Quality of life in elderly patients with localized breast cancer treated with radiotherapy. A prospective study

Highlights

• QL in elderly early stages breast cancer was high along RT and brief follow-up.

• Limitations were moderate in sexuality areas, future perspective and global QL.

• There was a decline in QL at the RT sessions end, that was recovered after six weeks.

• Axillary node dissection patients had a body image decrease in the follow up period.

• Results orientate towards good patients' adaptation to their disease and treatment.

Abstract

Purpose

There is a debate on the role of adjuvant Radiotherapy (RT) in elderly breast cancer patients.

The aim is to study Quality of Life (QL) throughout the treatment and follow-up periods in early stages breast cancer patients who have started radiotherapy, and to compare the QL of axillary surgery groups.

Methods

173 patients, ≥65 years completed the EORTC QLQ-C30 and QLQ-BR23, and the Interview for Deterioration in Daily Living Activities in Dementia(IDDD) questionnaires three times throughout treatment and follow-up periods. Linear mixed effect models were used to evaluate longitudinal changes in QL, and whether these changes differed among axillary surgery groups.

Results

QL scores were high (>70/100 points) in most QL areas, with moderate limitations (>30) in sexual functioning and enjoyment, future perspective and global QL.

In six areas there was a decline at the RT sessions end, that after 6 weeks was recovered. For three areas, there was an improvement in the follow-up measurement compared to the previous assessments. Changes in seven areas were <5 points.

Axillary node dissection patients had a body image decrease (6 points) in the follow up period. The lymphadenectomy group had more fatigue (10 points, p = 0.078) than the other two axillary surgery groups.

Conclusions

Results orientate towards good patients' adaptation to their disease and treatments, and to administering RT in early stages breast cancer patients. QL differences between the axillary surgery groups and in their evolutions were few but have appeared in key QL areas.

Introduction

Elderly patients constitute the largest group in oncologic medical practice [1]. Breast cancer is most prevalent in elderly patients [2], [3], as the risk of breast cancer increases significantly with age [4], [5]. Its management is becoming more important [3]. The number of older women with breast cancer who may be eligible for adjuvant irradiation is rising [6].

There is considerable controversy about what constitutes appropriate care for older breast cancer patients. This controversy is reflected in the persistence of age-dependent variations in care, with older women being less likely to receive standard therapies such as adjuvant Radiotherapy (RT) [6], [7], [8]. Physicians' and patients' assumptions might be misleading, including that elderly patients are unable to withstand treatments. Ballinger et al. [5] consider that older patients are a heterogeneous group, and that other variables, like functional and cognitive abilities, may be a more useful indicator for suitable treatments than age. Browall et al. [9] consider that age should not be used in isolation in decisions about adjuvant treatment in elderly breast cancer patients. Age based differences have been found in some Quality of Life(QL) dimensions in breast cancer patients [10], [11], not necessarily indicating elderly people have more limitations than younger ones.

Elderly patients(>70) are usually excluded from clinical trials [5], [7]. More clinical research is considered necessary in elderly breast cancer patients [8], [12], [13], [14].

QL is considered a key aim in elderly patients [8]. QL assessment has an important role in elderly breast cancer patients, as it can be helpful in aspects like determining the optimal adjuvant regimens for this patient population or offering better supportive care [2], [5], [15], [16].

There has been a debate in the last years about the possible negative role of adjuvant RT in elderly breast cancer patients' QL [7]. Several studies have shown that omission of RT might not increase elderly breast cancer patients' QL [5]. More studies on QL in adjuvant RT are needed to provide a more robust basis for RT practice [2], [6].

QL studies on surgery in elderly breast cancer patients are considered useful: more evidence-based surgical options in elderly cancer patients might lead to an increase in their overall cancer survival and QL [17], [18].

Axillary node dissection (ALND) was initially compared with no surgery in the axille in elderly patients, and was associated with limitations in QL and no clear clinical benefits [19], [20]. Sentinel node surgery (SLNB) is agreed to be an important advance in breast cancer in general, which may cause fewer long-term adverse outcomes than ALND: lower arm morbidity and better QL [21], [22]. More research in QL after different axillary procedures is advised [23], especially in elderly patients, as they are not frequently included in these studies.

Comprehensive Geriatric Assessment is an interdisciplinary evaluation of the heterogeneity of elderly patients. It includes measurements that are related to QL. Its use with cancer patients is recommended [5], [24], [25], [26]. A preliminary study was carried out by our group in a small part of the present sample, which we aim to confirm [27].

The aims of the present study were to assess QL in a sample of elderly early stages breast cancer patients treated with adjuvant RT; to evaluate their QL changes throughout the treatment period, and the differences between axillary surgery groups.

We expected QL scores to be high, with small limitations in emotional and physical areas and with small changes during the treatment period, that improved in the follow-up. We expected differences in the axillary surgery groups to appear in a few emotional and physical areas.