to describe and evaluate the long-term effects of breast cancer on Health-related Quality of Life 30 to 48 months after diagnosis. The HEAL-QOL study is overseen by staff in the Outcomes Research Branch.

The study consisted of questionnaires assessing global quality of life; physical and mental functioning; symptoms such as fatigue, pain, lymphedema, and changes in sexual functioning; stress and psychosocial responses to the cancer experience; social support; information access; optimism; and religiosity. Responses to these questionnaires are being examined in the context of demographic, clinical, and lifestyle factors assessed in the overall HEAL study.

All women who completed a HEAL baseline interview were eligible for the HEAL-QOL study. A total of 1,183 participants completed the baseline survey, including 615 from New Mexico, 202 from Western Washington, and 366 from Los Angeles County. Of those women who completed the baseline survey, 944 (80%) participated in a 24-month follow-up assessment and 858 (73%) participated in the subsequent HEAL-QOL ancillary study. Reasons for exclusion included death, refusal at time of contact for the HEAL-QOL study, being unlocatable, or illness.

A number of HEAL-QOL manuscripts have already been published, and others are in development. Here are a few highlights of findings from the study:

  • A factor analysis of the positive and negative impacts of breast cancer on four general quality-of-life areas showed that the most positive impact of breast cancer was on exercise and diet behaviors and on religion. These effects were still present 5 years after diagnosis. The most negative impact was on love life and financial situation. Younger women showed greater negative impact in these areas than older women (Alfano et al., 2006a).
  • An analysis of hormone-related symptoms showed that more than 98% of women in the study reported at least one symptom, and 50% of women reported 8 to 12 symptoms. The most commonly reported symptoms were forgetfulness, interrupted sleep, hot flashes,unhappiness with body appearance, and weight gain. Hot flashes and night sweats were the most bothersome symptoms (Alfano et al., 2006b).
  • A comparison of data from HEAL health and dietary intake surveys showed that diet and quality of life are directly related. Women who scored significantly higher on a mental health summary score reported a healthier diet as compared to those women with a poor diet. Physical health summary scores also were higher for women with healthier diets, though the results were not significant (Wayne et al., 2006).


Bowen DJ, Alfano CM, McGregor BA, Kuniyuki A, Bernstein L, Meeske K, Baumgartner KB, Fetherolf J, Reeve BB, Smith AW, Ganz PA, McTiernan A, Barbash RB. Possible socioeconomic and ethnic disparities in quality of life in a cohort of breast cancer survivors. Breast Cancer Res Treat 2007 Nov;106(1):85-95. [View Abstract]

Meeske K, Smith AW, Alfano CM, McGregor BA, McTiernan A, Baumgartner KB, Malone KE, Reeve BB, Ballard-Barbash R, Bernstein L. Fatigue in breast cancer survivors two to five years post diagnosis: a HEAL Study report. Qual Life Res 2007 Aug;16(6):947-60. [View Abstract]

Alfano CM, McGregor BA, Kuniyuki A, Reeve BB, Bowen DJ, Wilder Smith A, Baumgartner KB, Bernstein L, Ballard-Barbash R, Malone KE, Ganz PA, McTiernan A. Psychometric evaluation of the Brief Cancer Impact Assessment among breast cancer survivors. Oncology 2006a;70(3):190-202. [View Abstract]

Alfano CM, McGregor BA, Kuniyuki A, Reeve BB, Bowen DJ, Baumgartner KB, Bernstein L, Ballard-Barbash R, Malone KE, Ganz PA, McTiernan A. Psychometric properties of a tool for measuring hormone-related symptoms in breast cancer survivors. Psychooncology 2006b Nov;15(11):985-1000. [View Abstract]

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 Apr;96(3):227-32. [View Abstract]

Last modified:
08 Jan 2008
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