The effect of adjuvant chemotherapy on symptom burden and quality of life over time; a preliminary prospective observational study using individual data of patients aged ≥ 70 with early stage invasive breast cancer

Quinten, Chantal; Kenis, Cindy; Hamaker, Marije E.; Coolbrandt, Annemarie; Brouwers, Barbara; Lago, Lissandra Dal; Neven, Patrick; Vuylsteke, Peter; Debrock, Guy; Bulck, Hilde Van den; Smeets, Ann; Schöffski, Patrick; Bottomley, Andrew; Wedding, Ulrich; Wildiers, Hans

doi:10.1016/j.jgo.2017.10.001

Cited by 19 publications

(11 citation statements)

References 39 publications

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“…Nonetheless, these analyses have either focused on younger patients, where the risk/benefit ratio is different, or addressed the impact of breast cancer treatments (and not specifically of chemotherapy) on QoL in this age group. Our findings are consistent with a previous study in 109 patients aged 70 or older, of whom 57 received adjuvant docetaxel/cyclophosphamide chemotherapy [36].…”

Section: Discussionsupporting

confidence: 93%

Bridging the Age Gap in breast cancer: Impact of chemotherapy on quality of life in older women with early breast cancer

Battisti

Reed

Herbert

et al. 2021

European Journal of Cancer

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Introduction Older patients with early breast cancer (EBC) derive modest survival benefit from chemotherapy but have increased toxicity risk. Data on the impact of chemotherapy for EBC on quality of life in older patients are limited, but this is a key determinant of treatment acceptance. We aimed to investigate its effect on quality of life in older patients enrolled in the Bridging the Age Gap study. Materials and methods A prospective, multicentre, observational study of EBC patients ≥70 years old was conducted in 2013–2018 at 56 UK hospitals. Demographics, patient, tumour characteristics, treatments and adverse events were recorded. Quality of life was assessed using the European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaires (EORTC-QLQ) C30, BR23 and ELD 15 plus the Euroqol-5D (eq-5d) over 24 months and analysed at each time point using baseline adjusted linear regression analysis and propensity score-matching. Results Three thousand and four hundred sixteen patients were enrolled in the study; 1520 patients undergoing surgery and who had high-risk EBC were included in this analysis. 376/1520 (24.7%) received chemotherapy. At 6 months, chemotherapy had a significant negative impact in several EORTC-QLQ-C30 domains, including global health score, physical, role, social functioning, cognition, fatigue, nausea/vomiting, dyspnoea, appetite loss, diarrhoea and constipation. Similar trends were documented on other scales (EORTC-QLQ-BR23, EORTC-QLQ-ELD15 and EQ-5D-5L). Its impact was no longer significant at 18–24 months in unmatched and matched cohorts. Conclusions The negative impact of chemotherapy on quality-of-life is clinically and statistically significant at 6 months but resolves by 18 months, which is crucial to inform decision-making for older patients contemplating chemotherapy. Trial registration number ISRCTN 46099296.

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Section: Discussionsupporting

confidence: 93%

Bridging the Age Gap in breast cancer: Impact of chemotherapy on quality of life in older women with early breast cancer

Battisti

Reed

Herbert

et al. 2021

European Journal of Cancer

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“…Our analysis also demonstrates that chemotherapy has a significant negative impact at 6 months on QoL, which is a meaningful endpoint in the context of a more limited survival benefit and increased risk of toxicities in this population. However, this effect resolves at 12 months consistent with previous findings in smaller or younger cohorts of patients 33,34 and is described in a more extensive analysis performed on this patient cohort. 18 A key strength of this study is that patients were recruited from a broad range of academic and general centres across the UK, and were likely to reflect contemporary practice and outcomes.…”

