Accelerated partial breast irradiation compared with whole breast radiation therapy: a breast cancer cohort study measuring change in radiation side-effects severity and quality of life

Abstract

Purpose Radiotherapy (RT) after breast-conserving surgery for early-stage breast cancer patients has similar survival benefits with whole breast RT (WBRT) or accelerated partial breast irradiation (APBI). However, the impact of RT type and side-effects severity on change in quality of life (QOL) is unknown. We examined changes in RT side-effects severity and QOL by RT type. Methods We analyzed data from a cohort of 285 newly diagnosed early-stage breast cancer patients with tumor size ≤ 3.0 cm and lymph-node-negative disease. Patients (93 [32.6%] stage 0; 49 [17.2%] non-white; mean age = 59.3 years) completed four interviews (6 weeks, 6, 12, and 24 months) after definitive surgical treatment. We measured severity of RT side effects, fatigue and skin irritation, using a 5-point scale (1 “not at all” to 5 “all the time”) and measured QOL using the Functional Assessment of Cancer Therapy-Breast (FACT-B) and RAND 36-item Health Survey Vitality subscale. Repeated-measures analysis of covariance of each outcome controlled for demographic, clinical/treatment, and psychosocial factors. Results Patients initiated RT by 6 months (113 received APBI; 172 received WBRT) and completed RT by 12 months. Patients receiving WBRT (vs. APBI) reported greater increase in fatigue and skin irritation severity from 6-week to 6-month interviews (each P < 0.001). Improvement in neither total FACT-B nor Vitality differed significantly by RT type over 2-year follow-up. Conclusions Findings suggest that early-stage breast cancer patients can benefit from less-severe, short-term side effects of APBI with no differential impact on QOL change within 2-year follow-up.

Perceived social support in African American breast cancer patients: Predictors and effects

“…The MOS-SSS item scores were used to compute a total score for perceived availability of social support; mean scores were transformed into standardized scores ranging from 0 to 100, with higher scores indicating greater perceived support (RAND Corporation, 2014). The MOS-SSS, which was developed to measure perceived availability of social support in community-dwelling adults with chronic conditions, has been used in diverse samples of breast cancer patients, including patients at different cancer stages who received different treatment modalities (e.g., Ashing-Giwa and Rosales, 2013; Giedzinska et al, 2004; Pérez et al, 2017). In our sample, Cronbach's α was >0.96 at each interview.…”

The patient's perspective on breast radiotherapy: Initial fears and expectations versus reality

“…In addition, hypofractionated radiation schedules have not only reduced treatment length and increased convenience, but also have been associated with reduced short‐term toxicities, including acute dermatitis and breast pain . Finally, accelerated partial breast irradiation, a technique that allows for localized radiation delivery, has had an expanding scope of practice, and has similarly been associated with less acute toxicity . Furthermore, advances in radiation planning have continually allowed for more sparing of the heart and lungs, with recent reports indicating that the heart and lung doses currently achieved in practice are even superior to what is reported in the modern literature, and that the absolute risk of lung cancer or cardiac mortality as a result of breast RT is estimated to be <1% among nonsmokers .…”

“…23,26 Finally, accelerated partial breast irradiation, a technique that allows for localized radiation delivery, has had an expanding scope of practice, 36 and has similarly been associated with less acute toxicity. 24 Furthermore, advances in radiation planning have continually allowed for more sparing of the heart and lungs, with recent reports indicating that the heart and lung doses currently achieved in practice are even superior to what is reported in the modern literature, 23 and that the absolute risk of lung cancer or cardiac mortality as a result of breast RT is estimated to be <1% among nonsmokers. 30 Therefore, given these significant advances in RT that have improved convenience and reduced toxicities, the current study finding that patients perceive a better than expected treatment experience with modern breast RT, although novel, is not unexpected given the significant degree of baseline fears and misconceptions held by the general public.…”

“…17,18 However, in reality, significant advances in breast RT over the last 2 decades have resulted in increased accuracy, reduced toxicities, and improved treatment convenience. [19][20][21][22][23][24][25] Despite the wealth of published literature evaluating the efficacy and toxicity outcomes of breast RT, [26][27][28][29][30] to our knowledge there is relatively little known regarding the patient's perspective concerning their experience with breast RT. Given the documented misconceptions and fears regarding breast RT, we sought to explore the treatment experience from the patient's perspective to better inform future patients and providers.…”

Early‐stage breast cancer and employment participation after 2 years of follow‐up: A comparison with age‐matched controls

“…Furthermore, the presence of lingering side effects after surgical or adjuvant therapy may influence employment outcomes long after treatment ends. 3,4 Although cancer survivors are more likely to report unemployment than individuals without a cancer history, [5][6][7][8][9][10] working after diagnosis may represent a return to normalcy for some patients with breast cancer. In addition to the added benefit of employersponsored health insurance, paid employment has the potential to mitigate the financial stresses associated with cancer.…”