Association between Socioeconomic Status and Altered Appearance Distress, Body Image, and Quality of Life Among Breast Cancer Patients

Background: Breast cancer patients experience a variety of altered appearance - such as loss or disfigurementof breasts, discolored skin, and hair loss - which result in psychological distress that affect their quality of life.This study aims to evaluate the impact of socioeconomic status on the altered appearance distress, body image,and quality of life among Korean breast cancer patients. Materials and
Methods: A cross-sectional survey wasconducted at advocacy events held at 16 different hospitals in Korea. Subjects were eligible to participate ifthey were 18 years of age or older, had a histologically confirmed diagnosis of breast cancer, had no evidence ofrecurrence or metastasis, and had no psychological problems at the time of the survey. Employment status, maritalstatus, education, and income were assessed for patient socioeconomic status. Altered appearance distress wasmeasured using the NCI’s cancer treatment side effects scale; body image and quality of life were measured by theEORTC QLC-C30 and BR23. Means and standard deviations of each outcome were compared by socioeconomicstatus and multivariate linear regression models for evaluating the association between socioeconomic statusand altered appearance distress, body image, and quality of life.
Results: A total of 126 breast cancer patientsparticipated in the study; the mean age of participants was 47.7 (SD=8.4). Of the total, 83.2% were married,85.6% received more than high school education, 35.2% were employed, and 41% had more than $3000 inmonthly household income. About 46% had mastectomy, and over 30% were receiving either chemotherapy orradiation therapy at the time of the survey. With fully adjusted models, the employed patients had significantlyhigher altered appearance distress (1.80 vs 1.48; p<0.05) and poorer body image (36.63 vs 51.69; p<0.05)compared to the patients who were unemployed. Higher education (10.58, standard error (SE)=7.63) and familyincome (12.88, SE=5.08) was positively associated with better body image after adjusting for age, disease stage atdiagnosis, current treatment status, and breast surgery type. Similarly, patients who were married and who hadhigher education had better quality of life were statistically significant in the multivariate models.
Conclusions:Socioeconomic status is significantly associated with altered appearance distress, body image, and quality of lifein Korean women with breast cancer. Patients who suffer from altered appearance distress or lower body imageare much more likely to experience psychosocial, physical, and functional problems than women who do not,therefore health care providers should be aware of the changes and distresses that these breast cancer patientsgo through and provide specific information and psychosocial support to socioeconomically more vulnerablepatients.