A1 Refereed original research article in a scientific journal
Network analysis of quality of life and depression in a randomized breast cancer trial with ten-years follow-up; 
Authors: Hampf, Sofia; Kolokotroni, Eleni; Blomqvist, Carl; Hakamies-Blomqvist, Liisa; Stamatakos, Georgios; Huovinen, Riikka; Kellokumpu-Lehtinen, Pirkko-Liisa; Saarto, Tiina; Poikonen-Saksela, Paula
Publisher: Springer Nature
Publication year: 2026
Journal: Scientific Reports
eISSN: 2045-2322
DOI: https://doi.org/10.1038/s41598-026-51322-3
Publication's open availability at the time of reporting: Open Access
Publication channel's open availability : Open Access publication channel
Web address : https://doi.org/10.1038/s41598-026-51322-3
Due to the growing amount of breast cancer survivors we must understand their long-term quality of life (QoL) better. Many breast cancer survivors suffer for years from lower functioning capacity and several symptoms, but outcomes regarding their global Quality of Life (gQoL) are less clear. The current study explored the links between functions, symptoms, and gQoL using a network design. We used data from 364 women who had completed adjuvant chemotherapy or started adjuvant endocrine therapy. QoL, symptomatology and functioning were measured by the EORTC QLQ‐C30 and BR‐23 questionnaires, and depression by the Finnish version of Beck’s 13‐item depression scale. The multivariate inter-dependence between the symptom scales and gQoL was analyzed via regularized partial correlation networks (graphical LASSO). These networks identify associations, not directionality or causality. Our aim was to explore how the functions and symptoms associate with each other and with gQoL during ten-year follow-up, and to identify the most important scales in the network using centrality analysis. The results showed that three key areas—fatigue and physical functioning, emotional functioning and depression, and social and role functioning—emerged as most central to gQoL across all time points. Interventions targeting these areas may therefore have the greatest potential to improve long-term QoL in breast cancer survivors.
Keywords:
breast cancer survivors, depression, EORTC QLQ-C30, network analysis, quality of life
Funding information in the publication:
BREX trial was supported by the Finnish Breast Cancer Group and Cancer Society of Finland. The funders didn’t have any role in the trial design, analyses or reporting the results. Open access funded by Helsinki University Library.