Section: Discussionsupporting

confidence: 90%

Bridging The Age Gap: observational cohort study of effects of chemotherapy and trastuzumab on recurrence, survival and quality of life in older women with early breast cancer

et al. 2021

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Background Chemotherapy improves outcomes for high risk early breast cancer (EBC) patients but is infrequently offered to older individuals. This study determined if there are fit older patients with high-risk disease who may benefit from chemotherapy. Methods A multicentre, prospective, observational study was performed to determine chemotherapy (±trastuzumab) usage and survival and quality-of-life outcomes in EBC patients aged ≥70 years. Propensity score-matching adjusted for variation in baseline age, fitness and tumour stage. Results Three thousands four hundred sixteen women were recruited from 56 UK centres between 2013 and 2018. Two thousands eight hundred eleven (82%) had surgery. 1520/2811 (54%) had high-risk EBC and 2059/2811 (73%) were fit. Chemotherapy was given to 306/1100 (27.8%) fit patients with high-risk EBC. Unmatched comparison of chemotherapy versus no chemotherapy demonstrated reduced metastatic recurrence risk in high-risk patients(hazard ratio [HR] 0.36 [95% CI 0.19–0.68]) and in 541 age, stage and fitness-matched patients(adjusted HR 0.43 [95% CI 0.20–0.92]) but no benefit to overall survival (OS) or breast cancer-specific survival (BCSS) in either group. Chemotherapy improved survival in women with oestrogen receptor (ER)-negative cancer (OS: HR 0.20 [95% CI 0.08–0.49];BCSS: HR 0.12 [95% CI 0.03–0.44]).Transient negative quality-of-life impacts were observed. Conclusions Chemotherapy was associated with reduced risk of metastatic recurrence, but survival benefits were only seen in patients with ER-negative cancer. Quality-of-life impacts were significant but transient. Trial Registration ISRCTN 46099296

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“…For example, both the EORTC QLQ‐C30 Physical Functioning (PF) Scale and two of the GA measures, the Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (iADL), can be used to assess the physical functioning of a patient with cancer. In a previous study involving a group of older patients with cancer (Quinten et al., 2018), a strong correlation was reported between baseline ADL and iADL on the one hand and the EORTC QLQ‐C30 scales related to not only physical functioning but also global health status (GHS) and role functioning on the other. Similarly, an earlier study (Wedding, Röhrig, et al., 2007) reported that the EORTC GHS scale was significantly associated with iADL in a heterogeneous group of older patients with cancer when prognostic clinical and socio‐demographic variables were adjusted for.…”

Section: Introductionmentioning

confidence: 94%

The added value of geriatric assessment in evaluating a patient's Health‐Related Quality‐of‐Life: A study in ≥70‐year‐old early‐stage invasive breast cancer patients

et al. 2020

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Objective: The objective of this study was to assess the relationship between geriatric assessment (GA) and health-related Quality-of-Life (HRQOL) in older patients with breast cancer. Methods: Patients were assigned either to adjuvant chemotherapy (CTG) or to a control group (CG). Spearman rank coefficients (ρ) calculated correlations between HRQOL and GA at baseline, 3 months and 1 year. Multivariate regressions modelled the prognostic value of GA in evaluating of a patient's HRQOL and the accuracy of baseline GA in predicting HRQOL decline (change of ≥10 points). Results: The analysis included 57 patients in the CTG and 52 in the CG. Strong correlations (ρ ≥ 0.5) were reported between the EORTC QLQ-C30 Physical Functioning Scale and Activities of Daily Living (ADL), Instrumental ADL (iADL) and Leuven Oncogeriatric Frailty Score Scale (LOFS). Multivariate models demonstrated that poor iADL, ADL and LOFS (CG) and ADL and iADL (CTG) contributed to a statistically

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The effect of adjuvant chemotherapy on symptom burden and quality of life over time; a preliminary prospective observational study using individual data of patients aged ≥ 70 with early stage invasive breast cancer

Cited by 19 publications

References 39 publications

Bridging the Age Gap in breast cancer: Impact of chemotherapy on quality of life in older women with early breast cancer

Bridging the Age Gap in breast cancer: Impact of chemotherapy on quality of life in older women with early breast cancer

Bridging The Age Gap: observational cohort study of effects of chemotherapy and trastuzumab on recurrence, survival and quality of life in older women with early breast cancer

The added value of geriatric assessment in evaluating a patient's Health‐Related Quality‐of‐Life: A study in ≥70‐year‐old early‐stage invasive breast cancer patients

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