Psychosocial Distress, Physical Symptoms, Resilience and Health-Related Quality of Life in Women with Metastatic Breast Cancer

Date of Award

Fall 1-1-2025

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Advisor

Knobf, Tish

Abstract

Health-related quality of life (HRQOL) is an important patient-reported outcome in women with metastatic breast cancer (MBC). Currently, contemporary systemic therapies (i.e., novel targeted agents and immunotherapy) have improved overall survival among this population. However, women with MBC are underrepresented in breast cancer research. Their physical symptom burden, psychosocial issues, and HRQOL related to novel treatments haven’t been examined outside of clinical trials, and the role of protective factor, like resilience, in mediating adverse effects of both physical symptoms and psychological distress on HRQOL remains understudied. Thus, the purpose of this dissertation study was to examine the associations between physical symptoms, psychological distress, resilience, and HRQOL in women with MBC and explore the role of resilience among these relationships. This dissertation consists of three manuscripts. The first manuscript is an integrative review that summarized current research evidence and influencing factors on HRQOL in patients with MBC over the past ten years, entitled “Health-Related Quality of Life in Women with Metastatic Breast Cancer: An Integrative Review”, and has been published in the Journal of Advanced Nursing. The second manuscript, “Factors Influencing Patient-Reported Symptom Outcomes in Women with Metastatic Breast Cancer”, reported symptom prevalence and severity among 209 women with MBC and identified sociodemographic and clinical correlates of symptom outcomes (i.e., symptom severity, symptom interference, symptom burden). In the third manuscript, we examined the how resilience mediated the associations between physical symptoms, psychosocial distress, and HRQOL in the same sample using structural equation modeling and explored the serial multiple mediation effect via psychological distress and resilience, titled “Symptoms and Health-Related Quality of Life in Women with Metastatic Breast Cancer: The Mediating Role of Resilience”. The findings of this dissertation provide evidence on side effects and symptom outcomes related to novel systemic therapy for MBC and suggest the critical role of resilience as a modifiable factor that may mitigate the negative impact of both physical symptoms and psychological distress on health outcomes. The results provide implications for future interventions aimed at improving symptoms and HRQOL in women with MBC within the context of a paradigm shift in cancer treatment.

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