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  • A total of 6188 female breast cancer survivors were recruited from affiliated groups of Cancer Recovery Clubs in 34 cities across China. These Clubs are non-governmental organizations aiming to improve health and QOL of patients with different kinds of cancer in China. Participants fitting the following criteria were included in this study: (1) being a primary breast cancer, (2) active treatment completed, (3) having reading ability, and (4) free from mental disorders. A written Informed Consent was obtained from every participant and the study protocols were reviewed and proved by the Ethic Committee of Public Health School of Fudan University (protocol number RB #2013-04-0450). Information on diabetes including T1DM and T2DM was collected by self-reported questionnaires and was confirmed by physicians in ≥level 2 hospitals and health records. Measurement of Quality of Life (QOL) and the global health status (QL): The QOL was measured by the simplified Chinese version of the Quality of Life Questionnaire-Core 30(EORTC QLQ-C30) and the Quality of Life Questionnaire-Breast Cancer Module 23 (QLQ-BR23). The EORTC QLQ-C30 consists of five functional dimensions, three symptom dimensions, a global health status (QL), and six signal items, totaling 30 items. With 23 items, QLQ-BR23 is composed of four functional dimensions and four symptom dimensions. The original scores of each dimension were transformed into standard scores with a range of 0~100. The standard scores of functional and general health dimensions positively represented patients’ QOL, meanwhile the scores of symptom dimension negatively represented QOL. Higher scores for the functional scales represent a higher level of functioning and higher scores for the symptoms represent a greater extent of symptoms. The global health status (QL) scale was used as the overall summary measure. A high score for the QL represents a high QOL. QL are 7-point questions with range = 6.The level of self-assessed QL helps in predicting survival, which is especially important among survivors to improve the QOL. Data were analyzed with the Statistical Package for the Social Sciences (SPSS) for Windows (Version19.0). Participants’ characteristics and QOL were presented as percentages for categorical variables and mean ± standard deviation for continuous variables. Differences in terms of age, body mass index (BMI), years since diagnosis as well as QOL were analyzed using unpaired t-tests. Univariate analyses of covariance (ANCOVA) and multiple linear regression models were used to examine the effects of diabetes on different domains of QOL after controlling for age, BMI, education, household income, tumor characteristics (tumor size, regional lymph node metastasis, distant metastasis), and breast cancer treatment history. Statistical inferences were two-sided and P <0.05 was considered as statistical significant.
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