Long-term improvement of quality of life in patients with breast cancer: supporting patient-physician communication by an electronic tool for inpatient and outpatient care

Abstract

Purpose: The effectiveness of a pathway with quality of life (QoL) diagnosis and therapy has been already demonstrated in an earlier randomized trial (RCT) in patients with breast cancer. We refined the pathway by developing and evaluating an electronic tool for QoL assessment in routine inpatient and outpatient care.

Methods: In a single-arm study, patients with breast cancer with surgical treatment in two German hospitals were enrolled. QoL (EORTC QLQ-C30, QLQ-BR23) was measured with an electronic tool after surgery and during aftercare in outpatient medical practices (3, 6, 9, 12, 18, and 24 months) so that results (QoL-profile) were available immediately. Feedback by patients and physicians was analyzed to evaluate feasibility and impact on patient-physician communication.

Results: Between May 2016 and July 2018, 56 patients were enrolled. Physicians evaluated the QoL pathway as feasible. Patients whose physician regularly discussed QoL-profiles with them reported significantly more often that their specific needs were cared for (p < .001) and that their physician had found the right treatment strategy for these needs (p < .001) compared with patients whose doctor never/rarely discussed QoL-profiles. The latter significantly more often had no benefit from QoL assessments (p < .001).

Conclusion: The QoL pathway with electronic QoL assessments is feasible for inpatient and outpatient care. QoL results should be discussed directly with the patient.

Clinical trial information: NCT04334096, date of registration 06.04.2020.

Keywords: Breast cancer; Complex intervention; Electronic assessment; Patient-physician communication; Patient-reported outcomes; Quality of life.

Fig. 1

Quality of life (QoL-) profile: woman with primary breast cancer, 49 years, married, one child, working. Prognostic classification pT1b(m), SN0, M0, G1, ER pos, PR pos, HER2 neg; breast-conserving surgical therapy with revision surgery after 1 month followed by radiation and anti-estrogen treatment. Red bar = cutoff for a need for QoL therapy (< 50 points)

Fig. 2

Flow chart

Fig. 3

Rates of patients with a need for quality of life (QoL) therapy (QoL < 50 points on at least one of ten scales) in the present sample compared with two historical controls of the previous RCT (namely RCT’s intervention and control group) [13] over 12 months; scale “financial functioning” was excluded from the analyzes because this scale was not part of the RCT; rates at 18 and 24 months are not analyzed because these were not assessed in the RCT; χ² tests: 0 months p = .54, 3 months p = .32, 6 months p = .14, 9 months p = .66, 12 months p = .77