Integrating Biological, Clinical, and Behavioral Factors to Improve Breast Cancer Outcomes - Carolina Breast Cancer Study

Patient communication self-efficacy will be measured using the Patient's Communication Perceived Self-Efficacy Scale (PCSS), a validated patient-reported instrument comprising 16 items with a three-factor structure: Provide and Collect Information, Express Concerns and Doubts, and Verify Information. The scale assesses patients' confidence in their ability to communicate effectively with healthcare providers about health concerns, ask questions, express uncertainties, and confirm their understanding. Items are rated on a 5-point Likert scale (1 = not at all confident to 5 = very confident), with total scores ranging from 16 to 80. Higher scores indicate greater perceived communication self-efficacy.

Tumor recurrence will be identified via electronic medical records based on clinical documentation of local, regional, or distant recurrence of the primary cancer. The date and location of recurrence will be recorded using standardized clinical criteria.

Second primary tumors will be identified through electronic medical records and pathology reports. Criteria for classification as a second primary cancer and date of diagnosis will follow standard oncology definitions, distinct from recurrence of the original tumor.

Mortality data, including breast cancer-specific and all-cause mortality, will be collected from electronic medical records and/or linked national death registries. Information will include vital status, cause of death, and date of death.

Time Frame:

Quality of life will be assessed using the Breast (FACT-B) which is a validated, patient-reported outcome measure designed to assess quality of life in individuals with breast cancer. It combines the general FACT-G (Functional Assessment of Cancer Therapy - General) questionnaire with a breast cancer-specific subscale. The tool evaluates five domains: physical well-being, social/family well-being, emotional well-being, functional well-being, and additional concerns specific to breast cancer. The FACT-B consists of 37 items, combining the 27-item FACT-G (general quality of life) and a 10-item Breast Cancer Subscale (BCS). Each item is rated on a 5-point Likert scale from 0 (not at all) to 4 (very much). Higher scores indicate better quality of life.

Quality of life will be assessed using the EORTC QLQ-C30 is a cancer-specific instrument with 30 questions which incorporates 9 multi-item scales: 5 functional scales (physical, role, cognitive, emotional, and social); 9 symptom scales (fatigue, pain, nausea and vomiting, dyspnea, insomnia, appetite loss, constipation, diarrhea and financial difficulties); and a global health and quality-of-life scale. Most questions used 4 point scale (1 'Not at all' to 4 'Very much'); 2 questions used 7-point scale (1 'very poor' to 7 'Excellent'). The scores of these scales were averaged from the scores of the component items, transformed and analyzed on a 0 - 100 scale. A higher score=better level of functioning or greater degree of symptoms.