Self-esteem and quality of life in women with breast cancer before and after chemotherapy

Background

Breast cancer and its treatment impose a substantial psychosocial burden, affecting quality of life (QoL) and mental well-being. Self-esteem is an important psychological resource that may influence how patients cope with disease and treatment. This study aimed to assess changes in self-esteem in women undergoing neoadjuvant chemotherapy and its relationship with QoL across the treatment trajectory.

Methods

A prospective observational study was conducted among 211 women with breast cancer treated with neoadjuvant chemotherapy. Self-esteem was assessed using the Rosenberg Self-Esteem Scale, and QoL using EORTC QLQ-C30 and EORTC QLQ-BR23. Measurements were performed before and three weeks after treatment. Associations between self-esteem and QoL domains, including changes over time, were analysed using Spearman’s rank correlation coefficients.

Results

Self-esteem was significantly associated with all QoL domains (p < 0.05) before and after chemotherapy. Higher QoL was consistently linked to higher self-esteem, while greater symptom burden was associated with lower self-esteem. Correlations were moderate (|rS|≤0.50), consistent with psychometric measures. The strongest associations were observed for emotional functioning (rS = 0.49 post-treatment) and symptoms such as nausea, pain, and dyspnoea (up to − 0.44). Changes in self-esteem were significantly correlated with changes in QoL, indicating that deterioration in QoL is accompanied by declines in psychological well-being. These patterns were consistent across both general and breast cancer-specific domains.

Conclusions

Self-esteem is closely associated with both general and disease-specific QoL in women undergoing chemotherapy for breast cancer. These findings highlight the importance of addressing psychological resources in cancer care and support integrating structured psychosocial interventions, including those targeting self-esteem, to improve patient-reported outcomes.

Key messages

• Self-esteem is consistently associated with both general and disease-specific quality of life in women undergoing chemotherapy for breast cancer.

• Integrating structured psychosocial support, including self-esteem–focused interventions, into cancer care may improve patient-reported outcomes.