Reporter: Jacob E. Shabason, MD
University of Pennsylvania Department of Radiation Oncology
Last Modified: October 1, 2013
Presenter: Karna Sura, MD
Patient health related quality of life (QOL) is an important clinical outcome in all types of clinical oncology research. There are numerous patient and treatment related factors that affect the QOL in female patients undergoing treatment for breast cancer. However, these factors have not been carefully studied in women specifically undergoing radiotherapy. As such the authors sought to better characterize which pretreatment, on-treatment and post-treatment factors have a significant impact on patients’ health related QOL during radiation therapy. To study this question women were enrolled on a prospective survey study where QOL assessments were performed pre-radiation, during radiation and then 3 months post radiation using 2 separate assessment tools, the Euroqol (EQ-5D) and the Functional Assessment of Cancer Therapy-General (FACT-G).
This study ultimately included 141 women with all different stages of breast cancer, although the majority had stage I disease. The EQ-5D assessment tool demonstrated that longer radiation treatment duration and pre-radiation chemotherapy were predictors of decreased QOL during radiotherapy. Additionally, significant FACT- G associations with decreased QOL included pre-radiation chemotherapy, higher Body Mass Index (BMI), mastectomy, increase in lymph nodes removed, and increased radiation duration.
Interestingly the FACT-G survey identified prior radiation and higher number of involved lymph nodes as factors predictive of superior QOL. Prior radiation may lead to improved QOL because patients have a better understanding of what to expect during their radiation treatments.
This is a very well done study that identifies certain clinical and patient related factors associated with changes in QOL during radiation therapy. Many of the factors associated with QOL are not modifiable, with the exception of BMI. Interestingly in other breast cancer studies increased BMI is consistently associated with worse QOL, long-term toxicity and disease outcomes. Therefore, weight loss interventions can help improved patient QOL and likely other disease related outcomes. Patient counseling to improve patient expectations could potentially decrease distress associated with longer radiation duration, mastectomy, and pre-radiation chemotherapy. In addition, healthcare providers should be aware of the impact of these treatments on QOL so that at-risk patients can be screened and offered psychosocial interventions if needed.