Longitudinal changes in health‐related quality of life after a breast cancer diagnosis in sub‐Saharan Africa: Evidence from the prospective <scp>ABC</scp> ‐ <scp>DO</scp> cohort

Breast cancer and its treatments impact on women's health-related quality of life, but few studies have assessed these outcomes among survivors in sub-Saharan Africa (SSA). We investigated longitudinal changes in Global Health Status (GHS) and their correlates within the African Breast Cancer-Disparities in Outcomes cohort. Newly diagnosed women (≥18 years) across five SSA countries were recruited in 2014-2017. In four countries, follow-up interviews were conducted 3-monthly over 7 years using the European Organisation for Research and Treatment of Cancer Quality of Life 30-item core questionnaire version 3. Multilevel mixed-effects models identified correlates of GHS. Overall, 1358 women from Namibia, Nigeria, Uganda and Zambia were included, with a mean age of 50.6 (SD = 13.7) years. Median follow-up time was 3 (IQR = 2-5) years, with a median of 18 GHS assessments per woman (IQR = 10-23). GHS was lowest in the first 6 months post-diagnosis but improved gradually thereafter. GHS increased with increasing education (p-value for linear trend [p_t] < .0001), breast cancer awareness (adjusted-odds ratio: 1.32; 95% confidence interval 1.22-1.42), surgical treatment (1.90; 1.53-2.37), family support (1.46; 1.24-1.71) and maintaining pre-diagnosis employment (1.54; 1.41-1.68). In contrast, GHS decreased with increasing age at diagnosis (p_t <.0001), rural residence (0.76; 0.70-0.82), advanced tumour stage at diagnosis (p_t <.0001) and having non-HIV comorbidities (0.74; 0.60-0.92). GHS was not affected by HIV status, but it was higher during COVID-19 lockdowns than pre-/post-lockdown (1.27; 1.09-1.49). These patterns were similar at young and older ages, and in the short- and long-term. The potentially modifiable factors associated with GHS are known to influence breast cancer survival in SSA. Addressing them could improve survivorship and survival from this cancer in the region.