Acute toxicity and quality of life in breast cancer patients treated by radiotherapy – results from the REQUITE multi-centre cohort study

BackgroundAlthough patient-reported outcomes (PROs) to assess health-related quality-of-life (QoL) are increasingly incorporated in radiotherapy trials, QoL in the acute period following treatment remains under-reported. This study assessed the relationship between QoL in the acute treatment phase, toxicity, patient and treatment variables in breast cancer patients.MethodsBreast cancer patients (n = 2,072) were recruited following breast-conserving surgery across eight centres in Europe and North America into a multicentre prospective cohort study (www.requite.eu). Treatment data, toxicity scored according to CTCAE v4.0, and PROs from EORTC-QLQ-C30 and –B23 were available for 1,750 patients at baseline and on completion of radiotherapy. Association of acute toxicity endpoints (dichotomised) and worsening QoL (≥ 10 point change from baseline) was investigated using multivariate logistic regression, adjusted for age, BMI, total radiotherapy dose, seroma, chemotherapy, tamoxifen, analgesic use, smoking and alcohol intake.ResultsBy the end of radiotherapy, 24.2 % of patient experienced ≥ grade 2 erythema, 31.6 % ≥ grade 1 oedema, and 9.5 % were affected by acute desquamation (skin loss). Global health status, fatigue, pain, and breast symptoms worsened significantly compared to baseline. Acute erythema and acute desquamation were significantly associated with worsening breast symptoms (OR 1.71, 95 % CI 1.41-2.06; and OR 1.77, 1.18-2.67), while acute erythema was also associated with worsening pain (1.24, 1.03-1.50). There was no significant association of any acute toxicity endpoint with worsening global health status.ConclusionsManagement of early toxicities that affect breast-specific symptoms and pain may improve QoL during radiotherapy. Overall QoL (global health status) during breast radiotherapy is likely to be influenced by a range of non-treatment factors.