Quality of Life Assessment in Patients with Breast Cancer Receiving Radiation Therapy: A Prospective Study

Abstract

<h3>Purpose/Objective(s)</h3> Quality of life (QOL) is important for cancer patients while it is frequently neglected in clinical patient care as well as cancer research. The purpose of this study is to exam the changes of QOL status and the associated factors during the course of radiation therapy in patients with breast cancer. <h3>Materials/Methods</h3> Invasive breast cancer patients, aged 18-year-old and above requiring adjuvant radiation therapy were eligible. A self-addressed promise questionnaire according to NCI "promise" were used to assess the QOL. The Questionnaires were completed one day prior to and at the end of radiation. Patient, tumor and prior treatment factors were collected during the first visit of the treatment. The primary endpoint was QOL which included physical function, activities, anxiety, depression, fatigue, sleep disturbance and pain. Data are presented as mean ± SD unless otherwise specified. The computer adaptive testing algorithm present in these three PROMIS domains standardized T scores according to a reference population, providing a mean score of 50 and a standard deviation of 10. Statistical significance of QOL between pre-radiation and end-radiation were tested using paired t test. The factors affecting changes of QOL were analyzed by correlation of spearman for continuous variables, and the analysis of variance for categorical variables. P less than 0.05 was considered to be significant. <h3>Results</h3> Between July 2019 and June 2021, a total of 321 breast cancer patients enrolled this study. The mean age was 45 years old. 88.5% patients received hypofractionated radiation with 72.9% patients at stage II-III. All of them signed written consent forms and completed the QOL prospectively. There was no significant difference in the scores of fatigue, sleep disturbance, physical function, activities and pain between pre-radiation and end-radiation. After radiation, anxiety and depression were improved instead. T score of anxiety pre-radiation and end-radiation was 47.68 ± 8.64 and 44.96 ± 7.48 respectively (p = 0.023). The improvement of anxiety was significantly correlated with RT fractions, RT dose and integral dose of the total body (p values < 0.05), but not RT techniques, RT fields, mean lung dose, age, tumor subtypes, surgical approaches, stage and prior chemotherapy. T score of depression pre-radiation and end-radiation was 44.05 ± 5.86 and 42.65 ± 4.74 respectively (p = 0.041). The improvement of depression was significantly correlated with integral dose of the total body and anti-HER2 target therapy (p values < 0.05). <h3>Conclusion</h3> Most QOL measures were not significantly changed after radiation while anxiety and depression improved in patients with breast cancer. Future study with larger cohort shall be investigated to validate these finding. This is part of a prospective study of treatment toxicity, quality of life and biomarker in cancer patients (GCOG0001/NCT05061342).