HRQoL effects of breast cancer prognosis, treatment predict mortality risk
medwireNews: The health-related quality of life (HRQoL) of patients with ductal carcinoma in situ (DCIS) or invasive breast cancer is impaired by their prognosis and treatment, and measuring the extent of impairment could help predict mortality risk, research suggests.
Dale Sandler (National Institutes of Health, Research Triangle Park, North Carolina, USA) and co-investigators say: “The evaluation of HRQOL is important because it may hold potential as a tool for optimizing survivorship care.”
The study included data for 2453 patients with DCIS or invasive breast cancer who completed a survivorship survey, a median of 4.9-years after their initial diagnosis, as part of the Sister Study or Two Sister Study.
The patients had better HRQoL than the general US population, with mean T scores on the 10-item Patient Reported Outcomes Measurement Information System global health scale (PROMIS Global 10) of 51.50 and 51.56 points for the physical and mental components, respectively, versus 50.00 points among the general US population.
Notably, patients diagnosed with a higher disease stage at diagnosis – according to the American Joint Committee on Cancer criteria – had lower mean PROMIS T scores for the physical and mental components than patients with stage 0 disease.
Specifically, patients with stage IV, III, II, and I disease had mean T scores for physical HRQoL that were an average 7.15, 3.08, 2.36, and 0.77 points lower than that for patients with stage 0 disease, after adjusting for various factors including age and race. The corresponding mean reductions in the mental component were 0.45, 2.55, 1.07, and 0.32 points, respectively.
Patients who had a recurrence, metastasis, or secondary malignancy in the 12 months preceding the survey also had worse HRQoL scores than patients with none of the aforementioned events, at a mean of 4.84 points lower on the physical component and 3.45 points lower on the mental component.
Not having versus having breast reconstruction surgery was associated with a mean 1.44 lower PROMIS physical T score. And among patients who did have surgery, women experiencing surgical complications had lower physical and mental T scores, by an average of 2.21 and 2.10 points, respectively than those who did not. Lower mean scores were also seen among women who were dissatisfied with their mastectomy (–7.41 and –10.44 points, respectively) or reconstruction surgery (–4.69 and –5.91 points, respectively), compared with women who were satisfied.
Lower physical HRQoL T scores were reported among patients who had radiation therapy, with or without breast surgery, and those who received any chemotherapy, compared with patients who had a lumpectomy or breast-conserving surgery, with mean scores 2.75 and 3.69 points lower, respectively.
Patients with one or two or more comorbidities had a mean physical PROMIS T score that was 3.96 and 9.76 points lower, respectively, than patients with no comorbidities, and a mean mental PROMIS T score that was 2.27 and 5.92 points lower, respectively.
Within a mean 4 years of completing the survey, 3.5% of the study participants died. In multivariate analysis, patients who had a poor physical or mental health T score – less than 1 standard deviation (SD) below the mean for the US population – had significantly higher adjusted hazard ratios for death than patients with good T scores – equal to or better than 1 SD or more below the mean for the US population – at 3.14 and 2.24, respectively.
“PROMIS global health measures may offer additional insights into patients’ wellbeing and mortality risk,” say the researchers in Cancer.
They conclude: “[O]ur findings reinforce the importance of supportive physical and psychological care for breast cancer survivors,” adding that “when treatment options are being discussed, it is important that patients be informed of possible long-term impairments.”
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