Mammography Adherence and Quality of Life among Korean Breast Cancer Survivors

For survivors of breast cancer, follow-up mammography screening is crucial for early detection of cancer recurrence. Despite its importance, however, follow-up mammography screening rates have been decreasing in Western countries. In Korea, no research studies have examined screening adherence among breast cancer survivors, as previous researchers have addressed only routine mammography among healthy women and comprehensive screening for multiple cancers in cancer survivors. Moreover, the potential influence of symptoms and quality of life (QOL) on screening adherence remain unexplored. For these reasons, investigation of factors influencing survivor adherence behaviors in Korea is urgently needed. The purpose of the cross-sectional quantitative study described in this dissertation was to identify the multiple possible factors influencing mammography screening adherence in Korean breast cancer survivors. The study had two specific aims. Aim 1 was to describe the prevalence and severity of survivors’ main symptoms (anxiety, depression, fatigue, sleep disturbance, cognitive impairment, and distress) and their QOL as well as to evaluate potential relationships between symptoms and QOL. Aim 2 was to examine the potential relationships of multiple factors (individual characteristics, symptoms, QOL, cognitive appraisal, social support, and health care factors and access) to mammography screening adherence among survivors. The study sample of 199 breast cancer survivors was recruited from among women visiting the breast cancer clinic of Yonsei Medical Center in Seoul, Korea, and/or participating in hospital-based breast cancer support groups. Each participant completed a self-administered multi-questionnaire survey that provided the data for the study. This dissertation presents the findings of the study in three chapters. The first chapter described the model guiding in study and the aims. The second chapter describes the prevalence and severity of the main symptoms experienced by survivors (anxiety, depression, fatigue, sleep disturbance, cognitive impairment, and distress) as well as survivors’ QOL; moreover, this chapter examines potential relationships between symptoms and QOL. Among the findings for Aim 1, breast cancer survivors experienced high prevalence and severity of physical fatigability (71.1%), psychological distress (67.8%), anxiety (47.2%), poor sleep quality (38.7%), and depression (36.7%). Also, depression, physical fatigability, and cognitive impairment were found to have significant negative effects on their QOL. The final model fit statistics were significant at F(3, 182) = 43.42, p<.001, with 41% of the variance in QOL being explained by the three predictors. The third chapter examines the potential relationships of multiple factors (individual characteristics, symptoms, QOL, cognitive appraisal, social influences, and health care factors and access) to mammography screening adherence. For Aim 2, ordinal logistic regression analysis revealed that time since breast cancer diagnosis, depression, social support, and healthcare service utilization were significant predictors of mammography screening adherence. The full model (all 29 variables) fit statistics were significant at χ2 = 79.572, p<.001, with 76% (Nagelkerke R-square) of the variance in mammography screening adherence being explained by the four predictors. The study findings provide greater understanding of factors influencing mammography screening adherence and QOL among Korean breast cancer survivors. Based on the findings for Aim 1, even long-term breast cancer survivors continue to suffer from various symptoms. Given the fact that depression was the symptom found to be the strongest predictor for QOL, nursing professionals should make efforts to develop and implement interventions for depression in breast cancer survivors to enhance their QOL. The results for Aim 2 indicate that to identify ways of overcoming obstacles to compliance with mammography screening recommendations, researchers and health care providers may wish to apply an ecological perspective to comprehensively assess individual, social, and health care system factors. In partially filling the current research gap, the study findings will contribute to identification of health promotion strategies for promoting mammography screening adherence, enhancing QOL, and consequently improving breast cancer survivorship.