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Morse RT, Bean NW, Hall J, Deal A, Nyrop KA, Abdou Y, Dees EC, Ray EM, Jolly TA, Reeder-Hayes KE, Jones E, Gupta GP, Elmore S, Muss HB, Casey DL. Quality of Life Outcomes in Breast Cancer Patients Receiving Chemotherapy With or Without Radiation Therapy. Clin Breast Cancer 2024:S1526-8209(24)00228-3. [PMID: 39317637 DOI: 10.1016/j.clbc.2024.08.015] [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: 06/14/2024] [Revised: 07/21/2024] [Accepted: 08/19/2024] [Indexed: 09/26/2024]
Abstract
PURPOSE Understanding quality of life (QOL) implications of individual components of breast cancer treatment is important as systemic therapies continue to improve oncologic outcomes. We hypothesized that adjuvant radiation therapy does not significantly impact QOL domains in breast cancer patients undergoing chemotherapy. METHODS Data was drawn from three prospective studies in women with localized breast cancer being treated with chemotherapy from March 2014 to December 2019. Patient-reported measures were collected at baseline (pretreatment) and post-treatment using the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) measure, which consists of 5 subscales. Changes in mean QOL scores in patients who received radiotherapy were compared to those who did not using a one-sided noninferiority method. Statistical significance was determined below 0.05 to meet noninferiority. RESULTS In a sample of 175 patients, 131 were treated with radiation and 44 had no radiation. The sample consisted mostly of stage I-II breast cancer (78%) with hormone receptor positive (59%) disease, receiving either neoadjuvant (36%) or adjuvant chemotherapy (64%). Mean change in QOL for the group treated with radiation compared to no radiation was noninferior with respect to Physical Well-Being (P = .0027), Social/Family Well-Being (P = .0002), Emotional Well-Being (P = .0203), FACIT-Fatigue Subscale (P = .0072), and the Total FACIT-F score (P = .0005); however, mean change in QOL did not meet noninferiority for Functional Well-Being (P = .0594). CONCLUSION Patient-reported QOL from baseline to post-treatment, using the Total FACIT-F score, was noninferior in patients treated with versus without radiation therapy. This finding, in addition to individualized QOL subscales, provides important information in the informed decision-making process when discussing the effects of locoregional radiation on QOL in localized breast cancer patients treated with chemotherapy.
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Affiliation(s)
- Ryan T Morse
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC.
| | - Nathan W Bean
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Jacob Hall
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Allison Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Kirsten A Nyrop
- Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Yara Abdou
- Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Elizabeth C Dees
- Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Emily M Ray
- Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Trevor A Jolly
- Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Katherine E Reeder-Hayes
- Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Ellen Jones
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Gaorav P Gupta
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Shekinah Elmore
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Hyman B Muss
- Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Dana L Casey
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
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Li CL, Chen PY, Yang TY, Chang JTC, Tang WR, Chen ML. Changes in fatigue among cancer patients before, during, and after radiation therapy: A meta-analysis. Worldviews Evid Based Nurs 2024; 21:234-244. [PMID: 37574783 DOI: 10.1111/wvn.12672] [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: 12/05/2022] [Revised: 07/02/2023] [Accepted: 07/04/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Fatigue is a common symptom in cancer patients receiving radiotherapy. However, previous studies report inconsistent patterns of fatigue change. AIM The aim of this study was to estimate changes in fatigue among patients with cancer before, during, and after radiotherapy. METHODS Five databases (PubMed, SDOL, CINAHL Plus with Full Text, Medline [ProQuest], and ProQuest Dissertations) were searched for studies published from January 2006 to May 2021. Three effect sizes of fatigue change (immediate, short-term, and long-term) were calculated for each primary study using standardized mean difference. A random-effect model was used to combine effect sizes across studies. Subgroup analyses and meta-regression were performed to identify potential categorical and continuous moderators, respectively. RESULTS Sixty-five studies were included in this meta-analysis. The weighted mean effect size for immediate, short-term, and long-term effects was 0.409 (p < .001; 95% CI [0.280, 0.537]), 0.303 (p < .001; 95% CI [0.189, 0.417]), and 0.201 (p = .05; 95% CI [-0.001, 0.404]), respectively. Studies with prostate cancer patients had a significantly higher short-term (0.588) and long-term weight mean effect size (0.531) than studies with breast (0.128, -0.072) or other cancers (0.287, 0.215). Higher radiotherapy dosage was significantly associated with a higher effect size for both immediate (β = .0002, p < .05) and short-term (β = .0002, p < .05) effect. LINKING EVIDENCE TO ACTION Findings from this meta-analysis indicated that radiotherapy-induced fatigue (RIF) exist for more than 3 months after the completion of treatment. Assessment of radiation-induced fatigue in cancer patients should extend long after treatment completion, especially for patients with prostate cancer and patients receiving a higher radiation dose. Interventions to reduce fatigue tailored for different treatment phases may be developed.
