Scientists in the Netherlands recently conducted a systematic literature review to explore the direct relationship between personality traits and quality of life (QOL) in women with nonmetastatic breast cancer. They were cognizant of the fact that quality of life plays an important role in any disease process, with breast cancer among the most significant diseases for this.1  

A prior review concluded that a relationship exists between health-related quality of life and personality. The review comprised studies of various health profiles including cancer and chronic illnesses, as well as simply aging and healthy. However, limitations of this review were absence of quality and risk of bias assessment in the included studies. The researchers also noted that of 76 studies reviewed only 3 included patients with breast cancer. Therefore, this study explored that relationship with a focus on women with nonmetastatic breast cancer.

For this review, the researchers identified 1983 studies through a search of PubMed, PsycINFO, CINAHL, Web of Science, and Embase databases. Eligible studies assessed the direct relationship between personality and quality of life, involved only women aged 18 years and older with nonmetastatic breast cancer, used validated questionnaires to evaluate personality traits and quality of life, and were published in a peer-reviewed scientific journal.

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The search had no restrictions on publication dates. But an updated search conducted 16 months later with the same criteria limited publication dates to December 2020 to January 2022. After applying exclusion criteria, 12 studies remained for this systematic review.

Influential Personality Traits

The Five Factor Model (FFM) theory was used to conceptualize and measure personality and its traits, defined as “aspects of personality that are relatively stable over time and influence behavior.” The theory has 5 uncorrelated dimensions: agreeableness, conscientiousness, extraversion, neuroticism, and openness to experience; plus subcategories. Each dimension has its own focus. Studies included in this review evaluated the direct relationship between patients’ personality traits and their quality of life. Some significant associations were noted between certain personality traits and patients’ perception of quality of life in several of the included studies.

Optimism Three studies considered the relationship between optimism and quality of life, with all of them finding that women who were optimistic had better quality of life compared with pessimistic women, especially in the domains of mental health, emotional functioning, negative feelings, lack of positive feelings, and sexual impairment.

Neuroticism One study found that higher neuroticism scores predicted poor emotional and cognitive functioning, as well as poor global health status. Another found that 6 months after undergoing any type of surgical procedure, not necessarily breast surgery, patients who scored high on neuroticism scored significantly lower on quality of life.

Self-efficacy In the studies evaluating quality of life and patients’ self-efficacy levels, women who had high self-efficacy levels believed their quality of life was better compared with other study participants. In contrast,there was no significant negative relationship found between self-esteem and mental or physical functioning.

Pessimism As expected, women with high pessimism scores reported significantly worse quality of life compared with those who had high optimistic scores.

Trait anxiety Of the 3 studies that reviewed this personality trait, 1 found that patients in China had significantly higher trait anxiety levels than patients in the United States. Study participants with higher trait anxiety also had worse quality of life. The researchers reported that “all included studies examining the relationship between trait anxiety and [quality of life] found a statistically significant correlation between trait anxiety and each of the QOL domains, as well as overall [quality of life].”

The researchers found that women who demonstrate high trait anxiety may find some circumstances overly threatening or stressful with a negative effect on their quality of life — as is true for many women with high levels of neuroticism. These results stand in contrast with those of women with nonmetastatic breast cancer who have high levels of optimism, self-efficacy, or self-esteem, and therefore an attendant better quality of life.


Wintraecken VM, Vulik S, de Wild S, et al. A descriptive systematic review of the relationship between personality traits and quality of life of women with non-metastatic breast cancer. BMC Cancer. 2022;22(1):426. doi:10.1186/s12885-022-09408-4