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Robins VR, Gelcich S, Absolom K, Velikova G. The impact of age on physical functioning after treatment for breast cancer, as measured by patient-reported outcome measures: A systematic review. Breast 2024; 76:103734. [PMID: 38691921 PMCID: PMC11070762 DOI: 10.1016/j.breast.2024.103734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/04/2024] [Accepted: 04/15/2024] [Indexed: 05/03/2024] Open
Abstract
PURPOSE This systematic review aims to explore the impact of age on physical functioning post-treatment for early-stage, locally advanced, or locally recurrent breast cancer, as measured by patient-reported outcome measures (PROMs), identify PROMs used and variations in physical functioning terms/labels. METHODS MEDLINE, EmBase, PsycINFO, CINAHL and AMED were searched, along with relevant key journals and reference lists. Risk of bias (quality) assessment was conducted using a Critical Appraisal Skills Programme checklist. Data was synthesised through tables and narrative. RESULTS 28,207 titles were extracted from electronic databases, resulting in 44 studies with age sub-groups, and 120 without age sub-groups. Of those with findings on the impact of age, there was variability in the way findings were reported and 21 % found that age did not have a significant impact. However, 66 % of the studies found that with older age, physical functioning declined post-treatment. Comorbidities were associated with physical functioning declines. However, findings from sub-groups (breast cancer stage, treatment type and time post-treatment) lacked concordance. Twenty-eight types of PROM were used: the EORTC QLQ-C30 was most common (50.6 %), followed by the SF-36 (32.3 %). There were 145 terms/labels for physical functioning: 'physical functioning/function' was used most often (82.3 %). CONCLUSIONS Findings point towards an older age and comorbidities being associated with more physical functioning declines. However, it was not possible to determine if stage, treatment type and time since treatment had any influence. More consistent use of the terminology 'physical functioning/function' would aid future comparisons of study results.
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Affiliation(s)
- V R Robins
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, England, UK.
| | - S Gelcich
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, England, UK.
| | - K Absolom
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, England, UK; Leeds Institute of Health Sciences, University of Leeds, Leeds, England, UK.
| | - G Velikova
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, England, UK; Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, England, UK.
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Pelzer F, Tröger W, Reif M, Schönberg S, Martin DD, Müller C, Utz-Billing I, Kühn T, Baumgartner S, Kiechle M, Paepke D. Fatigue and quality of life during neoadjuvant chemotherapy of early breast cancer: a prospective multicenter cohort study. Breast Cancer 2024; 31:124-134. [PMID: 37966690 PMCID: PMC10764505 DOI: 10.1007/s12282-023-01520-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 10/22/2023] [Indexed: 11/16/2023]
Abstract
BACKGROUND Few measurements of fatigue and quality of life have been performed during neoadjuvant chemotherapy of early breast cancer. This study evaluates fatigue and quality of life experienced by early breast cancer patients during neoadjuvant chemotherapy and their association with different clinical parameters. METHODS Fifty-four stage I-III patients' responses to the Multidimensional Fatigue Inventory (MFI) and to the Functional Assessment of Cancer Therapy-Breast (FACT-B) were analyzed by a linear covariance pattern model. Chemotherapy regimen, age, baseline fatigue level, body-mass-index and cancer stage were added to the model to estimate their impact on both outcomes. RESULTS All fatigue dimensions worsened in clinically relevant levels. Physical fatigue worsened the most, mental fatigue the least. For quality of life, physical and functional well-being worsened the most. Only emotional well-being improved during chemotherapy. Physical well-being worsened more during standard than during dose-dense chemotherapy, and more during anthracycline than during taxane cycles. Age, body-mass-index and cancer stage had no impact. The higher the fatigue levels at baseline, the less they worsened during chemotherapy. CONCLUSIONS Further actions to reduce fatigue and improve quality of life during neoadjuvant chemotherapy of early breast cancer are needed. Focus should be laid on the physical dimension. Future research should also investigate the impact of different chemotherapy sequences and densities on fatigue and quality of life. STUDY REGISTRATION The study was registered in the German Clinical Trials Register in May 2019 (DRKS00016761).