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Affiliation(s)
- Chia-Ling Li
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Pei-Ying Chen
- Department of Nursing, Yuanpei University of Medical Technology, Hsin-Chu, Taiwan
| | - Tsui-Yun Yang
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Linkou, Taiwan
- School of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Woung-Ru Tang
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Mei-Ling Chen
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial, Tao-Yuan, Taiwan
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Rosas JC, Aguado-Barrera ME, Azria D, Briers E, Elliott R, Farcy-Jacquet MP, Giraldo A, Gutiérrez-Enríquez S, Rancati T, Rattay T, Reyes V, Rosenstein B, De Ruysscher D, Sperk E, Stobart H, Talbot C, Vega A, Taboada-Valladares B, Veldeman L, Ward T, Webb A, West C, Chang-Claude J, Seibold P. Reply to: Comments on "(Pre)treatment risk factors for late fatigue and fatigue trajectories following radiotherapy for breast cancer". Int J Cancer 2024; 154:759-761. [PMID: 37908014 DOI: 10.1002/ijc.34772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 11/02/2023]
Affiliation(s)
- Juan C Rosas
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians University, Munich, Germany
| | - Miguel E Aguado-Barrera
- Instituto de Investigación Sanitaria de Santiago de Compostela, Fundación Pública Galega de Medicina Xenómica (FPGMX), Santiago de Compostela, Spain
| | - David Azria
- University of Montpellier, INSERM U1194 IRCM, Institut du Cancer Montpellier (ICM), Montpellier, France
| | | | | | - Marie-Pierre Farcy-Jacquet
- Federation Universitaire d'Oncologie Radiothérapie d'Occitanie Méditerranée, Institut du Cancer Du Gard (ICG), CHU Carémeau, Nîmes, France
| | - Alexandra Giraldo
- Radiation Oncology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Sara Gutiérrez-Enríquez
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Tiziana Rancati
- Istituto Nazionale dei Tumori, Data Science Unit, Milan, Italy
| | | | - Victoria Reyes
- Radiation Oncology Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Barry Rosenstein
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dirk De Ruysscher
- Maastro Clinic, Maastricht, The Netherlands
- KU Leuven, Leuven, Belgium
| | - Elena Sperk
- Universitätsmedizin Mannheim, Mannheim Cancer Center, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | | | | | - Ana Vega
- Instituto de Investigación Sanitaria de Santiago de Compostela, Fundación Pública Galega de Medicina Xenómica (FPGMX), Santiago de Compostela, Spain
- Biomedical Network on Rare Diseases (CIBERER), Seville, Spain
| | - Begoña Taboada-Valladares
- Instituto de Investigación Sanitaria de Santiago de Compostela, Fundación Pública Galega de Medicina Xenómica (FPGMX), Santiago de Compostela, Spain
- Department of Radiation Oncology, Complexo Hospitalario Universitario de Santiago, SERGAS, Santiago de Compostela, Spain
| | - Liv Veldeman
- Ghent University Hospital, Ghent, Belgium
- Ghent University, Ghent, Belgium
| | | | - Adam Webb
- University of Leicester, Leicester, UK
| | | | - Jenny Chang-Claude
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
- University Cancer Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Petra Seibold
- Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
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Behroozian T, Milton L, Zhang L, Lou J, Shariati S, Karam I, Chow E. A comparison of acute patient-reported outcomes in breast cancer patients with and without regional nodal irradiation using the ESAS and PRFS tool. Support Care Cancer 2023; 31:279. [PMID: 37074458 DOI: 10.1007/s00520-023-07728-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 04/03/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND AND PURPOSE Regional nodal irradiation (RNI) is commonly administered in patients with breast cancer with node-positive disease to prevent cancer recurrence. The purpose of this study is to identify whether RNI is associated with greater acute symptom burden from baseline to 1 to 3 months post completion of radiotherapy (RT) when compared to localized RT. MATERIALS AND METHODS