Abstract
OBJECTIVE: To analyze the relationship between negative affectivity and work and social repercussions in female breast cancer survivors in Spain, assessing its impact on quality of life. DESIGN: Multicenter, cross-sectional study using a self-administered online questionnaire (Quality of Life in Adult Cancer Survivors, QLACS). SETTING: Spain, between June 2024 and February 2025. PARTICIPANTS: 1,293 women aged 18 years and older, breast cancer survivors, who had completed primary treatment (surgery, radiotherapy, and/or chemotherapy) and were disease-free at the time of the study. MAIN MEASUREMENTS: «Negative affectivity» domain (primary variable): Assessed using a 7-point Likert scale (1: never to 7: always). Work-related repercussions: To determine whether women considered they had been «forced» to leave work or be fired due to cancer and its relationship with the primary outcome. Correlation between negative affectivity and social avoidance, financial problems, lifestyle habits (tobacco, alcohol, ultra-processed foods), and physical symptoms (pain, fatigue, cognitive problems) and their relationship based on the type of treatment received. RESULTS: Negative affectivity had a median of 4.3 points («almost always»). Work-related repercussions (forced to leave work in 15.4% or to be fired in 7.9%) were significantly associated with greater negative affectivity (Kruskal-Wallis=46.9; p <0.001), although the effect size was small (ɛ(2)=0.0447). Social avoidance showed a moderate correlation with negative affectivity (Pearson's r=0.628; p <0.001), explaining 39.5% of the variability in social avoidance. Financial problems were moderately correlated with negative affectivity (Spearman's=0.319; p <0.001). LIFESTYLE HABITS: Negative affectivity increased the likelihood of tobacco use (OR=1.35; 95% CI: 1.05-1.74) and ultra-processed food use (OR=1.228; 95% CI: 1.121-1.345), but reduced alcohol consumption (OR=0.769 for>4 times/week; p=0.018). PHYSICAL SYMPTOMS: Moderate correlations with pain (Kendall=0.507), fatigue (Kendall=0.471), and cognitive problems (Kendall=0.416; all p <0.001). Hormone therapy: It was the only treatment significantly associated with negative affectivity (Mann-Whitney U=179,415; p=0.032), although with minimal clinical effect (r=0.0715). CONCLUSIONS: Breast cancer survivors in Spain present high levels of negative affectivity, significantly associated with work-related impacts, social avoidance, and financial problems. It is also significantly associated with pain and cognitive problems and whether they have received hormone therapy. These findings underscore the need for multidisciplinary follow-up in primary care, addressing psychological, occupational, and social dimensions to improve survivors' quality of life and lifestyle.