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Affiliation(s)
- Florian Pelzer
- Institute for Integrative Medicine, Witten/Herdecke University, Witten, Germany.
- Society for Cancer Research, Arlesheim, Switzerland.
| | | | - Marcus Reif
- Gesellschaft Für Klinische Forschung e.V., Berlin, Germany
| | | | - David D Martin
- Institute for Integrative Medicine, Witten/Herdecke University, Witten, Germany
- Tübingen University Children's Hospital, Tübingen, Germany
| | - Cornelia Müller
- Brandenburgisches Brustzentum, Universitätsklinikum Brandenburg an der Havel, Brandenburg an der Havel, Germany
| | | | - Thorsten Kühn
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Esslingen, Esslingen, Germany
- Filderklinik, Filderstadt, Germany
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Stephan Baumgartner
- Institute for Integrative Medicine, Witten/Herdecke University, Witten, Germany
- Society for Cancer Research, Arlesheim, Switzerland
- Gesellschaft Für Klinische Forschung e.V., Berlin, Germany
| | - Marion Kiechle
- Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniela Paepke
- Department of Obstetrics and Gynecology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
- Spital Zollikerberg, Zurich, Switzerland
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Thompson S, Madsen LT, Bazzell A. Impact of Fasting on Patients With Cancer: An Integrative Review. J Adv Pract Oncol 2023; 14:608-619. [PMID: 38196666 PMCID: PMC10715290 DOI: 10.6004/jadpro.2023.14.7.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024] Open
Abstract
Background Patients with cancer often pursue nutrition as an avenue to positively impact their care management and disease outcomes. Nutritional interventions are increasing in popularity, especially intermittent fasting as an adjunct to chemotherapy. However, limited research is available on the impact of intermittent fasting on patients with cancer. Methods A comprehensive literature search was conducted using Ovid MEDLINE, Ovid EMBASE, and CINAHL databases. Results 514 articles were identified from the three databases. Seven studies remained after applying inclusion and exclusion criteria. The seven studies included in this review examined fasting compliance, malnutrition, therapy side effects, endocrine parameters, quality of life measures, and cancer outcomes. Data suggest overall good compliance, no malnutrition, minimal side effects, a trend toward improved endocrine parameters, unchanged quality of life (QOL), and mixed results for cancer outcomes. Conclusion Intermittent fasting as an adjunct to chemotherapy in normal-weight patients with cancer has potential as a safe, tolerable, and feasible nutritional intervention that could positively impact treatment outcomes and QOL. Large-scale randomized controlled trials are needed to validate these findings and determine what future role intermittent fasting may play in cancer management.
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Affiliation(s)
- Samantha Thompson
- From Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lydia T Madsen
- From Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Angela Bazzell
- From Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
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Krepper D, Giesinger JM, Dirven L, Efficace F, Martini C, Thurner AMM, Al-Naesan I, Gross F, Sztankay MJ. Information about missing patient-reported outcome data in breast cancer trials is frequently not documented: a scoping review. J Clin Epidemiol 2023; 162:1-9. [PMID: 37517504 DOI: 10.1016/j.jclinepi.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVES This review addresses the common problem of missing patient-reported outcome (PRO) data in clinical trials by assessing the current practice of their statistical handling as reported in publications of randomized controlled trials (RCTs) in patients with breast cancer. STUDY DESIGN AND SETTING We searched PubMed to identify RCTs evaluating biomedical treatments in breast cancer patients with at least one PRO endpoint published between January 2019 and February 2022. Two reviewers independently assessed the eligibility of the publications for this scoping review and extracted prespecified information on missing PRO data and related statistical practices. RESULTS Of 1,598 publications identified, 118 trials met the inclusion criteria. Eighty-eight (74.6%) trials reported the extent of missing data, with 11 (9.3%) not containing any missing PRO data. Twenty-one (19.6%) trials explicitly stated the statistical approach for handling missing data, with a preference for single imputation over multiple imputation approaches (57.2%/19.0%). Only six (5.6%) trials reported a sensitivity analysis to examine the extent to the results being affected by changes in assumptions made about missing PRO data. CONCLUSION International efforts to raise awareness of the importance of accurately reporting state-of-the-art handling of missing PRO data are not yet fully reflected in the current literature of breast cancer RCTs.