Patient and treatment characteristics were collected prospectively for breast cancer patients with and without RNI from February 2018 to September 2020. The Edmonton Symptom Assessment System (ESAS) and Patient-Reported Functional Status (PRFS) tool were completed by patients at baseline, weekly during RT, and at a 1- to 3-month follow-up visit. The Wilcoxon rank-sum or Fisher exact tests were used to compare variables between patients with or without RNI. RESULTS A total of 781 patients were included in the analysis. Baseline symptom reporting was similar between cohorts, with the exception of PRFS scores (p = 0.0023), which were worse in patients receiving RNI. Across all time points, differences in outcomes between cohorts were minimal, except for lack of appetite (p = 0.03) and PRFS scores (p = 0.049), which were significantly aggravated in patients treated with RNI. CONCLUSION There is insufficient evidence to suggest that RNI is associated with greater symptom burden as assessed with the ESAS. Further research should be conducted over a longer time period to determine the impact of late effects of RNI on patient-reported symptoms.
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Affiliation(s)
- Tara Behroozian
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Lauren Milton
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | | | - Julia Lou
- McMaster University, Hamilton, ON, Canada
| | - Saba Shariati
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Irene Karam
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Edward Chow
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
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Tödt K, Engström M, Ekström M, Efverman A. Fatigue During Cancer-Related Radiotherapy and Associations with Activities, Work Ability and Quality of Life: Paying Attention to Subgroups more Likely to Experience Fatigue. Integr Cancer Ther 2022; 21:15347354221138576. [PMID: 36444775 PMCID: PMC9716605 DOI: 10.1177/15347354221138576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Having knowledge of which patients are more likely to experience fatigue during radiotherapy and the relationship between fatigue and health-related quality of life (HRQL) is important to improve identification and care of patients experiencing burdensome fatigue. OBJECTIVE To identify subgroups of patients, varying in situational, physiological, and psychological factors, who are more likely to experience fatigue an ordinary week of radiotherapy, and to compare patients experiencing and not experiencing fatigue regarding perceived HRQL and functional performance, that is, daily and physical activity and work ability. METHODS Cross-sectional study of 457 patients (52% women) undergoing radiotherapy (38% breast, 32% prostate cancer), using self-reported questionnaire data on fatigue, HRQL and functional performance analyzed using multivariable regression models. RESULTS Of the 448 patients who answered the fatigue question, 321 (72%) experienced fatigue. Patients reporting any comorbidity or depressed mood were more likely to experience fatigue, relative risk (RR) 1.56 ([95% confidence interval (CI)] 1.13-2.16) and RR 2.57 (CI 1.73-3.83), respectively. Patients with fatigue reported worse HRQL and performed less physical activity, including daily (P = .003), vigorous (P = .003) and moderate (P = .002) activity. Patients with and without fatigue reported 60% versus 40% sickness absence. CONCLUSION Patients with depressed mood or comorbidity were more likely to experience fatigue an ordinary week of radiotherapy than other patients were. Patients experiencing fatigue perceived worse HRQL and performed less daily and physical activity compared to patients not experiencing fatigue. Cancer care practitioners may consider paying extra attention to these subgroups of patients.
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Affiliation(s)
- Kristina Tödt
- University of Gävle, Gävle, Sweden,Skåne University Hospital, Lund, Sweden,Kristina Tödt, Department of Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle 801 76, Sweden.
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