How Pretreatment Quality of Life Relates to Cancer Treatment Adverse Effects

A study in breast cancer found that pretreatment quality of life was associated with chemotherapy dose reductions during treatment and adverse effects after chemotherapy.

A Pioneering Study 

This relationship had not previously been measured. In summary, pretreatment fatigue and impaired physical functioning were associated with dose reduction and post-chemotherapy adverse effects. Quality of life was assessed using the EORTC QLQ-C30 questionnaire.

The findings were published in Cancer on January 15, 2023.

Why Quality of Life Matters in Cancer

Quality of life describes people's satisfaction with their lives and reflects physical, emotional, social, economic and environmental factors. Its measurement assesses views and expectations across different dimensions of life, helping establish how satisfying life is for an individual.

Research has generally focused on how cancer and treatment affect quality of life. This study offers a different perspective.

Physical, emotional and social circumstances may influence treatment delivery, duration and intensity. Better general health and quality of life may facilitate treatment and influence outcomes. Conversely, poorer quality of life can complicate treatment and reduce its effect.

Study Details

Although quality of life is recognized as a survival indicator in advanced cancer, evidence in early breast cancer is less clear.

To understand its role in early breast cancer, researchers analyzed a study enrolling women at 26 French centers with newly diagnosed stage 1-3 breast cancer .

The study investigated baseline quality of life, dose reductions and post-chemotherapy adverse effects in 3079 patients, including 718 receiving neoadjuvant (preoperative tumor-shrinking) chemotherapy and 2361 receiving adjuvant (postoperative preventive) chemotherapy.

Most received taxanes (94.2%) and/or anthracyclines (90.5%). Other major adjuvant treatments were breast radiotherapy (92.6%), trastuzumab (21%) and endocrine therapy (74%). All underwent breast-conserving surgery (74%) and/or lymph node dissection (60%). Fatigue and physical functioning were assessed using EORTC QLQ-C30 (European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire 30).

Among 3079 patients, 15.5% had a chemotherapy dose reduction, and 31% developed post-chemotherapy adverse effects.

After multivariable adjustment for clinical and patient factors, those with baseline fatigue scores above 39 (39 versus 39 or lower) had a dose-reduction risk 1.43 times higher, and a post-chemotherapy adverse-effect risk 1.32 times higher.

The authors also found that baseline physical functioning scores below 83 (83 versus 83 or higher) were associated with higher dose-reduction (1.54-fold) and post-chemotherapy adverse-effect (1.5-fold) rates.

They also found that overall performance status was not associated with these outcomes, suggesting that patient-reported quality of life may be a better indicator.

Conclusion

Pretreatment fatigue and impaired physical functioning may help identify patients at risk of poor chemotherapy tolerance.

Pretreatment quality of life was associated with chemotherapy tolerance and may help anticipate adverse effects and dose reductions.