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Affiliation(s)
- Daniela Krepper
- Department of Psychiatry, Psychotherapy Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria.
| | - Johannes Maria Giesinger
- Department of Psychiatry, Psychotherapy Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Linda Dirven
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA), Data Center and Health Outcomes Research Unit, Rome, Italy
| | - Caroline Martini
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Anna Margarete Maria Thurner
- Department of Psychiatry, Psychotherapy Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Imad Al-Naesan
- Department of Psychiatry, Psychotherapy Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Franziska Gross
- Department of Psychiatry, Psychotherapy Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | - Monika Judith Sztankay
- Department of Psychiatry, Psychotherapy Psychosomatics and Medical Psychology, University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
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Loibl S, Loirat D, Tolaney SM, Punie K, Oliveira M, Rugo HS, Bardia A, Hurvitz SA, Brufsky AM, Kalinsky K, Cortés J, O'Shaughnessy JA, Dieras V, Carey LA, Gianni L, Gharaibeh M, Preger L, Phan S, Chang L, Shi L, Piccart MJ. Health-related quality of life in the phase III ASCENT trial of sacituzumab govitecan versus standard chemotherapy in metastatic triple-negative breast cancer. Eur J Cancer 2023; 178:23-33. [PMID: 36379186 PMCID: PMC11195534 DOI: 10.1016/j.ejca.2022.10.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/10/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND The antibody-drug conjugate sacituzumab govitecan (SG) prolongs progression-free survival and overall survival in patients with refractory/relapsed metastatic triple-negative breast cancer (mTNBC). Here, we investigated its effect on health-related quality of life (HRQoL). METHODS This analysis was based on the open-label phase III ASCENT trial (NCT02574455). Adults with refractory/relapsed mTNBC who had received ≥2 prior systemic therapies (≥1 in the metastatic setting) were randomised 1:1 to SG or treatment of physician's choice (TPC; capecitabine, eribulin, vinorelbine, or gemcitabine). HRQoL was assessed on day 1 of each treatment cycle using the EORTC QLQ-C30. Score changes from baseline were analysed using linear mixed-effect models for repeated measures. Stratified Cox regressions evaluated time to first clinically meaningful change of HRQoL. RESULTS The analysis population comprised 236 patients randomised to SG and 183 to TPC. For global health status (GHS)/QoL, physical functioning, fatigue, and pain, changes from baseline were superior for SG versus TPC. Compared with TPC, SG was inferior regarding changes from baseline for nausea/vomiting and diarrhoea but non-inferior for other QLQ-C30 domains. Median time to first clinically meaningful worsening was longer for SG than for TPC for physical functioning (22.1 versus 12.1 weeks, P < 0.001), role functioning (11.4 versus 7.1 weeks, P < 0.001), fatigue (7.7 versus 6.0 weeks, P < 0.05), and pain (21.6 versus 9.9 weeks, P < 0.001). CONCLUSIONS SG was generally associated with greater improvements and delayed worsening of HRQoL scores compared with TPC. This supports the favourable profile of SG as an mTNBC treatment.
