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Observational Study
. 2021 Feb:144:269-280.
doi: 10.1016/j.ejca.2020.11.022. Epub 2020 Dec 26.

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

Nicolò Matteo Luca Battisti  1 , Malcolm W R Reed  2 , Esther Herbert  3 , Jenna L Morgan  4 , Karen A Collins  5 , Sue E Ward  6 , Geoffrey R Holmes  6 , Michael Bradburn  3 , Stephen J Walters  3 , Maria Burton  5 , Kate Lifford  7 , Adrian Edwards  7 , Thompson G Robinson  8 , Charlene Martin  4 , Tim Chater  3 , Kirsty J Pemberton  3 , Anne Shrestha  4 , Alan Brennan  6 , Kwok L Cheung  9 , Annaliza Todd  4 , Riccardo A Audisio  10 , Juliet Wright  2 , Richard Simcock  11 , Tracey Green  12 , Deirdre Revell  12 , Jacqui Gath  12 , Kieran Horgan  13 , Chris Holcombe  14 , Matthew C Winter  15 , Jay Naik  16 , Rishi Parmeshwar  17 , Margot A Gosney  18 , Matthew Q Hatton  14 , Alastair M Thompson  19 , Lynda Wyld  20 , Alistair Ring  1 ; Age Gap TMG
Affiliations
Observational Study

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

Nicolò Matteo Luca Battisti et al. Eur J Cancer. 2021 Feb.

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.

Keywords: Adjuvant chemotherapy; Breast cancer; Older patients; Quality of life.

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Conflict of interest statement

Conflict of interest statement The authors declare no conflict of interest. Professors Stephen Walters and Thompson Robinson are National Institute for Health Research (NIHR) Senior Investigators; Jenna Morgan is a NIHR Clinical Lecturer; and Kate Lifford is funded by the NIHR as part of this project. The views expressed in this article are those of the author(s) and not necessarily those of the NIHR, or the Department of Health and Social Care.

Figures

Fig. 1
Fig. 1
The STROBE flow diagram for the chemotherapy versus no chemotherapy analyses. ∗ Patients who only received palliative chemotherapy regimens where not counted as having received chemotherapy. STROBE, Strengthening the Reporting of Observational Studies in Epidemiology.
Fig. 2
Fig. 2
Mean (95% CI) scores over time points for the chemotherapy versus no chemotherapy population measured on the EORTC-QLQ-C30 scale. CI, confidence interval; EORTC-QLQ, European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaires; QoL, quality of life.
Fig. 3
Fig. 3
Mean (95% CI) scores over time points for the chemotherapy versus no chemotherapy population measured on the EORTC-QLQ-B23 scale. CI, confidence interval; EORTC-QLQ, European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaires.
Fig. 4
Fig. 4
Mean (95% CI) scores over time points for the chemotherapy versus no chemotherapy population measured on the EORTC-QLQ-ELD15 scale. CI, confidence interval; EORTC-QLQ, European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaires.
Fig. 5
Fig. 5
Mean (95% CI) scores over time points for the chemotherapy versus no chemotherapy population measured on the EQ-5D-5L scale. The calculated score is a single summary number (index value) which reflects the health state in the context of the preferences of the general population of a country/region and is derived by applying a formula attaching weights to each of the levels in each dimension as per the EQ-5D-5L User Guide. CI, confidence interval.
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