Quality of life in long-term breast cancer survivors in Sub-Saharan Africa: the African Breast Cancer-Disparities in Outcomes study.

Purpose: In Sub-Saharan Africa (SSA), breast cancer survivors' (BCS) quality of life (QoL) remains understudied. We compared QoL in BCS to cancer-free (CF) women across SSA settings with different levels of development, healthcare systems, ethnic compositions, and HIV prevalence.

Methods: In 2022-2023, all 5 + year BCS from the African Breast Cancer-Disparities in Outcomes study and age-matched CF women from the community setting answered the WHOQOL-BREF questionnaire in Namibia, Nigeria, and Uganda. For each WHOQOL-BREF domain and general item, we estimated BCS-CF adjusted mean differences (AMD) in scores in absolute percentage points (p.p.).

Results: Overall, 862 women (BCS 357 vs. CF 505) (mean age ± SD, 57.5 ± 12.5 vs. 55.1 ± 11.2; tertiary education, 30% vs. 20%) were included. BCS reported higher/better overall QoL (AMD (95% CI) 10.65 p.p. (7.56, 13.74), i.e., ~ 40% of a change in QoL category), general health (5.84 (2.71, 8.98)), psychological (3.46 (1.43, 5.49)), social relationships (3.94 (1.25, 6.63)), and environment scores (4.27 (1.88, 6.67)) than CF women. There was no BCS-CF difference for physical health in all settings (1.52 (- 0.82, 3.87)), psychological health in Namibian Black women (0.58 (- 2.90, 4.06)), and social relationships in Nigeria (- 0.33 (- 5.81, 5.14)). BCS reported both lower energy and sexual life satisfaction than CF women.

Conclusions: In SSA, long-term BCS have slightly better QoL than CF women except for physical health. Areas for which BCS scored lower or similar than CF women may indicate BCS' QoL issues.

Implications For Cancer Survivors: BCS-only studies using cancer-specific QoL questionnaires are needed to better characterize BCS' QoL in SSA.