Toxicity of Loco-regional Treatment for Early Breast Cancer: What do our Patients have to say.


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Ee-Siang Choong1, Ada Keding1, Bindu Musunuru1, Jay Naik1, Sreedevi Kumar1
1St James's Institute of Oncology, Leeds, West Yorkshire, UK

Background

We are increasingly treating good prognosis early breast cancers where the benefit from adjuvant treatments is likely to be low. Therefore, toxicity: benefit ratio is critical. Yet, outside of trials there is little published on patient-reported outcomes after loco-regional treatment for early breast cancer.(EBC)

Aim :

To evaluate patient reported breast symptoms following surgery and radiotherapy in EBC and to assess the potential use of quality of life questionnaires to capture radiotherapy toxicity data outside a trial setting

Method

After obtaining consent, consecutive patients were approached at their routine outpatient follow up between 01/05/2011-31/08/2011. All patients had completed adjuvant loco regional radiotherapy 1-5 years prior. Patients completed a questionnaire based on the format used in the QOL-study in the START trial. This included breast and upper body specific questions and a validated ten item body image scale. All questions had a 4 point response format(0-3) with 3 being the worst score. Scales were numerically corrected to allow comparison.

Results

84 patients participated in the study. The median follow up after RT was 35 months. In our study, the mean body image (BIS) score was 3.8(0 -24). mean upper body functional score(FS) was 6(0-30), mean breast score(BS) was 6.7(0-22). Only half the patients scored their breast appearance as excellent or good. From treatment perspective, mastectomy, axillary clearance, SCF radiotherapy and adjuvant chemotherapy recorded worse outcomes. Younger patients scored worse on all three scales. Time on follow up did not appear to influence BS or FS, but BIS improved with time.

Conclusion

Although, general satisfaction following loco regional treatment for breast cancer is high, there is considerable morbidity particularly in younger women. The questionnaires were easy to use and may be helpful in evaluation and management of treatment toxicity in an era of patient led follow up.