The Impact of AC and AC-T Chemotherapy’s Toxicities on Quality of Life Among Women with Breast Cancer in Ethiopia: A Prospective Patient-Reported Outcomes Study

Abstract

Purpose The study aimed to evaluate the quality of life patterns and the effects of AC and AC-T chemotherapy’s toxicities on QoL among Ethiopian women with breast cancer. Methods QoL was measured at baseline and at every end of two cycles, for the median of 8 cycles among 146 breast cancer women on AC and AC-T chemotherapy, using EORTC QLQ-C30 and BR23 instruments. The effect of QoL score, socio-demographic, and clinical variables at baseline were adjusted for the effect of chemotherapy’s toxicities on QoL. Results Overall QoL, all functional scales (except cognitive functioning, body image, future perspectives, and sexual functioning) and symptom scales (except dyspnea, insomnia, pain score, arm, and breast symptoms) of EORTC QLQ-C30 and BR23 deteriorated significantly both clinically and statistically, in particular, during the first two cycles of chemotherapy. After the end of cycle 2 or 4, except for cognitive, social functioning, and financial difficulties of the patients, almost all other QoL dimensions were improved towards pretreatment score by the end of cycle 8. In addition to age, educational status, and tumor stage, the Global Health Status (−10.55≤B≤−7.71, P≤0.013), and the functional scales (−25.320≤B≤−6.351, P≤0.033) of EORTC QLQ-C30 and BR23 were significantly affected at least by one of the AC and AC-T chemotherapy’s toxicity such as grade≥2 fatigue, dysgeusia, constipation, dry mouth, vomiting, oral mucositis, skin hyperpigmentation and/or peripheral neuropathy than their lower grade. Grade≥2 fatigue, dysgeusia, oral mucositis, constipation, peripheral neuropathy, anemia arthralgia/myalgia, dry mouth, diarrhea, constipation, and/or skin hyperpigmentation were positively predicted for the deterioration of symptoms scale of EORTC QLQ-C30 and BR23 (4.819≤B≤26.451, P≤0.043). Conclusion Quality of life among Ethiopian breast cancer patients on AC and AC-T regimens significantly deteriorated particularly during the first two cycles of chemotherapy. In addition to the age, tumor stage and educational status of the patients, grade≥2 fatigue, dysgeusia, constipation, oral mucositis, dry mouth, peripheral neuropathy, and skin hyperpigmentation due to AC and AC-T chemotherapy were frequently associated with deterioration of different scales/items QoL. Hence, devising different strategies to improve the deteriorated QoL due to chemotherapy’s toxicities particularly during the first two cycles has paramount importance.

Impact of anticancer therapy on the quality of life of Sudanese patients with breast cancer at Khartoum oncology hospital

“…A similar pattern of results was demonstrated in a previous study wherein global health status was declined after cycle 2 of the conventional chemotherapy. Likewise, cognitive functioning, emotional functioning, social functioning, role functioning, and physical functioning of the patients were signi cantly deteriorated during the rst two cycles of chemotherapy [41]. Akin, et al reported that all quality of life dimensions were negatively affected in Turkish breast cancer patients undergoing chemotherapy [42].…”

“…Furthermore, nancial di culties were signi cantly worse in patient taking conventional chemotherapy when compared with patients on HER2targeted therapy. Gadisa et al reported that QOL of patients with breast cancer was negatively affected by chemotherapy's side effects such as fatigue, constipation, dry mouth, vomiting, oral mucositis, skin hyperpigmentation and peripheral neuropathy [41].…”

“…Moreover, patients on HER2-targeted therapy had 10.8 times chances to have good QOL than patients taking conventional chemotherapy. A previous study demonstrated that systemic side effects of conventional chemotherapy, such as oral mucositis, constipation, peripheral neuropathy, anemia arthralgia/myalgia, dry mouth, diarrhea, constipation, and skin hyperpigmentation, were predictors for deteriorated QLQ [41] The study was conducted during COVID-19 pandemic; therefore, large sample size was not attained.…”

Impact of anticancer therapy on the quality of life of Sudanese patients with breast cancer at Khartoum oncology hospital

“…A previous study showed that the toxicity profile of tamoxifen and aromatase inhibitors did not show significant reduction in the overall QOL [44]. Gadisa et alreported that QOL of patients with BC was adversely affected by chemotherapy's side effects [39].…”

“…Moreover, patients on HER2-targeted therapy had 10.2 times chances to get good QOL than patients on conventional chemotherapy. A previous study demonstrated that systemic side effects of conventional chemotherapy (oral mucositis, constipation, peripheral neuropathy, anemia arthralgia/myalgia, dry mouth, diarrhea, constipation, and skin hyperpigmentation) were predictors for deteriorated QLQ [39].…”