Relationship between time elapsed since completion of radiotherapy and quality of life of patients with breast cancer

Abstract

BackgroundTo investigate the relationship between time elapsed since completion of radiotherapy (RT) and quality of life (QOL) of patients with breast cancer.MethodsA total of 300 patients with breast cancer were treated at the First Affiliated Hospital of Anhui Medical University between January 2013 and April 2016. Of these, 212 patients were included in the study. Patients were divided into 4 groups based on the time elapsed since completion of RT. The generic cancer questionnaire, EORTC QLQ-30, and the breast cancer-specific questionnaire, QLQ-BR23, were used to assess the QOL.ResultsAnalysis of time elapsed since completion of RT and QOL revealed changes in the scores for role function with passage of time; the third year’s scores were the highest. Pain symptoms during the 3rd and 4th years after RT were lower than those during the 1st and 2nd years after RT; scores for financial difficulties fluctuated with passage of time; perception of own body scores improved within first 3 years; sexual activity and enjoyment of sexual activity showed a significant decrease during the 2nd to 4th year post RT. Scores pertaining to concerns about future state of health showed a significant increase during the 2nd to 4th year after RT, while breast symptoms score showed fluctuations with passage of time.ConclusionsSocial function, pain symptoms, and concerns about future state of health tended to improve with passage of time after RT. Other scales showed no correlation with time elapsed since completion of RT.

Quality of life after simultaneously integrated boost with intensity-modulated versus conventional radiotherapy with sequential boost for adjuvant treatment of breast cancer: 2-year results of the multicenter randomized IMRT-MC2 trial

“…However, there were some patient related factors like body mass index and breast size, that influenced the occurrence of moist desquamation as well [28]. For arm symptoms after radiotherapy in breast cancer patients, no significant changes over time were reported by others [25,26,29]. This is in line with the present study, demonstrating differences for arm symptoms between the two study arms, but no significant changes over time.…”

“…In breast cancer survivors, it is well documented that radiotherapy may increase pain symptoms and that pain symptoms are significantly associated with poorer QoL [24]. Patient-reported pain after radiotherapy and the recovery of pain scores over time during follow-up, as seen in the 3-D-CRT-seqB group, was also confirmed by others [25][26][27]. Moist desquamation may be one reason for pain after radiotherapy of the breast, and seems to appear more often and to last longer in patients treated with standard radiotherapy compared to IMRT: In a multicenter, randomized clinical trial of Pignol et al testing the potential impact of IMRT on reducing acute skin reaction in comparison to standard wedge radiotherapy, the use of IMRT resulted in a significantly decreased risk of moist desquamation, which was associated with less pain.…”

“…The decrease in functioning scores after radiotherapy, seen in both treatment arms was confirmed by the results of Versmessen et al [29]. However, after a more extended follow-up these impairments of functioning scores are also expected to recover, as demonstrated by Zhang et al in a cross-sectional analysis of 212 breast cancer patients [25]. Furthermore, scores for role functioning and social functioning may also be influenced by impaired cosmesis after surgery or by endocrine therapy.…”

The Role of Response-Shift in Studies Assessing Quality of Life Outcomes Among Cancer Patients: A Systematic Review

“…Only four, of the 35, studies assessed the time elapsed between diagnosis and first/baseline testing and controlled for it in their analyses (28, 29, 33, 47). Future studies should consider controlling for this important factor in their analyses as this information has considerable relevance for quality of life outcomes due to expected consequences of specific treatments and for efforts to identify the expected rehabilitative needs of cancer survivors (50).…”

“…Given that the relationship between social support and QoL is well-established (51–54), where social support is associated with improved QoL and is shown to influence the patients' level of perceived distress related to their cancer diagnosis, which in turn may alter their evaluation of their outcomes, future studies should consider controlling for its contribution to the presence or absence of response shift in patient reported outcomes (12, 51–54). Other important factors such as cancer type (found to be a statistically significant contributor in one of the three studies that reported it) and stage (a significant contributor in one of the five studies who examined it), the presence of comorbidities (found significant in two of the three studies who assessed it), occupation (evaluated in two studies), and marital status (found to be statistically significant in two of three studies who evaluated it) which have been documented to be associated with QoL outcomes among various cancer types, should be considered as possible confounds and included in future studies evaluating response shift given their considerable relevance to QoL outcomes among cancer patients due to efforts to identify modifiable and non-modifiable life factors in better survivorship (50). Lastly, we note the lack of standardization in the measurement and reporting of response shift in the studies reviewed here.…”