TY - JOUR
T1 - Dynamics of Long-Term Patient-Reported Quality of Life and Health Behaviors After Adjuvant Breast Cancer Chemotherapy
AU - Di Meglio, Antonio
AU - Havas, Julie
AU - Gbenou, Arnauld S.
AU - Martin, Elise
AU - El-Mouhebb, Mayssam
AU - Pistilli, Barbara
AU - Menvielle, Gwenn
AU - Dumas, Agnes
AU - Everhard, Sibille
AU - Martin, Anne Laure
AU - Cottu, Paul H.
AU - Lerebours, Florence
AU - Coutant, Charles
AU - Lesur, Anne
AU - Tredan, Olivier
AU - Soulie, Patrick
AU - Vanlemmens, Laurence
AU - Joly, Florence
AU - Delaloge, Suzette
AU - Ganz, Patricia A.
AU - André, Fabrice
AU - Partridge, Ann H.
AU - Jones, Lee W.
AU - Michiels, Stefan
AU - Vaz-Luis, Ines
N1 - Publisher Copyright:
© American Society of Clinical Oncology.
PY - 2022/4/1
Y1 - 2022/4/1
N2 - PURPOSEWe aimed to characterize long-term quality of life (QOL) trajectories among patients with breast cancer treated with adjuvant chemotherapy and to identify related patterns of health behaviors.METHODSFemale stage I-III breast cancer patients receiving chemotherapy in CANTO (CANcer TOxicity; ClinicalTrials.gov identifier: NCT01993498) were included. Trajectories of QOL (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 Summary Score) and associations with trajectory group membership were identified by iterative estimations of group-based trajectory models and multivariable multinomial logistic regression, respectively.RESULTSFour trajectory groups were identified (N = 4,131): excellent (51.7%), very good (31.7%), deteriorating (10.0%), and poor (6.6%) QOL. The deteriorating trajectory group reported fairly good baseline QOL (mean [95% CI], 78.3/100 [76.2 to 80.5]), which significantly worsened at year-1 (58.1/100 [56.4 to 59.9]) and never recovered to pretreatment values through year-4 (61.1/100 [59.0 to 63.3]) postdiagnosis. Healthy behaviors were associated with better performing trajectory groups. Obesity (adjusted odds ratio [aOR] v lean, 1.51 [95% CI, 1.28 to 1.79]; P <.0001) and current smoking (aOR v never, 1.52 [95% CI, 1.27 to 1.82]; P <.0001) at diagnosis were associated with membership to the deteriorating group, which was also characterized by a higher prevalence of patients with excess body weight and insufficient physical activity through year-4 and by frequent exposure to tobacco smoking during chemotherapy. Additional factors associated with membership to the deteriorating group included younger age (aOR, 1-year decrement 1.01 [95% CI, 1.01 to 1.02]; P =.043), comorbidities (aOR v no, 1.22 [95% CI, 1.06 to 1.40]; P =.005), lower income (aOR v wealthier households, 1.21 [95% CI, 1.07 to 1.37]; P =.002), and endocrine therapy (aOR v no, 1.14 [95% CI, 1.01 to 1.30]; P =.047).CONCLUSIONThis latent-class analysis identified some patients with upfront poor QOL and a high-risk cluster with severe, persistent postchemotherapy QOL deterioration. Screening relevant patient-level characteristics may inform tailored interventions to mitigate the detrimental impact of chemotherapy and preserve QOL, including early addressal of behavioral concerns and provision of healthy lifestyle support programs.
AB - PURPOSEWe aimed to characterize long-term quality of life (QOL) trajectories among patients with breast cancer treated with adjuvant chemotherapy and to identify related patterns of health behaviors.METHODSFemale stage I-III breast cancer patients receiving chemotherapy in CANTO (CANcer TOxicity; ClinicalTrials.gov identifier: NCT01993498) were included. Trajectories of QOL (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 Summary Score) and associations with trajectory group membership were identified by iterative estimations of group-based trajectory models and multivariable multinomial logistic regression, respectively.RESULTSFour trajectory groups were identified (N = 4,131): excellent (51.7%), very good (31.7%), deteriorating (10.0%), and poor (6.6%) QOL. The deteriorating trajectory group reported fairly good baseline QOL (mean [95% CI], 78.3/100 [76.2 to 80.5]), which significantly worsened at year-1 (58.1/100 [56.4 to 59.9]) and never recovered to pretreatment values through year-4 (61.1/100 [59.0 to 63.3]) postdiagnosis. Healthy behaviors were associated with better performing trajectory groups. Obesity (adjusted odds ratio [aOR] v lean, 1.51 [95% CI, 1.28 to 1.79]; P <.0001) and current smoking (aOR v never, 1.52 [95% CI, 1.27 to 1.82]; P <.0001) at diagnosis were associated with membership to the deteriorating group, which was also characterized by a higher prevalence of patients with excess body weight and insufficient physical activity through year-4 and by frequent exposure to tobacco smoking during chemotherapy. Additional factors associated with membership to the deteriorating group included younger age (aOR, 1-year decrement 1.01 [95% CI, 1.01 to 1.02]; P =.043), comorbidities (aOR v no, 1.22 [95% CI, 1.06 to 1.40]; P =.005), lower income (aOR v wealthier households, 1.21 [95% CI, 1.07 to 1.37]; P =.002), and endocrine therapy (aOR v no, 1.14 [95% CI, 1.01 to 1.30]; P =.047).CONCLUSIONThis latent-class analysis identified some patients with upfront poor QOL and a high-risk cluster with severe, persistent postchemotherapy QOL deterioration. Screening relevant patient-level characteristics may inform tailored interventions to mitigate the detrimental impact of chemotherapy and preserve QOL, including early addressal of behavioral concerns and provision of healthy lifestyle support programs.
UR - http://www.scopus.com/inward/record.url?scp=85130143265&partnerID=8YFLogxK
U2 - 10.1200/JCO.21.00277
DO - 10.1200/JCO.21.00277
M3 - Article
C2 - 35446677
AN - SCOPUS:85130143265
SN - 0732-183X
VL - 385
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
ER -