The impact of age and clinical factors on quality of life in early breast cancer: An analysis of 2208 women recruited to the UK START Trial (Standardisation of Breast Radiotherapy Trial)

Abstract

Summary Quality of life (QOL) assessments of women entering a UK randomised trial of adjuvant radiotherapy (START) were investigated to estimate the independent effects on QOL of age, time since surgery, type of breast surgery, chemotherapy and endocrine therapy. QOL was evaluated using the EORTC general cancer QOL scale (EORTC QLQ-C30), breast cancer module (BR23), the Body Image Scale (BIS) and the Hospital Anxiety and Depression Scale (HADS). Independent effects of age and clinical factors were tested using multiple regression analysis.A total of 2208 (mean age 56.9 years, range 26-87) consented to the QOL study prior to radiotherapy; 17.1% had undergone mastectomy (Mx) and the remainder had undergone a wide local excision (WLE). 33.3% had received adjuvant chemotherapy (CT) and 56.7% were taking endocrine therapy (ET). Age had significant effects on QOL with older and younger subgroups predicting poorer QOL for different domains. CT affected most QOL domains and resulted in worse body image, sexual functioning, breast and arm symptoms (o0.001). Mx was associated with greater body image concerns (po0.001), and WLE with more arm symptoms (p ¼ 0.01). There were no effects of ET on QOL. Women o50 years (proxy pre-menopausal) had worse QOL in respect of anxiety, body image and breast symptoms but age and clinical factors had no effect on depression.Overall, QOL and mental health were favourable for most women about to start RT, but younger age and receiving CT were significant risk factors for poorer QOL, and so patients in these subgroups warrant further monitoring. Surgery had a limited impact and ET had no effect on QOL.

Quality of Life and Psychological Well-Being of Breast Cancer Survivors in Jordan

“…This was followed by insomnia with 13.5% of participants scoring more than 66.7%. These results are close to regional and international figures (Hopwood et al, 2007;Waldmann et al, 2007;Jassim and Whitford, 2013). Studies examining the prevalence of fatigue among breast cancer patients found that up to 99% of patients suffer from some degree of fatigue during chemotherapy and/or radiotherapy and that more than 60% of them experience moderate to severe fatigue (Bower et al, 2000;2006).…”

“…This score is close to scores reported in Kuwait (Alawadi and Ohaeri, 2009), but slightly lower than scores reported in Bahrain (Jassim and Whitford, 2013) and Germany (Waldmann et al, 2007). The remaining scores of QLQ-C30 functional scales were also lower than those reported in Western countries (Hopwood et al, 2007;Waldmann et al, 2007). The physical functioning mean score in this study was 69.6±26.1 SD, which is lower than that reported in Bahrain (mean=74.9±21.7 SD) (Jassim and Whitford, 2013) and much lower than reported from Germany (mean=93.2±6.8 SD) (Waldmann et al, 2007).…”

“…The study participants' mean age of 50.7 years is similar to the mean age in the Bahraini study (Jassim and Whitford, 2013) and only 5.5% of the Jordanian patients had at least one chronic disease. There is no difference in the prevalence of fatigue between our sample and the published figures (Hopwood et al, 2007;Waldmann et al, 2007;Jassim and Whitford, 2013). We therefore suggest further research in this field in addition to focusing on this scale in counseling services and health promotion campaigns targeting breast cancer survivors in Jordan.…”

“…On the other hand, when compared with regional or international figures (Hopwood et al, 2007;Waldmann et al, 2007;Jassim and Whitford, 2013), the patients' low scores in the physical functioning domain, could not be justified by the age difference (Arndt et al, 2004), the presence of other co-morbidities, or by the prevalence of fatigue (Bower et al, 2000). The study participants' mean age of 50.7 years is similar to the mean age in the Bahraini study (Jassim and Whitford, 2013) and only 5.5% of the Jordanian patients had at least one chronic disease.…”

“…This score is worse than scores from the UK (mean=78.1±25.8 SD) (Hopwood et al, 2007) and Germany (score=73.7±30.6 SD) (Waldmann et al, 2007). Breast reconstruction rates have not been assessed in Jordan in any published report.…”