Impact of partial versus whole breast radiation therapy on fatigue, perceived stress, quality of life and natural killer cell activity in women with breast cancer

Abstract

IntroductionThis pilot study used a prospective longitudinal design to compare the effect of adjuvant whole breast radiation therapy (WBRT) versus partial breast radiation therapy (PBRT) on fatigue, perceived stress, quality of life and natural killer cell activity (NKCA) in women receiving radiation after breast cancer surgery.MethodsWomen (N = 30) with early-stage breast cancer received either PBRT, Mammosite brachytherapy at dose of 34 Gy 10 fractions/5 days, (N = 15) or WBRT, 3-D conformal techniques at dose of 50 Gy +10 Gy Boost/30 fractions, (N = 15). Treatment was determined by the attending oncologist after discussion with the patient and the choice was based on tumor stage and clinical need. Women were assessed prior to initiation of radiation therapy and twice after completion of radiation therapy. At each assessment, blood was obtained for determination of NKCA and the following instruments were administered: Perceived Stress Scale (PSS), Functional Assessment of Cancer Therapy-Fatigue (FACT-F), and Functional Assessment of Cancer Therapy-General (FACT-G). Hierarchical linear modeling (HLM) was used to evaluate group differences in initial outcomes and change in outcomes over time.ResultsFatigue (FACT-F) levels, which were similar prior to radiation therapy, demonstrated a significant difference in trajectory. Women who received PBRT reported progressively lower fatigue; conversely fatigue worsened over time for women who received WBRT. No difference in perceived stress was observed between women who received PBRT or WBRT. Both groups of women reported similar levels of quality of life (FACT-G) prior to initiation of radiation therapy. However, HLM analysis revealed significant group differences in the trajectory of quality of life, such that women receiving PBRT exhibited a linear increase in quality of life over time after completion of radiation therapy; whereas women receiving WBRT showed a decreasing trajectory. NKCA was also similar between therapy groups but additional post hoc analysis revealed that better quality of life significantly predicted higher NKCA regardless of therapy.ConclusionsCompared to WBRT, PBRT results in more rapid recovery from cancer-related fatigue with improved restoration of quality of life after radiation therapy. Additionally, better quality of life predicts higher NKCA against tumor targets, emphasizing the importance of fostering quality of life for women undergoing adjuvant radiation therapy.

Effectiveness of Programmed Deep Breathing Exercises on Reducing the Level of Fatigue During External Radiation Therapy

“…This may be attributed to physical and psychological exhaustion caused by cancer treatment and distressing side effects. Similar findings were reported by Albuquerque Kevin et al [6] in a prospective longitudinal study to examine the effect of radiation therapy on fatigue and it were reported that higher duration of radiation therapy was significantly associated with level of fatigue (p= 0.02).…”

Accelerated partial irradiation for breast cancer: Systematic review and meta-analysis of 8653 women in eight randomized trials

“…Moreover, a shorter period of time needed to deliver treatment might improve the convenience and quality of life of the patients, possibly reducing the physical and psychological stress related to the radiotherapy [41,42]. For patients with several comorbidities, or for those who live far from radiation oncology centers, a short course of irradiation could increase their adherence and also reduce the likelihood of mastectomy [13,43].…”

Utilization and Outcomes of Breast Brachytherapy in Younger Women

“…Brachytherapy confers value to patients as total treatment time is decreased and radiation-related fatigue may be lessened (24), yet such gains could be offset by higher recurrence risks or much higher costs, either from brachytherapy itself or salvage treatment (such as for recurrent disease, though this outcome was not directly measured in our current study) (25). Prior literature has sought to estimate value using costs derived from Medicare reimbursement (25,26), but such approaches are dated given changes to brachytherapy reimbursement that occurred in 2009 (27) and further do not extend to younger patients with private insurance.…”