Comparison of early quality of life in patients treated with radiotherapy following mastectomy or breast conservation therapy: A prospective study

doi:10.1016/j.radonc.2010.04.008

Radiotherapy and Oncology

Volume 97, Issue 2, November 2010, Pages 288-293

https://doi.org/10.1016/j.radonc.2010.04.008 Get rights and content

Abstract

Introduction

To compare quality of life (QOL) in breast cancer patients from a developing country after breast conservation surgery (BCS) or mastectomy and adjuvant radiotherapy (RT).

Materials and methods

In a 6-month period, all consecutive early and locally advanced breast cancer patients treated with either BCS or mastectomy and treated with RT were analyzed. All patients who underwent mastectomy were treated with 45 Gray/20#/4 weeks. Patients with BCS were treated with a dose of 45–50 Gray/25#/5 weeks to whole breast followed by tumor bed boost (15 Gray/6#/6 days with suitable energy electrons). Prospective evaluation of QOL using EORTC QLQ C30 and breast cancer specific QLQ BR23 was done before starting RT (baseline), at mid-RT and at RT conclusion for all patients.

Results

One hundred and thirteen patients had mastectomy and 142 patients underwent BCS. Reliability test (Cronbach alpha) for questionnaire filling was 0.669–0.886. At pre-RT assessment, global QOL scores in mastectomy and BCS groups were 71.1 and 71.3, respectively. There was no significant difference in pre-RT EORTC QLQ C30 functional and symptom domains between mastectomy and BCS patients. However, social function domain score was higher in patients who underwent mastectomy (83 versus 73.9; p = 0.018). In QLQ BR23 domains, body image and sexual functioning domains were similar between the two groups. However, sexual enjoyment (10.9 versus 47.6; p = 0.006) and future perspective (7.4 versus 37.1; p = 0.036) domains were significantly better in BCS arm. There was no difference between systemic side effect (BRSSE), breast symptom (BRBS) and arm symptom (BRAS) domain scores between the groups. There was no significant difference in change of QOL scores between mastectomy and BCS patients at RT completion as compared to baseline.

Conclusions

There was no significant difference in quality of life in patients with BCS versus those with mastectomy. However, patients who underwent BCS had better sexual enjoyment and future perspective scores compared with mastectomy patients. There was no significant change of QOL domain scores after RT in mastectomy and BCS patients.

Section snippets

Material and methods

All consecutive patients registered at Tata Memorial Hospital, Mumbai, India, for 6 months and treated with RT were assessed in the present analysis. The inclusion criteria were (1) early or locally advanced breast cancer treated with either mastectomy or breast conservation; (2) patients planned for adjuvant RT. All patients for palliative RT, patients who had received RT to any site earlier, and patients with synchronous bilateral breast cancer were excluded from this prospective study. All

Patient characteristics

Among 336 patients accrued, 255 patients had filled the pre-RT, mid-RT, and RT completion QOL questionnaire. These 255 patients were considered for present analysis. Characteristics of patients who underwent mastectomy and BCS are described in Table 1. One hundred and thirteen patients had mastectomy and 142 had BCS. In the mastectomy arm 51 had early breast cancer (being irradiated mostly in view of axillary nodal positivity) and 62 patients had locally advanced breast cancer (LABC); in BCS

Discussion

In the present analysis, at pre-RT evaluation there was no significant difference in GQOL score between mastectomy and BCS patients. EORTC QLQ C30 symptom and functional domain scores were also similar in these two groups. On the other hand, in BR23 scale there was significant difference between these two groups in symptom and functional domains. Patients who underwent mastectomy had poorer sexual enjoyment and future perspective domain score compared with patients undergoing BCS and there was

Conflict of interest

None.

Acknowledgements

We want to thank the EORTC for allowing the usage of the questionnaires for this study. We would also like to thank Arsha Ramachandran for data entry support for this study.

References (23)

P. Kenny et al.
Early stage breast cancer: costs and quality of life one year after treatment by mastectomy or conservative surgery and radiation therapy
Breast
(2000)
V. Peuckmann et al.
Health care utilisation and characteristics of long-term breast cancer survivors: nationwide survey in Denmark
Eur J Cancer
(2009)
K. Härtl et al.
Impact of medical and demographic factors on long-term quality of life and body image of breast cancer patients
Ann Oncol
(2003)
M.M. Norberg et al.
Quality of life and anxiety and depressive disorder comorbidity
J Anxiety Disord
(2008)
B. Fisher et al.
Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer
N Engl J Med
(2002)
U. Veronesi et al.
Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer
N Engl J Med
(2002)
P.A. Parker et al.
Short-term and long-term psychosocial adjustment and quality of life in women undergoing different surgical procedures for breast cancer
Ann Surg Oncol
(2007)
T. Takahashi et al.
Evaluation of quality of life and psychological response in cancer patients treated with radiotherapy
Radiat Med
(2008)
M. Pandey et al.
Early effect of surgery on quality of life in women with operable breast cancer
Jpn J Clin Oncol
(2006)
J.I. Arraras et al.
Impact of radiotherapy on the quality of life of elderly patients with localized breast cancer: a prospective study
Clin Transl Oncol
(2008)

U. Veronesi et al.

Breast conservation: current results and future perspectives at the European Institute of Oncology

Int J Cancer

(2007)

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Quality of life after radiotherapyComparison of early quality of life in patients treated with radiotherapy following mastectomy or breast conservation therapy: A prospective study☆

Abstract

Introduction

Materials and methods

Results

Conclusions

Section snippets

Material and methods

Patient characteristics

Discussion

Conflict of interest

Acknowledgements

Breast

Eur J Cancer

Ann Oncol

J Anxiety Disord

Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer

N Engl J Med

Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer

N Engl J Med

Short-term and long-term psychosocial adjustment and quality of life in women undergoing different surgical procedures for breast cancer

Ann Surg Oncol

Evaluation of quality of life and psychological response in cancer patients treated with radiotherapy

Radiat Med

Early effect of surgery on quality of life in women with operable breast cancer

Jpn J Clin Oncol

Impact of radiotherapy on the quality of life of elderly patients with localized breast cancer: a prospective study

Clin Transl Oncol

Breast conservation: current results and future perspectives at the European Institute of Oncology

Int J Cancer

Quality of life after radiotherapy
Comparison of early quality of life in patients treated with radiotherapy following mastectomy or breast conservation therapy: A prospective study☆