A Prospective Analysis of Quality of Life in Patients Undergoing Whole Breast Irradiation

Abstract

The impact of Whole Breast Irradiation (WBI) on Quality of Life (QoL) outcomes is unclear, especially in developing countries, therefore a prospective, observational, cohort study was conducted to gain insight into this aspect of patient care. 74 women with stage I-III breast cancer and treated with breast-conserving surgery followed by adjuvant systemic therapy, were prospectively enrolled in this study, after ethics committee approval. CT based target delineation was performed according to RTOG guidelines. The entire breast comprised the PTV, which was prescribed either 46–50 Gy in 23-25 fractions or 40–42.5Gy in 15-16 fractions, as per physician preference. All patients were treated with Forward-Optimized IMRT, following which they received a boost to the lumpectomy cavity (10 Gy in 4 fractions). QoL assessment was performed using the self-administered FACT-B questionnaire (in English or patient's native language). All FACT-B subscales [Physical (PWB), Emotional (EWB), Social (SWB) and Functional (FWB) well-being, as well as Breast Cancer-Specific Subscale (BCSS)] were assessed. The assessments were performed before starting radiotherapy, at the end of every week during radiotherapy, and at 3 and 6 months after radiotherapy. Repeated measures ANOVA was performed to determine any statistically significant differences throughout radiotherapy delivery. A comparison between baseline and every time-point henceforth was performed using the paired t-test. For the entire cohort and across all subscales, scores at 3 and 6 months were higher compared to baseline scores (p < 0.001 for all comparisons). During radiotherapy delivery, PWB, FWB and BCSS scores increased during the first week of treatment, followed by a gradual decline towards end-of-treatment, whereas SWB and EWB gradually improved (p < 0.001 for all comparisons). FACT-B score improved for first 2 weeks followed by a gradual decline towards end-of-treatment. There is a significant QoL reduction in all patients undergoing adjuvant WBI irrespective of fractionation regimen. However, QoL returned to baseline after completion of WBI.Abstract 2498; TableMean scores with standard deviations for all assessed QoL subscales. (*Week 5 & 6 assessment was performed for patients undergoing conventionally fractionated WBI)SubscalesBaselineWk 1Wk 2Wk 3Wk 4Wk 5 *Wk 6 *3 mo.6 mo.PWB9.5 ± 1.015.3 ± 2.814.2 ± 3.212.1 ± 3.49.6 ± 3.17.1 ± 3.66.1 ± 3.321.0 ± 2.915.1 ± 3.7SWB19.3 ± 1.420.8 ± 5.221.3 ± 5.122.2 ± 4.822.7 ± 4.922.8 ± 4.923.0 ± 4.825.7 ± 2.725.6 ± 3.9FWB12.5 ± 1.015 ± 5.314.1 ± 5.313.5 ± 5.512.5 ± 1.010.7 ± 5.49.8 ± 5.320.8 ± 4.517.0 ± 4.6EWB15 ± 2.815.1 ± 2.315.2 ± 2.415.4 ± 2.615.4 ± 4.815.6 ± 4.616.0 ± 4.518.7 ± 4.218.7 ± 4.1BCSS10 ± 1.421.2 ± 2.818.6 ± 3.315.6 ± 3.912.8 ± 3.910.6 ± 3.78.9 ± 3.724.4 ± 2.818.2 ± 4.8FACT-B66.4 ± 3.787.4 ± 11.383.4 ± 11.378.6 ± 12.372.5 ± 14.766.8 ± 14.663.8 ± 14.1110.5 ± 10.494.4 ± 15.4 Open table in a new tab