---
title: "Metastatic Breast Cancer Quality of Life: Effects of Symptom Fluctuations and Positive Affect"
id: "pubmed-42811801"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42811801"
content_type: "clinical_feed_article"
specialty: "Oncology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42811801/"
doi: "10.1002/cam4.72338"
published_at: "2026-10-01T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Metastatic Breast Cancer Quality of Life: Effects of Symptom Fluctuations and Positive Affect
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42811801
- **Specialty:** [Oncology](https://medichelpline.com/clinical-feed/oncology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42811801/)
- **DOI:** [10.1002/cam4.72338](https://doi.org/10.1002%2Fcam4.72338)
- **Published At:** 2026-10-01T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This study used ecological momentary assessment (EMA) to measure day-to-day **quality of life (QoL)**, symptom severity, and **positive affect** in adults with metastatic breast cancer (MBC). - Participants (N = 108; mean age 57.8 years) were recruited from five Mid-Atlantic sites between 2023 and 2024 and completed 12 EMAs over 4 weeks. - EMAs assessed global QoL, nine symptom domains (including depression, anxiety, pain, fatigue, slowed cognition, appetite loss, nausea, gastrointestinal distress, decreased libido), and three positive affect items (social connection, peace, joy). - Multilevel mixed-effects models separated **between-person** effects (differences across individuals) from **within-person** effects (fluctuations within the same individual over time). - Between-person findings: individuals reporting more **nausea** had worse QoL and individuals reporting less **joy** had worse QoL (statistically significant associations reported). - Within-person findings: when a person experienced higher-than-usual **depression**, **anxiety**, **fatigue**, **appetite loss**, or **decreased libido**, QoL was lower; when they reported higher-than-usual **social connectedness**, **joy**, or **peace**, QoL was higher. - QoL was not associated with years since MBC diagnosis in the analyses reported. - Baseline characteristics associated with higher estimated QoL at MBC diagnosis included older age and being partnered; being employed at baseline was associated with positive changes in QoL per year since diagnosis. - The abstract and available text report effect sizes and p-values for multiple associations; parts of the results text were truncated in the source and some detail was not reported there. - The study highlights the importance of tracking both symptom burdens and positive affect in daily life to understand QoL variation in adults with **metastatic breast cancer**.
## Clinical Analysis & Structured Key Points
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Quality of Life in Adults With Metastatic Breast Cancer: The Impact of Between- and Within-Person Changes in Symptoms and Positive Affect [Brenna Mossman](https://pubmed.ncbi.nlm.nih.gov/?term=Mossman+B&cauthor_id=42811801)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#full-view-affiliation-1 "Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA."), [Brent J Small](https://pubmed.ncbi.nlm.nih.gov/?term=Small+BJ&cauthor_id=42811801)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#full-view-affiliation-2 "School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA."), [Elizabeth L Addington](https://pubmed.ncbi.nlm.nih.gov/?term=Addington+EL&cauthor_id=42811801)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#full-view-affiliation-3 "Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA."), [Judith Tedlie Moskowitz](https://pubmed.ncbi.nlm.nih.gov/?term=Moskowitz+JT&cauthor_id=42811801)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#full-view-affiliation-3 "Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA."), [Mikaela A Velazquez-Sosa](https://pubmed.ncbi.nlm.nih.gov/?term=Velazquez-Sosa+MA&cauthor_id=42811801)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#full-view-affiliation-1 "Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA."), [Jennifer D Rodriguez](https://pubmed.ncbi.nlm.nih.gov/?term=Rodriguez+JD&cauthor_id=42811801)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#full-view-affiliation-1 "Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA."), [Aigner Bobbitt](https://pubmed.ncbi.nlm.nih.gov/?term=Bobbitt+A&cauthor_id=42811801)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#full-view-affiliation-4 "John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA."), [Alene Mathurin](https://pubmed.ncbi.nlm.nih.gov/?term=Mathurin+A&cauthor_id=42811801)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#full-view-affiliation-4 "John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA."), [Lesley Glenn](https://pubmed.ncbi.nlm.nih.gov/?term=Glenn+L&cauthor_id=42811801)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#full-view-affiliation-5 "Patient Author, Project Life Metastatic Breast Cancer, Calabasas, California, USA."), [Shontè