Quality of life impact of early radiation treatment for breast cancer

Abstract

Accelerated partial breast radiotherapy is a treatment modality that may offer tumor control similar to traditional breast radiotherapy while reducing the burden of therapy. Evaluation of the importance of such an advance requires measurement of patient preference and tolerance for the side effects of early treatment. In our study, we evaluated patient-reported quality of life for women early in their radiation treatment for breast cancer. Breast cancer patients undergoing radiation treatment at Northwestern Memorial Hospital were recruited for participation in the study. All patients receiving radiation treatment for breast cancer were considered eligible. After obtaining informed consent, a baseline interview was conducted with each patient during the first week of radiation therapy, and a second interview was conducted during the second week of therapy. Participants completed multiple outcome measures at each interview. The ECOG performance status is a general measure of patient function. The FACT-B poses specific questions to the patients about aspects of their well-being. Four of the subscales are designed to generalize to all cancer patients, and the fifth addresses specific concerns for women with breast cancer. Standard gamble and time trade-off utility questionnaires were also administered. Each asks patients to think broadly about their overall quality of life, without delineation of specific factors of their well-being that might be affected by cancer or its treatment. Descriptive analyses were conducted to characterize quality of life during the first 2 weeks of radiation treatment. Changes in quality of life were analyzed using a linear regression model, to determine whether patient characteristics (baseline function, age, and living arrangements) could predict improvement or worsening of quality of life, early in radiation treatment. All statistical analyses were conducted at the alpha = 0.10 level. A total of 69 patients completed both assessments. Measures of the impact of early radiation treatment differed substantially, with patient function declining between week one and week two, measured by the ECOG performance status (p < 0.001) and quality of life remaining unchanged, when measured by four of the five domains of the FACT-B, or even increasing, when measured by the FACT-B breast cancer subscale, and by both utility measures (p < 0.01). Statistically significant predictors of change differed across the three models. Improvement in standard gamble utilities was weakly related to higher baseline ECOG performance status (no symptoms relative to some bed rest) while improvement in breast cancer subscale scores was more substantially related to lower baseline ECOG performance status (some symptoms relative to none). Improvement in time trade-off utilities was related to the presence of other adults in the home (a measure of social support). Currently there is significant interest in accelerated partial breast radiotherapy (PBRT). It has been thought that treatment delivered rapidly over one week would be more convenient and therefore have the potential to reduce treatment burden and improve overall quality of life relative to standard breast radiotherapy. This current study found a small improvement in patient-reported quality of life during the second week of standard breast radiotherapy. However, concurrent reductions in patient function were also found. The extent to which improvements in quality of life reflect adjustments in expectations of treatment effects by the patients, rather than true improvement in quality of life, has not been tested. As we move forward in the use of PBRT it is important to prospectively measure quality of life in addition to standard toxicity and efficacy