Bridging the Age Gap in breast cancer: Impact of chemotherapy on quality of life in older women with early breast cancer

Nicolò Matteo Luca Battisti; Malcolm W R Reed; Esther Herbert; Jenna L Morgan; Karen A Collins; Sue E Ward; Geoffrey R Holmes; Michael Bradburn; Stephen J Walters; Maria Burton; Kate Lifford; Adrian Edwards; Thompson G Robinson; Charlene Martin; Tim Chater; Kirsty J Pemberton; Anne Shrestha; Alan Brennan; Kwok L Cheung; Annaliza Todd; Riccardo A Audisio; Juliet Wright; Richard Simcock; Tracey Green; Deirdre Revell; Jacqui Gath; Kieran Horgan; Chris Holcombe; Matthew C Winter; Jay Naik; Rishi Parmeshwar; Margot A Gosney; Matthew Q Hatton; Alastair M Thompson; Lynda Wyld; Alistair Ring; Age Gap TMG

doi:10.1016/j.ejca.2020.11.022

Bridging the Age Gap in breast cancer: Impact of chemotherapy on quality of life in older women with early breast cancer

Eur J Cancer. 2021 Feb:144:269-280. doi: 10.1016/j.ejca.2020.11.022. Epub 2020 Dec 26.

Authors

Nicolò Matteo Luca Battisti¹, Malcolm W R Reed², Esther Herbert³, Jenna L Morgan⁴, Karen A Collins⁵, Sue E Ward⁶, Geoffrey R Holmes⁶, Michael Bradburn³, Stephen J Walters³, Maria Burton⁵, Kate Lifford⁷, Adrian Edwards⁷, Thompson G Robinson⁸, Charlene Martin⁴, Tim Chater³, Kirsty J Pemberton³, Anne Shrestha⁴, Alan Brennan⁶, Kwok L Cheung⁹, Annaliza Todd⁴, Riccardo A Audisio¹⁰, Juliet Wright², Richard Simcock¹¹, Tracey Green¹², Deirdre Revell¹², Jacqui Gath¹², Kieran Horgan¹³, Chris Holcombe¹⁴, Matthew C Winter¹⁵, Jay Naik¹⁶, Rishi Parmeshwar¹⁷, Margot A Gosney¹⁸, Matthew Q Hatton¹⁴, Alastair M Thompson¹⁹, Lynda Wyld²⁰, Alistair Ring¹; Age Gap TMG

Affiliations

¹ Department of Medicine, Breast Unit the Royal Marsden Hospital NHS Foundation Trust, London, UK; Breast Cancer Research Division, The Institute of Cancer Research, London, UK.
² Brighton and Sussex Medical School, Falmer, Brighton, UK.
³ Clinical Trials Research Unit, School for Health and Related Research, University of Sheffield, Sheffield, UK.
⁴ Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, UK.
⁵ College of Health, Wellbeing and Life Sciences, Department of Allied Health Professions, Sheffield Hallam University, Collegiate Crescent Campus, Sheffield, UK.
⁶ Health Economics and Decision Science Section, School for Health and Related Research (ScHARR), University of Sheffield, UK.
⁷ Division of Population Medicine, Cardiff University, 8th Floor, Neuadd Meirionnydd, Heath Park, Cardiff, UK.
⁸ Department of Cardiovascular Sciences and NIHR Biomedical Research Centre, University of Leicester, Cardiovascular Research Centre, The Glenfield Hospital, Leicester, UK.
⁹ University of Nottingham, Royal Derby Hospital, Uttoxeter Road, Derby, UK.
¹⁰ University of Gothenberg, Sahlgrenska Universitetssjukhuset, Göteborg, Sweden.
¹¹ Sussex Cancer Centre, Royal Sussex County Hospital, Brighton, UK.
¹² Yorkshire and Humber Consumer Research Panel, Cottingham, UK.
¹³ Department of Breast Surgery, Bexley Cancer Centre, St James's University Hospital, Leeds, UK.
¹⁴ Liverpool University Hospitals Foundation Trust, Liverpool, UK.
¹⁵ Weston Park Hospital, Sheffield, UK.
¹⁶ Pinderfields Hospital, Mid Yorkshire NHS Foundation Trust, Wakefield, UK.
¹⁷ University Hospitals of Morecambe Bay, Royal Lancashire Infirmary, Lancaster, Lancashire, UK.
¹⁸ Royal Berkshire NHS Foundation Trust, Reading, UK.
¹⁹ Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
²⁰ Department of Oncology and Metabolism, University of Sheffield Medical School, Beech Hill Road, Sheffield, UK. Electronic address: l.wyld@sheffield.ac.uk.

Abstract

Introduction: Older patients with early breast cancer (EBC) derive modest survival benefit from chemotherapy but have increased toxicity risk. Data on the impact of chemotherapy for EBC on quality of life in older patients are limited, but this is a key determinant of treatment acceptance. We aimed to investigate its effect on quality of life in older patients enrolled in the Bridging the Age Gap study.

Materials and methods: A prospective, multicentre, observational study of EBC patients ≥70 years old was conducted in 2013-2018 at 56 UK hospitals. Demographics, patient, tumour characteristics, treatments and adverse events were recorded. Quality of life was assessed using the European Organisation for Research and Treatment of Cancer Quality-of-Life Questionnaires (EORTC-QLQ) C30, BR23 and ELD 15 plus the Euroqol-5D (eq-5d) over 24 months and analysed at each time point using baseline adjusted linear regression analysis and propensity score-matching.

Results: Three thousand and four hundred sixteen patients were enrolled in the study; 1520 patients undergoing surgery and who had high-risk EBC were included in this analysis. 376/1520 (24.7%) received chemotherapy. At 6 months, chemotherapy had a significant negative impact in several EORTC-QLQ-C30 domains, including global health score, physical, role, social functioning, cognition, fatigue, nausea/vomiting, dyspnoea, appetite loss, diarrhoea and constipation. Similar trends were documented on other scales (EORTC-QLQ-BR23, EORTC-QLQ-ELD15 and EQ-5D-5L). Its impact was no longer significant at 18-24 months in unmatched and matched cohorts.

Conclusions: The negative impact of chemotherapy on quality-of-life is clinically and statistically significant at 6 months but resolves by 18 months, which is crucial to inform decision-making for older patients contemplating chemotherapy.

Trial registration number isrctn: 46099296.

Keywords: Adjuvant chemotherapy; Breast cancer; Older patients; Quality of life.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
Breast Neoplasms / drug therapy
Breast Neoplasms / pathology
Breast Neoplasms / psychology*
Carcinoma, Ductal, Breast / drug therapy
Carcinoma, Ductal, Breast / pathology
Carcinoma, Ductal, Breast / psychology*
Carcinoma, Lobular / drug therapy
Carcinoma, Lobular / pathology
Carcinoma, Lobular / psychology*
Female
Follow-Up Studies
Humans
Prognosis
Prospective Studies
Quality of Life*
Surveys and Questionnaires

Associated data

ISRCTN/ISRCTN46099296

Grants and funding

RP-PG-1209-10071/DH_/Department of Health/United Kingdom