Early effects of contemporary breast radiation on health-related quality of life – Predictors of radiotherapy-related fatigue

Abstract

Background and purpose . The aim of this study was to report on early effects of contemporary radiotherapy (RT) on healthrelated quality of life (HRQOL) and explore treatment-related contributors to the development of fatigue during RT in breast cancer (BC) patients. Material and methods . Consecutive BC patients (n ϭ 248) referred for postoperative RT at St. Olavs University Hospital in Trondheim, Norway were enrolled from February 2007 to October 2008. Clinical-and treatment data were recorded, and HRQOL were assessed before starting (baseline) and immediately after ending RT using the " EORTC QLQ-C30 " and the breast module " EORTC QLQ-BR23 " . Change scores from baseline were calculated. Predictors of increased fatigue during RT were explored with multiple regression analysis adjusted for relevant confounders. Results. The global QOL-and all functional scales remained stable, except for " future perspective " which improved signifi cantly during RT. Breast symptoms and fatigue increased signifi cantly during RT. Groups with elevated baseline fatigue remained more stable during RT than those with lower levels at baseline. The body volume receiving 40 Gy or more (V40) was a signifi cant predictor of increased fatigue during RT adjusted for chemotherapy, comorbidity and age (p ϭ 0.035). Conclusion . Contemporary RT has limited early effects on HRQOL. V40 is a signifi cant predictor of RT-related fatigue.Multimodal treatment has become standard management of most breast cancer (BC) patients [1]. Where multiple treatment modalities are involved, the contribution of each to quality of life and symptoms is diffi cult to quantify [2]. The impact of BC treatment on health-related quality of life (HRQOL) has broadly been reported in relation to surgery techniques [3] and systemic therapies [4]. Improvements of radiotherapy (RT) techniques with more individual treatment plans (contemporary RT) should indicate less adverse effects and impact on HRQOL, but these assumptions have not been documented sufficiently [2,3,5,6]. Limitations of previous studies involve lack of baseline measures [7,8], small study samples [6,9] or older trials with incomparable RT-techniques to current practice [5,10].Fatigue is one of the most frequent and debilitating side effects of BC treatment with adverse effects on quality of life [6,11 -16]. The etiologies of fatigue are multi-factorial and poorly understood and the relative contributions of the various treatment modalities remain unclear [14,17,18]. The association between the severity of fatigue and RT-variables (like dose or dose-volume) has been investigated [13,15], but hampered by limited samples (n ϭ 41 and n ϭ 52). To our knowledge no studies have tested specifi c hypotheses concerning RT-related contributors to fatigue developed during RT.Prospective longitudinal study designs are generally preferred when exploring associations and predictors of post-RT fatigue [11], and baseline-values of fatigue have commonly been adjusted for in regression models [11,14]. However, incl...

Efeito da radioterapia na função pulmonar e na fadiga de mulheres em tratamento para o câncer de mama

“…Even though there have been correlations between pulmonary function and fatigue, the reduction of values such as volume, capacities and respiratory muscle strength can also influence the appearance of fatigue 26 . The symptoms of lack of energy, tiredness, and intolerance to effort can be a reflex of the RT itself, of psychological factors, of the need to sleep/rest during the day 8,15,21,26 , and they can even be increased by the negative repercussions of RT on the respiratory function 26 . Clinically, it is expected that when the pulmonary function is compromised, even if temporarily or without great repercussions, the patients can experiment situations of indisposition or exhaustion.…”

“…Despite the decreased pulmonary function and the reduction of more than 20% of FVC and FEV1, the values remained within normality, according to weight, age and height of the studied sample 18,19 . Changes in lung capacity and volume are expected after RT 11,[21][22][23][24][25] , since there are potential risks of damaging the pulmonary parenchyma, losing type ii pneumocytes, losing surfactant and edema in the basement membrane 26 . But there is also the possibility that the patient can remain asymptomatic or never present any changes, be it in the parenchyma or in the pulmonary function, due to the "compensation in relation to the health lung", which did not receive radiation 24 .…”

“…These domains had complaints of indisposition, lack of energy, somnolence, loss in the work activities, pain, among others. According to literature and the clinical practice, the presence of fatigue, tiredness and physical exhaustion as a secondary effect of RT 8 has a negative repercussion on the performance of daily life tasks, socialization, recreational activities and in the global physical conditioning 15,26 . Even though there have been correlations between pulmonary function and fatigue, the reduction of values such as volume, capacities and respiratory muscle strength can also influence the appearance of fatigue 26 .…”

“…According to literature and the clinical practice, the presence of fatigue, tiredness and physical exhaustion as a secondary effect of RT 8 has a negative repercussion on the performance of daily life tasks, socialization, recreational activities and in the global physical conditioning 15,26 . Even though there have been correlations between pulmonary function and fatigue, the reduction of values such as volume, capacities and respiratory muscle strength can also influence the appearance of fatigue 26 . The symptoms of lack of energy, tiredness, and intolerance to effort can be a reflex of the RT itself, of psychological factors, of the need to sleep/rest during the day 8,15,21,26 , and they can even be increased by the negative repercussions of RT on the respiratory function 26 .…”

“…Lung disorders can be temporarily classified as actinic pneumonitis, which appears from three to six months, and pulmonary fibrosis, which occurs about one year after RT 26 . Due to the period in which they were reassessed, until one week after the conclusion of RT, the patients did not present with any characteristic symptom of the aforementioned chronic lesions.…”