Health-related quality of life in survivors of stage I-II breast cancer: randomized trial of post-operative conventional radiotherapy and hypofractionated tomotherapy

Versmessen, Harijati; Vinh-Hung, Vincent; Parijs, Hilde Van; Miedema, Geertje; Voordeckers, Mia; Adriaenssens, Nele; Storme, Guy; Ridder, Mark De

doi:10.1186/1471-2407-12-495

Cited by 45 publications

(48 citation statements)

References 43 publications

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“…Chemotherapy also has been reported to predict impaired QOL in 5- and 10-year survivors. 51,52 QOL following specific adjuvant treatment regimens has been described in longitudinal studies with patients receiving radiation, 44,45,53 chemotherapy, 54 radiation and chemotherapy, 55,56 and endocrine therapy. 57–60 However, unlike these studies, we included an adjuvant chemotherapy*time interaction term in our analysis—in relation to receipt of BCS or mastectomy as well—allowing us to determine if, and how, the change in QOL over time differed by receipt of chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

The Effects of Surgery Type and Chemotherapy on Early-Stage Breast Cancer Patients’ Quality of Life Over 2-Year Follow-up

et al. 2015

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Purpose We examined the effects of surgery type and adjuvant chemotherapy on change in early-stage breast cancer patients' quality of life (QOL) over time. Methods A cohort of 549 patients (33.5% ductal carcinoma in situ, 66.5% stages I/IIA) were interviewed a mean 6.1 weeks (Time1), and 6.2 (Time2), 12.3 (Time3), and 24.4 (Time4) months following definitive breast-conserving surgery (BCS) or mastectomy. QOL was measured using the total Functional Assessment of Cancer Therapy-Breast (FACT-B). Adjusting for demographic, psychosocial, and clinical variables, multiple linear regression models estimated the associations between QOL and each of surgery type, chemotherapy and their 2-way interaction at each interview. Adjusted Generalized Estimating Equation (GEE) models tested Time1-Time4 change in QOL. Results At T2, chemotherapy (P < 0.001) and BCS (P < 0.001) were independently associated with worse QOL in adjusted linear regression, and the adverse effect of chemotherapy was prominent among patients who received BCS compared with those who received mastectomy (Pinteraction = 0.031). In the GEE model, QOL significantly improved over time among patients who received BCS (Ptrend = 0.047), mastectomy (Ptrend = 0.024), and chemotherapy (Ptrend < 0.001) but not among patients who did not receive chemotherapy (Ptrend = 0.720). All patients completed adjuvant chemotherapy and radiation by Time3. Regardless of surgery type, patients receiving chemotherapy reported lower QOL following surgery, and QOL improved after completion of adjuvant treatment. Conclusions Chemotherapy had a short-term negative impact on QOL after definitive surgical treatment regardless of surgery type. QOL rebounded after completion of adjuvant treatment.

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Section: Discussionmentioning

confidence: 99%

The Effects of Surgery Type and Chemotherapy on Early-Stage Breast Cancer Patients’ Quality of Life Over 2-Year Follow-up

et al. 2015

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“…The primary outcome of interest was the presence of severe fatigue at 2 years after diagnosis, defined by a score of EORTC QLQ‐C30 ≥ 40 …”

Section: Methodsmentioning

confidence: 99%

Fatigue and physical activity in cancer survivors: A cross‐sectional population‐based study