Drakeford](https://pubmed.ncbi.nlm.nih.gov/?term=Drakeford+S&cauthor_id=42811801)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#full-view-affiliation-6 "Patient Author, Upper Marlboro, Maryland, USA."), [Roxana Guerra](https://pubmed.ncbi.nlm.nih.gov/?term=Guerra+R&cauthor_id=42811801)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#full-view-affiliation-7 "Patient Author, Washington, District of Columbia, USA."), [Claudine Isaacs](https://pubmed.ncbi.nlm.nih.gov/?term=Isaacs+C&cauthor_id=42811801)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#full-view-affiliation-1 "Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA."), [Ami Chitalia](https://pubmed.ncbi.nlm.nih.gov/?term=Chitalia+A&cauthor_id=42811801)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#full-view-affiliation-8 "MedStar Washington Hospital Center, Washington, District of Columbia, USA."), [Christopher Gallagher](https://pubmed.ncbi.nlm.nih.gov/?term=Gallagher+C&cauthor_id=42811801)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#full-view-affiliation-8 "MedStar Washington Hospital Center, Washington, District of Columbia, USA."), [Deena Graham](https://pubmed.ncbi.nlm.nih.gov/?term=Graham+D&cauthor_id=42811801)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#full-view-affiliation-4 "John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA."), [Nina Kadan-Lottick](https://pubmed.ncbi.nlm.nih.gov/?term=Kadan-Lottick+N&cauthor_id=42811801)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#full-view-affiliation-1 "Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA."), [Suzanne C O'Neill](https://pubmed.ncbi.nlm.nih.gov/?term=O%27Neill+SC&cauthor_id=42811801)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#full-view-affiliation-1 "Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA."), [Claire C Conley](https://pubmed.ncbi.nlm.nih.gov/?term=Conley+CC&cauthor_id=42811801)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#full-view-affiliation-1 "Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA.") Affiliations Expand ### Affiliations * 1 Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA. * 2 School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. * 3 Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. * 4 John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA. * 5 Patient Author, Project Life Metastatic Breast Cancer, Calabasas, California, USA. * 6 Patient Author, Upper Marlboro, Maryland, USA. * 7 Patient Author, Washington, District of Columbia, USA. * 8 MedStar Washington Hospital Center, Washington, District of Columbia, USA. * PMID: **42811801** * DOI: [ 10.1002/cam4.72338 ](https://doi.org/10.1002/cam4.72338) Item in Clipboard # Quality of Life in Adults With Metastatic Breast Cancer: The Impact of Between- and Within-Person Changes in Symptoms and Positive Affect Brenna Mossman et al. Cancer Med. 2026 Oct. Show details Display options Display options Format Abstract PubMed PMID Cancer Med Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Cancer+Med%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Cancer+Med%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42811801/) . 2026 Oct;15(10):e72338. doi: 10.1002/cam4.72338. ### Authors [Brenna Mossman](https://pubmed.ncbi.nlm.nih.gov/?term=Mossman+B&cauthor_id=42811801)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#short-view-affiliation-1 "Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA."), [Brent J Small](https://pubmed.ncbi.nlm.nih.gov/?term=Small+BJ&cauthor_id=42811801)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#short-view-affiliation-2 "School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA."), [Elizabeth L Addington](https://pubmed.ncbi.nlm.nih.gov/?term=Addington+EL&cauthor_id=42811801)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#short-view-affiliation-3 "Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA."), [Judith Tedlie Moskowitz](https://pubmed.ncbi.nlm.nih.gov/?term=Moskowitz+JT&cauthor_id=42811801)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#short-view-affiliation-3 "Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA."), [Mikaela A Velazquez-Sosa](https://pubmed.ncbi.nlm.nih.gov/?term=Velazquez-Sosa+MA&cauthor_id=42811801)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#short-view-affiliation-1 "Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA."), [Jennifer D Rodriguez](https://pubmed.ncbi.nlm.nih.gov/?term=Rodriguez+JD&cauthor_id=42811801)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#short-view-affiliation-1 "Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA."), [Aigner Bobbitt](https://pubmed.ncbi.nlm.nih.gov/?term=Bobbitt+A&cauthor_id=42811801)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#short-view-affiliation-4 "John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA."), [Alene Mathurin](https://pubmed.ncbi.nlm.nih.gov/?term=Mathurin+A&cauthor_id=42811801)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#short-view-affiliation-4 "John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA."), [Lesley