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Affiliation(s)
- Sibylle Loibl
- Hämatologisch-Onkologische Gemeinschaftspraxis Am Bethanien-Krankenhaus, Frankfurt, Germany.
| | - Delphine Loirat
- Medical Oncology Department and D3i, Institut Curie, Paris, France
| | - Sara M Tolaney
- Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kevin Punie
- Department of General Medical Oncology and Multidisciplinary Breast Centre, Leuven Cancer Institute, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Mafalda Oliveira
- Medical Oncology Department and Breast Cancer Group, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Hope S Rugo
- Department of Medicine, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Aditya Bardia
- Department of Hematology and Oncology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
| | - Sara A Hurvitz
- Department of Medicine, Division of Hematology/Medical Oncology, David Geffen School of Medicine, University of California, Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Adam M Brufsky
- Division of Hematology/Oncology, Magee-Womens Hospital and the Hillman Cancer Center, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kevin Kalinsky
- Department of Medicine, Columbia University Irving Medical Center, New York, USA; Department of Hematology and Medical Oncology, Winship Cancer Institute at Emory University, Atlanta, GA, USA
| | - Javier Cortés
- Oncology Department, International Breast Cancer Center (BCC), Pangaea Oncology, Quirónsalud, Barcelona, Spain; Department of Medicine, Faculty of Biomedical and Health Sciences, European University of Madrid, Madrid, Spain
| | - Joyce A O'Shaughnessy
- Medical Oncology, Texas Oncology - Baylor Charles A. Sammons Cancer Center, Dallas, TX, USA
| | - Véronique Dieras
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Lisa A Carey
- Medicine - Hematology/Oncology Division, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
| | - Luca Gianni
- Medical Oncology, Gianni Bonadonna Foundation, Milano, Italy
| | - Mahdi Gharaibeh
- Department of Global Value and Access, Gilead Sciences, Inc., Foster City, CA, USA
| | - Luciana Preger
- Department of Medical Affairs, Gilead Sciences, Inc., Foster City, CA, USA
| | - See Phan
- Department of Clinical Development, Gilead Sciences, Inc., Foster City, CA, USA
| | - Lawrence Chang
- Department of Global Value and Access, Gilead Sciences, Inc., Foster City, CA, USA
| | - Ling Shi
- Evidence Synthesis, Modeling & Communication (EMC), Evidera PPD, Waltham, MA, USA
| | - Martine J Piccart
- Medical Oncology Department, Institut Jules Bordet and l'Université Libre de Bruxelles, Brussels, Belgium
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A graphical LASSO analysis of global quality of life, sub scales of the EORTC QLQ-C30 instrument and depression in early breast cancer. Sci Rep 2022; 12:2112. [PMID: 35136160 PMCID: PMC8826362 DOI: 10.1038/s41598-022-06138-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 01/25/2022] [Indexed: 12/20/2022] Open
Abstract
We aimed to (a) investigate the interplay between depression, symptoms and level of functioning, and (b) understand the paths through which they influence health related quality of life (QOL) during the first year of rehabilitation period of early breast cancer. A network analysis method was used. The population consisted of 487 women aged 35–68 years, who had recently completed adjuvant chemotherapy or started endocrine therapy for early breast cancer. At baseline and at the first year from randomization QOL, symptomatology and functioning by the EORTC QLQ-C30 and BR-23 questionnaires, and depression by the Finnish version of Beck's 13-item depression scale, were collected. The multivariate interplay between the related scales was analysed via regularized partial correlation networks (graphical LASSO). The median global quality of life (gQoL) at baseline was 69.9 ± 19.0 (16.7–100) and improved to 74.9 ± 19.0 (0–100) after 1 year. Scales related to mental health (emotional functioning, cognitive functioning, depression, insomnia, body image, future perspective) were clustered together at both time points. Fatigue was mediated through a different route, having the strongest connection with physical functioning and no direct connection with depression. Multiple paths existed connecting symptoms and functioning types with gQoL. Factors with the strongest connections to gQoL included: social functioning, depression and fatigue at baseline; emotional functioning and fatigue at month 12. Overall, the most important nodes were depression, gQoL and fatigue. The graphical LASSO network analysis revealed that scales related to fatigue and emotional health had the strongest associations to the EORTC QLQ-C30 gQoL score. When we plan interventions for patients with impaired QOL it is important to consider both psychological support and interventions that improve fatigue and physical function like exercise. Trial registration: http://www.clinicaltrials.gov/ (identifier number NCT00639210).
