Quality of Life Outcomes in Breast Cancer Patients Receiving Chemotherapy With or Without Radiation Therapy

Ryan T Morse; Nathan W Bean; Jacob Hall; Allison Deal; Kirsten A Nyrop; Yara Abdou; Elizabeth C Dees; Emily M Ray; Trevor A Jolly; Katherine E Reeder-Hayes; Ellen Jones; Gaorav P Gupta; Shekinah Elmore; Hyman B Muss; Dana L Casey

doi:10.1016/j.clbc.2024.08.015

Quality of Life Outcomes in Breast Cancer Patients Receiving Chemotherapy With or Without Radiation Therapy

Clin Breast Cancer. 2024 Aug 30:S1526-8209(24)00228-3. doi: 10.1016/j.clbc.2024.08.015. Online ahead of print.

Authors

Affiliations

¹ Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC. Electronic address: rtmmqc@gmail.com.
² Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC.
³ Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC.
⁴ Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC.
⁵ Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC.

PMID: 39317637
DOI: 10.1016/j.clbc.2024.08.015

Abstract

Purpose: Understanding quality of life (QOL) implications of individual components of breast cancer treatment is important as systemic therapies continue to improve oncologic outcomes. We hypothesized that adjuvant radiation therapy does not significantly impact QOL domains in breast cancer patients undergoing chemotherapy.

Methods: Data was drawn from three prospective studies in women with localized breast cancer being treated with chemotherapy from March 2014 to December 2019. Patient-reported measures were collected at baseline (pretreatment) and post-treatment using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) measure, which consists of 5 subscales. Changes in mean QOL scores in patients who received radiotherapy were compared to those who did not using a one-sided noninferiority method. Statistical significance was determined below 0.05 to meet noninferiority.

Results: In a sample of 175 patients, 131 were treated with radiation and 44 had no radiation. The sample consisted mostly of stage I-II breast cancer (78%) with hormone receptor positive (59%) disease, receiving either neoadjuvant (36%) or adjuvant chemotherapy (64%). Mean change in QOL for the group treated with radiation compared to no radiation was noninferior with respect to Physical Well-Being (P = .0027), Social/Family Well-Being (P = .0002), Emotional Well-Being (P = .0203), FACIT-Fatigue Subscale (P = .0072), and the Total FACIT-F score (P = .0005); however, mean change in QOL did not meet noninferiority for Functional Well-Being (P = .0594).

Conclusion: Patient-reported QOL from baseline to post-treatment, using the Total FACIT-F score, was noninferior in patients treated with versus without radiation therapy. This finding, in addition to individualized QOL subscales, provides important information in the informed decision-making process when discussing the effects of locoregional radiation on QOL in localized breast cancer patients treated with chemotherapy.

Keywords: Fatigue; Informed decision-making; Patient reported outcomes; Radiation side effects; Well-being.

Published by Elsevier Inc.