Patient and treatment factors associated with adverse quality of life 2 years following radiotherapy – results from the REQUITE breast cancer patient cohort


Session type:

Tim Rattay1, Harkeran Jandu2, Colin Veal2, Petra Seibold3, David Azria4, Ananya Chaudhury5, Alison Dunning6, Dirk de Ruysscher4, Sara Gutierrez-Henriquez7, Philippe Lambin8, Tiziana Rancati4, Barry Rosenstein9, Elena Sperk4, R Paul Symonds2, Christopher Talbot2, Riccardo Valdagni4, Ana Vega4, Liv Veldeman4, Adam Webb2, Hilary Stobart4, Catharine West10
1University of Leicester, Leicester, UK, 2University of Leicester, 3German Cancer Research Center (DKFZ), 4Other, 5The Christie NHS Foundation Trust, 6University of Cambridge, 7Vall d’Hebron Institute of Oncology, 8Maastricht University, 9Icahn School of Medicine at Mount Sinai (ISMMS), 10University of Manchester



The 10-year survival rate for breast cancer is now approaching 80 %.  Previous qualitative research has shown that breast cancer survivors regard long-term quality of life (QoL) as an increasingly important outcome.  This study assessed the relationship between QoL, patient demographic and treatment variables 2 years following radiotherapy.


Breast cancer patients (n=2,059) were recruited prospectively following breast-conserving surgery across eight centres in the UK, Europe and North America into the multicentre REQUITE cohort study ( between 2014 and 2016.  Longitudinal patient reported outcomes (PROs, EORTC-QLQ-C30 and –B23) were available for 1,561 patients at baseline, following radiotherapy, and at 2-year follow-up.  Patient demographic and treatment predictors of health-related QoL across the six domains of Global Health Status, Fatigue, Pain, Body Image, Arm Symptoms and Breast Symptoms were identified using multivariable linear mixed effects models.


Clinician-reported toxicity was poorly correlated with PROs.  Patient BMI was adversely associated with global health status (p=0.003), pain (p<0.001) and fatigue (p=0.01). Smoking negatively affected all QoL domains (p-values between 0.003 and <0.001).  Depression at baseline was adversely associated with global health status, pain and fatigue (all p<0.001).  Analgesic use negatively affected all QoL domains (p=0.004 to <0.001).  Non-European ethnicity was associated with increased fatigue (p=0.007) and arm symptoms (p<0.001).

Prior chemotherapy adversely affected fatigue (p=0.007) and body image (p<0.001), but reduced breast symptoms (beta -4.15, CI -3.12 to -5.18, p<0.001).  Post-operative complications (haematoseroma or infection) negatively affected breast symptoms (p<0.001).  Hypo-fractionated radiotherapy was associated with reduced pain, fatigue and breast symptoms (all p<0.001), whereas use of boost adversely affected global health status (p=0.002), fatigue (p=0.003) and breast symptoms (p<0.001). 


BMI, smoking status, depression, analgesic use at baseline and non-European ethnicity but not other co-morbidities were associated with adverse outcomes across multiple QoL domains.  Hypo-fractionation and boost use strongly affected general QoL and local symptom scales independent of radiotherapy technique.  The effect for chemotherapy was mixed and other co-treatments did not affect PROs in this patient cohort.

Impact statement

The findings of this study help to identify patient and treatment characteristics associated with adverse long-term QoL following breast radiotherapy and should be addressed independently of factors affecting clinician-reported toxicity.