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Crumpei-Tanasă I, Crumpei I. A Machine Learning Approach to Predict Stress Hormones and Inflammatory Markers Using Illness Perception and Quality of Life in Breast Cancer Patients. ACTA ACUST UNITED AC 2021; 28:3150-3171. [PMID: 34436041 PMCID: PMC8395480 DOI: 10.3390/curroncol28040275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/15/2021] [Accepted: 08/17/2021] [Indexed: 11/16/2022]
Abstract
Psychosocial factors have become central concepts in oncology research. However, their role in the prognosis of the disease is not yet well established. Studies on this subject report contradictory findings. We examine if illness perception and quality of life reports measured at baseline could predict the stress hormones and inflammatory markers in breast cancer survivors, one year later. We use statistics and machine learning methods to analyze our data and find the best prediction model. Patients with stage I to III breast cancer (N = 70) were assessed twice, at baseline and one year later, and completed scales assessing quality of life and illness perception. Blood and urine samples were obtained to measure stress hormones (cortisol and adrenocorticotropic hormone (ACTH) and inflammatory markers (c-reactive protein (CRP), erythrocyte sedimentation rate (ESR) and fibrinogen). Family quality of life is a strong predictor for ACTH. Women who perceive their illness as being more chronic at baseline have higher ESR and fibrinogen values one year later. The artificial intelligence (AI) data analysis yields the highest prediction score of 81.2% for the ACTH stress hormone, and 70% for the inflammatory marker ESR. A chronic timeline, illness control, health and family quality of life were important features associated with the best predictive results.
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Affiliation(s)
- Irina Crumpei-Tanasă
- Department of Psychology, Faculty of Psychology and Educational Sciences, Alexandru Ioan Cuza University, 700554 Iași, Romania
- Correspondence:
| | - Iulia Crumpei
- Faculty of Medicine, Grigore T. Popa University, 700115 Iași, Romania;
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Quality of life and illness perceptions in patients with breast cancer using a fasting mimicking diet as an adjunct to neoadjuvant chemotherapy in the phase 2 DIRECT (BOOG 2013-14) trial. Breast Cancer Res Treat 2020; 185:741-758. [PMID: 33179154 PMCID: PMC7921018 DOI: 10.1007/s10549-020-05991-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023]
Abstract
Purpose In the phase II DIRECT study a fasting mimicking diet (FMD) improved the clinical response to neoadjuvant chemotherapy as compared to a regular diet. Quality of Life (QoL) and illness perceptions regarding the possible side effects of chemotherapy and the FMD were secondary outcomes of the trial. Methods 131 patients with HER2-negative stage II/III breast cancer were recruited, of whom 129 were randomly assigned (1:1) to receive either a fasting mimicking diet (FMD) or their regular diet for 3 days prior to and the day of neoadjuvant chemotherapy. The European Organisation for Research and Treatment of Cancer (EORTC) questionnaires EORTC-QLQ-C30 and EORTC-QLQ-BR23; the Brief Illness Perception Questionnaire (BIPQ) and the Distress Thermometer were used to assess these outcomes at baseline, halfway chemotherapy, before the last cycle of chemotherapy and 6 months after surgery. Results Overall QoL and distress scores declined during treatment in both arms and returned to baseline values 6 months after surgery. However, patients’ perceptions differed slightly over time. In particular, patients receiving the FMD were less concerned and had better understanding of the possible adverse effects of their treatment in comparison with patients on a regular diet. Per-protocol analyses yielded better emotional, physical, role, cognitive and social functioning scores as well as lower fatigue, nausea and insomnia symptom scores for patients adherent to the FMD in comparison with non-adherent patients and patients on their regular diet. Conclusions FMD as an adjunct to neoadjuvant chemotherapy appears to improve certain QoL and illness perception domains in patients with HER2-negative breast cancer. Trialregister ClinicalTrials.gov Identifier: NCT02126449. Electronic supplementary material The online version of this article (10.1007/s10549-020-05991-x) contains supplementary material, which is available to authorized users.
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