Nicolò Matteo Luca Battisti1, Malcolm W R Reed2, Esther Herbert3, Jenna L Morgan4, Karen A Collins5, Sue E Ward6, Geoffrey R Holmes6, Michael Bradburn3, Stephen J Walters3, Maria Burton5, Kate Lifford7, Adrian Edwards7, Thompson G Robinson8, Charlene Martin4, Tim Chater3, Kirsty J Pemberton3, Anne Shrestha4, Alan Brennan6, Kwok L Cheung9, Annaliza Todd4, Riccardo A Audisio10, Juliet Wright2, Richard Simcock11, Tracey Green12, Deirdre Revell12, Jacqui Gath12, Kieran Horgan13, Chris Holcombe14, Matthew C Winter15, Jay Naik16, Rishi Parmeshwar17, Margot A Gosney18, Matthew Q Hatton14, Alastair M Thompson19, Lynda Wyld20, Alistair Ring1. 1. Department of Medicine, Breast Unit the Royal Marsden Hospital NHS Foundation Trust, London, UK; Breast Cancer Research Division, The Institute of Cancer Research, London, UK. 2. Brighton and Sussex Medical School, Falmer, Brighton, UK. 3. Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK. 4. Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, UK. 5. College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Collegiate Crescent Campus, Sheffield, UK. 6. Health Economics and Decision Science Section, School for Health and Related Research (ScHARR), University of Sheffield, UK. 7. Division of Population Medicine, Cardiff University, 8th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, UK. 8. Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, Cardiovascular Research Centre, The Glenfield Hospital, Leicester, UK. 9. University of Nottingham, Royal Derby Hospital, Uttoxeter Road, Derby, UK. 10. University of Gothenberg, Sahlgrenska Universitetssjukhuset, Göteborg, Sweden. 11. Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK. 12. Yorkshire and Humber Consumer Research Panel, Cottingham, UK. 13. Department of Breast Surgery, Bexley Cancer Centre, St James's University Hospital, Leeds, UK. 14. Liverpool University Hospitals Foundation Trust, Liverpool, UK. 15. Weston Park Hospital, Sheffield, UK. 16. Pinderfields Hospital, Mid Yorkshire NHS Foundation Trust, Wakefield, UK. 17. University Hospitals of Morecambe Bay, Royal Lancashire Infirmary, Lancaster, Lancashire, UK. 18. Royal Berkshire NHS Foundation Trust, Reading, UK. 19. Department of Surgery, Baylor College of Medicine, Houston, TX, USA. 20. Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, UK. Electronic address: l.wyld@sheffield.ac.uk.
Abstract
INTRODUCTION: Older patients with early breast cancer (EBC) derive modest survival benefit from chemotherapy but have increased toxicity risk. Data on the impact of chemotherapy for EBC on quality of life in older patients are limited, but this is a key determinant of treatment acceptance. We aimed to investigate its effect on quality of life in older patients enrolled in the Bridging the Age Gap study. MATERIALS AND METHODS: A prospective, multicentre, observational study of EBC patients ≥70 years old was conducted in 2013-2018 at 56 UK hospitals. Demographics, patient, tumour characteristics, treatments and adverse events were recorded. Quality of life was assessed using the European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaires (EORTC-QLQ) C30, BR23 and ELD 15 plus the Euroqol-5D (eq-5d) over 24 months and analysed at each time point using baseline adjusted linear regression analysis and propensity score-matching. RESULTS: Three thousand and four hundred sixteen patients were enrolled in the study; 1520 patients undergoing surgery and who had high-risk EBC were included in this analysis. 376/1520 (24.7%) received chemotherapy. At 6 months, chemotherapy had a significant negative impact in several EORTC-QLQ-C30 domains, including global health score, physical, role, social functioning, cognition, fatigue, nausea/vomiting, dyspnoea, appetite loss, diarrhoea and constipation. Similar trends were documented on other scales (EORTC-QLQ-BR23, EORTC-QLQ-ELD15 and EQ-5D-5L). Its impact was no longer significant at 18-24 months in unmatched and matched cohorts. CONCLUSIONS: The negative impact of chemotherapy on quality-of-life is clinically and statistically significant at 6 months but resolves by 18 months, which is crucial to inform decision-making for older patients contemplating chemotherapy. TRIAL REGISTRATION NUMBER ISRCTN: 46099296.
INTRODUCTION: Older patients with early breast cancer (EBC) derive modest survival benefit from chemotherapy but have increased toxicity risk. Data on the impact of chemotherapy for EBC on quality of life in older patients are limited, but this is a key determinant of treatment acceptance. We aimed to investigate its effect on quality of life in older patients enrolled in the Bridging the Age Gap study. MATERIALS AND METHODS: A prospective, multicentre, observational study of EBCpatients ≥70 years old was conducted in 2013-2018 at 56 UK hospitals. Demographics, patient, tumour characteristics, treatments and adverse events were recorded. Quality of life was assessed using the European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaires (EORTC-QLQ) C30, BR23 and ELD 15 plus the Euroqol-5D (eq-5d) over 24 months and analysed at each time point using baseline adjusted linear regression analysis and propensity score-matching. RESULTS: Three thousand and four hundred sixteen patients were enrolled in the study; 1520 patients undergoing surgery and who had high-risk EBC were included in this analysis. 376/1520 (24.7%) received chemotherapy. At 6 months, chemotherapy had a significant negative impact in several EORTC-QLQ-C30 domains, including global health score, physical, role, social functioning, cognition, fatigue, nausea/vomiting, dyspnoea, appetite loss, diarrhoea and constipation. Similar trends were documented on other scales (EORTC-QLQ-BR23, EORTC-QLQ-ELD15 and EQ-5D-5L). Its impact was no longer significant at 18-24 months in unmatched and matched cohorts. CONCLUSIONS: The negative impact of chemotherapy on quality-of-life is clinically and statistically significant at 6 months but resolves by 18 months, which is crucial to inform decision-making for older patients contemplating chemotherapy. TRIAL REGISTRATION NUMBER ISRCTN: 46099296.
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