A graphical LASSO analysis of global quality of life, sub scales of the EORTC QLQ-C30 instrument and depression in early breast cancer

Paula Poikonen-Saksela, Eleni Kolokotroni, Leena Vehmanen, Johanna Mattson, Georgios Stamatakos, Riikka Huovinen, Pirkko-Liisa Kellokumpu-Lehtinen, Carl Blomqvist, Tiina Saarto, Paula Poikonen-Saksela, Eleni Kolokotroni, Leena Vehmanen, Johanna Mattson, Georgios Stamatakos, Riikka Huovinen, Pirkko-Liisa Kellokumpu-Lehtinen, Carl Blomqvist, Tiina Saarto

Abstract

We aimed to (a) investigate the interplay between depression, symptoms and level of functioning, and (b) understand the paths through which they influence health related quality of life (QOL) during the first year of rehabilitation period of early breast cancer. A network analysis method was used. The population consisted of 487 women aged 35-68 years, who had recently completed adjuvant chemotherapy or started endocrine therapy for early breast cancer. At baseline and at the first year from randomization QOL, symptomatology and functioning by the EORTC QLQ-C30 and BR-23 questionnaires, and depression by the Finnish version of Beck's 13-item depression scale, were collected. The multivariate interplay between the related scales was analysed via regularized partial correlation networks (graphical LASSO). The median global quality of life (gQoL) at baseline was 69.9 ± 19.0 (16.7-100) and improved to 74.9 ± 19.0 (0-100) after 1 year. Scales related to mental health (emotional functioning, cognitive functioning, depression, insomnia, body image, future perspective) were clustered together at both time points. Fatigue was mediated through a different route, having the strongest connection with physical functioning and no direct connection with depression. Multiple paths existed connecting symptoms and functioning types with gQoL. Factors with the strongest connections to gQoL included: social functioning, depression and fatigue at baseline; emotional functioning and fatigue at month 12. Overall, the most important nodes were depression, gQoL and fatigue. The graphical LASSO network analysis revealed that scales related to fatigue and emotional health had the strongest associations to the EORTC QLQ-C30 gQoL score. When we plan interventions for patients with impaired QOL it is important to consider both psychological support and interventions that improve fatigue and physical function like exercise.Trial registration: http://www.clinicaltrials.gov/ (identifier number NCT00639210).

Conflict of interest statement

The authors declare no competing interests.

© 2022. The Author(s).

Figures

Figure 1
Figure 1
Networks constructed via graphical LASSO visualizing the regularized partial correlations between global health/QoL, symptoms, functioning and depression, measured by EORTC-QLQ C30, EORTC-QLQ B23 and BDI questionnaires, at baseline and 12-month follow up. Green edges represent positive partial correlations and red edges negative ones. Thicker and more saturated edges represent stronger partial correlations. Edges with absolute weight above 0.05 are displayed. The distance between two nodes reflects the absolute edge weight between them (Fruchterman–Reingold layout). All edge weights are reported in Supplement Table 3. The depression score and the symptom scores have been reversed to follow the functioning scales interpretation, i.e. higher score indicates a lower level of symptoms and a better state of the patient.
Figure 2
Figure 2
Centrality plots for graphical LASSO networks at baseline and 12 month follow up. The strength, closeness and betweenness of each node are depicted as standardized z-scores. Abbreviations: gQoL: Global Quality of Life, PF: Physical functioning, RF: Role functioning, SF: Social functioning, CF: Cognitive functioning, EF: Emotional functioning, BDI: Depression score, Ftg: Fatigue, Ftr: Future perspective, Body: Body image, Pain: Pain, SdE: Systemic therapy side effects, Ins: Insomnia, Arm: Arm symptoms, Fnn: Financial Difficulties.
Figure 3
Figure 3
Difference network. Each edge corresponds to the difference in the absolute value of edge weights between the baseline and month 12. Green lines represent an increase in the absolute value of edge weight from baseline to month 12 and red lines a decrease. Thicker and more saturated lines represent a higher difference. Differences of absolute value above 0.04 are displayed.

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