Bridging the Age Gap in breast cancer: Impact of chemotherapy on quality of life in older women with early breast cancer

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...

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Bibliographic Details
Published in:European journal of cancer (1990) 2021-02, Vol.144, p.269-280
Main Authors: Battisti, Nicolò Matteo Luca, Reed, Malcolm W.R., Herbert, Esther, Morgan, Jenna L., Collins, Karen A., Ward, Sue E., Holmes, Geoffrey R., Bradburn, Michael, Walters, Stephen J., Burton, Maria, Lifford, Kate, Edwards, Adrian, Robinson, Thompson G., Martin, Charlene, Chater, Tim, Pemberton, Kirsty J., Shrestha, Anne, Brennan, Alan, Cheung, Kwok L., Todd, Annaliza, Audisio, Riccardo A., Wright, Juliet, Simcock, Richard, Green, Tracey, Revell, Deirdre, Gath, Jacqui, Horgan, Kieran, Holcombe, Chris, Winter, Matthew C., Naik, Jay, Parmeshwar, Rishi, Gosney, Margot A., Hatton, Matthew Q., Thompson, Alastair M., Wyld, Lynda, Ring, Alistair
Format: Article
Language:English
Subjects:
Adjuvant chemotherapy
Adverse events
Age differences
Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
Appetite loss
Breast cancer
Breast Neoplasms - drug therapy
Breast Neoplasms - pathology
Breast Neoplasms - psychology
Cancer therapies
Carcinoma, Ductal, Breast - drug therapy
Carcinoma, Ductal, Breast - pathology
Carcinoma, Ductal, Breast - psychology
Carcinoma, Lobular - drug therapy
Carcinoma, Lobular - pathology
Carcinoma, Lobular - psychology
Chemotherapy
Cognition
Constipation
Decision making
Demographics
Demography
Diarrhea
Dyspnea
Female
Follow-Up Studies
Global health
Humans
Nausea
Older patients
Original Research
Patients
Prognosis
Prospective Studies
Public health
Quality assessment
Quality of Life
Regression analysis
Respiration
Social interactions
Statistical analysis
Surgery
Surveys and Questionnaires
Toxicity
Tumors
Vomiting
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Summary: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. 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. 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. 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. 46099296. •This is a multicentre, cohort study of 3416 women (aged >70 years) with breast cancer.•In older women with high-risk, early breast cancer, chemotherapy reduces quality of life.•The relevant affected domains include cognition, fatigue, physical, role and social functioning.•Chemotherapy QoL impacts are transient and largely resolve completely by 18–24 months.
ISSN:0959-8049
1879-0852
DOI:10.1016/j.ejca.2020.11.022