et al. 2019

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Purpose A substantial proportion of cancer survivors experience fatigue after diagnosis. Physical activity (PA) can impact fatigue after cancer. In this study, we evaluated the prevalence and association of fatigue and the practice of PA in a population with early cancer. Methods Using the national population‐based French cross‐sectional study Vie après le cancer 2 , we included 1984 patients with early breast (61.1%), prostate (21.5%), and colorectal (17.4%) cancer. Severe fatigue at 2 years postdiagnosis was defined by a score ≥40 in the European Organization for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ C30) fatigue subscale. PA was defined as (a) self‐reported PA before diagnosis (active/inactive) and (b) change in PA since diagnosis (increased/maintained exposure vs decreased exposure/remaining inactive). Multivariate regression examined associations of severe fatigue with PA, adjusting for baseline clinical and treatment variables. Results Median age was 52 years. 51.5% of patients experienced severe fatigue 2 years post‐diagnosis. 87.7% reported to be physically active before cancer diagnosis; 53.3% of patients either decreased PA or remained inactive at 2 years postdiagnosis. At 2 years postdiagnosis, severe fatigue was associated with a change in PA since diagnosis: patients with decreasing PA/remaining inactive from pre‐ to postdiagnosis had a higher risk of severe fatigue vs those with increasing/maintaining PA (adjusted odds ratio [95% confidence interval] 2.32 [1.85‐2.90]). Conclusion Fatigue continues to be a substantial problem for cancer survivors 2 years after cancer diagnosis and is associated with PA decreasing/remaining inactive since diagnosis. Interventions to maintain or increase PA for cancer survivors should be tested to mitigate long‐term fatigue after cancer.

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“…Additionally, the benefit of shorter treatment course on quality of life has also been suggested. In a study cohort of stage I‐II breast cancer comparing conventional and hypofractionated tomotherapy, women reported faster recovery of fatigue, and physical, cognitive, and emotional functioning scores with shorter course treatment . Evaluation of patient factors in the current analysis revealed that increasing age category, race, and stage were not associated with delivery of shorter fractionation regimens.…”

Section: Discussionmentioning

confidence: 72%

“…In a study cohort of stage I-II breast cancer comparing conventional and hypofractionated tomotherapy, women reported faster recovery of fatigue, and physical, cognitive, and emotional functioning scores with shorter course treatment. 20 Evaluation of patient factors in the current analysis revealed that increasing age category, race, and stage were not associated with delivery of shorter fractionation regimens. This is similar to findings of an analysis by Bekelman where age in patients who met ASTRO guideline indications was not significant for utilization of hypofractionation.…”

Section: Discussionmentioning

confidence: 75%

Hypofractionated radiation in older women with breast cancer

et al. 2019

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Background American Society of Radiation Oncology Choosing Wisely campaign recommends hypofractionated radiation and against routine use of intensity‐modulated radiation therapy (IMRT) in early‐stage estrogen receptor‐positive breast cancer. We analyzed guideline recommendation adherence and financial implications in a modern Medicare cohort of women treated across the southeastern United States. Methods Our study population comprised Medicare patients over 65 years of age with breast cancer diagnosis from 12 cancer centers in the Southeast United States with stage 0‐II breast treated with lumpectomy from 2012 to 2015. Hypofractionation was defined as 4 or fewer weeks of radiation treatments. Factors associated with utilization of hypofractionation and IMRT were identified using Poisson regression. Median costs during radiation treatments were compared for hypofractionation and IMRT. Results In older women (median age 71), 75% were treated with conventional fractionation, and 20% received IMRT. Hypofractionated women were more likely to have a positive estrogen(ER) or progestorone(PR) receptor status, lower comorbidity scores, and be treated at a high volume center (all P < 0.05). IMRT was utilized in 20% of patients and was more common in women treated with conventional fractionation (P < 0.001). Positive ER/PR status (P < 0.001) and utilization of hormonal blockade (P = 0.02) were associated with increased utilization of IMRT. Conclusion In an older cohort of patients with early‐stage breast cancer, a majority were treated with conventional fractionated radiation, while approximately 20% were treated with IMRT. Both of which were associated with increased cost relative to hypofractionation.

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Health-related quality of life in survivors of stage I-II breast cancer: randomized trial of post-operative conventional radiotherapy and hypofractionated tomotherapy

Cited by 45 publications

References 43 publications

The Effects of Surgery Type and Chemotherapy on Early-Stage Breast Cancer Patients’ Quality of Life Over 2-Year Follow-up

The Effects of Surgery Type and Chemotherapy on Early-Stage Breast Cancer Patients’ Quality of Life Over 2-Year Follow-up

Fatigue and physical activity in cancer survivors: A cross‐sectional population‐based study

Hypofractionated radiation in older women with breast cancer

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