The Asco Post

Timing and Choice of Treatment May Affect the Quality of Life of Young Breast Cancer Survivors

By Susan Reckling
Posted: 11/15/2013 3:39:17 PM
Last Updated: 11/15/2013 3:39:17 PM

Key Points:
  • Most young breast cancer patients surveyed did not experience shifts in family or home as a consequence of their treatment.
  • Systemic therapy had no statistically significant impact on any single quality-of-life domain or on overall quality of life.
  • Locoregional therapies such as therapeutic mastectomy, contralateral prophylactic mastectomy, and radiation therapy had the greatest impact on quality-of-life indicators.

The choice and timing of therapeutic interventions may significantly affect the quality of life of young breast cancer survivors in the short term, although other quality-of-life domains such as family relationships may not be negatively impacted after treatment. These findings were reported by Marie Catherine Lee, MD, and colleagues at H. Lee Moffitt Cancer Center and Research Institute in Tampa, Florida, in a recent issue of the American Journal of Surgery.

Study Details

The investigators examined the short-term quality-of-life impairment of 300 premenopausal patients with breast cancer, who were diagnosed before the age of 50 years. Areas of focus included self-perception, views on their sexuality, impact of surgical and oncologic treatment, femininity, and changes in relationships with partners and other family members. All of the women were at least 6 months from their last curative treatment (except for ongoing hormone therapy).

Survey questionnaires—which included 50 validated questions from other tools and 13 new, unvalidated quality-of-life items—were sent to all 300 women, and nearly 50% responded. Eight domain clusters centered on family/social network, appearance, relationships, sexuality, work/finances, physical symptoms, distress, and life with breast cancer. Other questions focused on demographics and treatment, and the investigators collected specific treatment data from electronic medical records for correlation with patient-reported information.

Of the 143 respondents, 86% were white, and the mean age at diagnosis was 40.4 years (range, 26.6–48.1). Half of these women were diagnosed between the ages of 41 and 50 years, more than 40% were diagnosed between the ages of 31 and 40 years, and the others were diagnosed before 30 years of age. Most of the patients were married or partnered (83%) and had at least one child (81%). About 20% received chemotherapy in the neoadjuvant setting, and 67% were given chemotherapy in the adjuvant setting.

Treatment Effects on Quality-of-Life Domains

The investigators found that the majority of surveyed patients did not experience shifts in family or home as a result of their treatment for breast cancer. Significantly lower overall quality-of-life interference scores were reported in partnered women than in unmarried women (P = .002), but marital status did not relate to interference with sexuality or sexual attractiveness. Age at diagnosis did not significantly affect any single domain or overall quality of life.

Although the use of systemic therapy had no statistically significant impact on quality of life, locoregional therapies such as therapeutic mastectomy, contralateral prophylactic mastectomy, and radiation therapy had the greatest impact on quality-of-life indicators. Dr. Lee and colleagues noted that they were surprised to find that neither the use nor the timing of systemic therapy had any effect on quality of life.

Surgical treatments clearly were related to quality of life, particularly in the domains of appearance (P < .001) and work and finances (P = .02). Higher quality-of-life interference scores were reported in patients undergoing mastectomy (35%) and mastectomy with reconstruction (23%).

Moreover, the use of contralateral prophylactic mastectomy had a significant effect on sexuality (P = .03), with the 54 patients (38%) who underwent immediate contralateral prophylactic mastectomy reporting higher interference scores than those undergoing delayed contralateral prophylactic mastectomy (9%) or no such surgery. The investigators emphasized that the negative effects on sexuality and appearance associated with contralateral prophylactic mastectomy should be taken into consideration when physicians and surgeons counsel their patients on the use and timing of procedures in an unaffected breast.

Quality of life was also affected by radiation therapy, particularly in the domains of appearance (P < .001), sexuality (P = .02), and work and finances (P = .03). The effects of radiation therapy on quality of life were closely tied to surgical decision-making, given that those who underwent lumpectomy received whole-breast radiation therapy and many of those who underwent mastectomy did not receive adjuvant radiation therapy at all. The investigators were not surprised that women who underwent breast conservation followed by standard whole-breast irradiation or no radiation therapy reported lower quality-of-life interference scores in all domains than women undergoing mastectomy.

In closing, the investigators declared, “Our hope is that physicians and surgeons will take these findings into consideration when counseling young patients regarding local and regional therapies, particularly the timing and impact of contralateral prophylactic mastectomy.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.

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