Glenn](https://pubmed.ncbi.nlm.nih.gov/?term=Glenn+L&cauthor_id=42811801)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#short-view-affiliation-5 "Patient Author, Project Life Metastatic Breast Cancer, Calabasas, California, USA."), [Shontè Drakeford](https://pubmed.ncbi.nlm.nih.gov/?term=Drakeford+S&cauthor_id=42811801)[ 6 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#short-view-affiliation-6 "Patient Author, Upper Marlboro, Maryland, USA."), [Roxana Guerra](https://pubmed.ncbi.nlm.nih.gov/?term=Guerra+R&cauthor_id=42811801)[ 7 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#short-view-affiliation-7 "Patient Author, Washington, District of Columbia, USA."), [Claudine Isaacs](https://pubmed.ncbi.nlm.nih.gov/?term=Isaacs+C&cauthor_id=42811801)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#short-view-affiliation-1 "Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA."), [Ami Chitalia](https://pubmed.ncbi.nlm.nih.gov/?term=Chitalia+A&cauthor_id=42811801)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#short-view-affiliation-8 "MedStar Washington Hospital Center, Washington, District of Columbia, USA."), [Christopher Gallagher](https://pubmed.ncbi.nlm.nih.gov/?term=Gallagher+C&cauthor_id=42811801)[ 8 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#short-view-affiliation-8 "MedStar Washington Hospital Center, Washington, District of Columbia, USA."), [Deena Graham](https://pubmed.ncbi.nlm.nih.gov/?term=Graham+D&cauthor_id=42811801)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#short-view-affiliation-4 "John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA."), [Nina Kadan-Lottick](https://pubmed.ncbi.nlm.nih.gov/?term=Kadan-Lottick+N&cauthor_id=42811801)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#short-view-affiliation-1 "Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA."), [Suzanne C O'Neill](https://pubmed.ncbi.nlm.nih.gov/?term=O%27Neill+SC&cauthor_id=42811801)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#short-view-affiliation-1 "Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA."), [Claire C Conley](https://pubmed.ncbi.nlm.nih.gov/?term=Conley+CC&cauthor_id=42811801)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42811801/#short-view-affiliation-1 "Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA.") ### Affiliations * 1 Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA. * 2 School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. * 3 Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA. * 4 John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, New Jersey, USA. * 5 Patient Author, Project Life Metastatic Breast Cancer, Calabasas, California, USA. * 6 Patient Author, Upper Marlboro, Maryland, USA. * 7 Patient Author, Washington, District of Columbia, USA. * 8 MedStar Washington Hospital Center, Washington, District of Columbia, USA. * PMID: **42811801** * DOI: [ 10.1002/cam4.72338 ](https://doi.org/10.1002/cam4.72338) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract **Introduction:** Quality of life (QoL) is important for patients with metastatic breast cancer (MBC). We examined QoL in daily life among patients with MBC using ecological momentary assessment (EMA). **Methods:** From 2023 to 2024, patients with MBC were recruited from 5 Mid-Atlantic sites. Eligible patients were English- or Spanish-speaking, with a life expectancy > 6 months and access to a smartphone. Participants were invited to complete 12 EMAs over 4 weeks. EMAs assessed global QoL, symptom severity (depression, anxiety, pain, fatigue, slowed cognition, appetite loss, nausea, gastrointestinal distress, decreased libido), and positive affect (social connection, peace, joy). Multilevel mixed-effects models analyzed the relationships between QoL and between-person and within-person variations in symptom severity and positive affect. We also explored associations between QoL and years since MBC diagnosis at the time of study entry. **Results:** Participants (N = 108; Mean age 57.8 years) were a mean of 4.4 years post-diagnosis (range = 0.06-20.65 years). Between-person effects indicated QoL was worse among individuals reporting more nausea (β = -0.109, p = 0.035) and less joy (β = 0.593, p < 0.001). Within-person effects indicated individuals' QoL was lower at times when they had more depression (β = -0.177, p < 0.001), anxiety (β = -0.049, p = 0.023), fatigue (β = -0.052, p = 0.009), appetite loss (β = -0.053, p = 0.028), and decreased libido (β = -0.058, p = 0.036) and less social connectedness (β = 0.091, p = 0.001), joy (β = 0.055, p = 0.047), and peace (β = 0.107, p < 0.001) than their personal average. QoL was not associated with years since MBC diagnosis (β = 0.106, p = 0.956). Age (β = 0.482, p = 0.013) and being partnered (β = 13.356, p = 0.005) at baseline were positively associated with estimated QoL at MBC diagnosis. Changes in QoL per year since MBC diagnosis were positively associated with being employed at baseline (β = 2.453, p < 0.001) and negatively associated with HR posit
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