Longitudinal changes of health-related quality of life over 10 years in breast cancer patients treated with radiotherapy following breast-conserving surgery

Quality of Life Research https://doi.org/10.1007/s11136-023-03408-y Longitudinal changes of health‑related quality of life over 10 years in breast cancer patients treated with radiotherapy following breast‑conserving surgery Yifeng Gao1,2 · Juan C. Rosas1 · Hanna Fink1,2 · Sabine Behrens1 · Jenny Chang‑Claude1,3 · Petra Seibold1 Accepted: 16 March 2023 © The Author(s) 2023 Abstract Purposes The study intended to (1) assess changes of health-related quality of life (HRQoL) between early treatment-related time points and 10 years post-treatment in a cohort of breast cancer (BC) patients who received radiotherapy (RT), (2) to evaluate differences in HRQoL between long-term BC survivors and unaffected women from the same geographical region and (3) to identify determinants of long-term HRQoL in the survivor cohort. Methods 292 BC patients were recruited prior to RT after breast-conserving surgery between 1998 and 2001 in Germany and prospectively followed up for a median of 11.4 years (range 10.3–12.8 years). HRQoL was assessed using EORTC QLQC30 at pre-RT (baseline), during RT, 6 weeks after RT, and at the 10-year follow-up. Changes in mean HRQoL scores over time were assessed using linear-mixed models. HRQoL in long-term survivors and controls was compared using Wilcoxon rank-sum test, stratified by age groups. Multivariable linear regression models were used to identify determinants for HRQoL in long-term BC survivors. Results Compared to baseline level (mean summary score of 64.9), global health status/quality of life (GHS/QoL) declined during RT (62.4) and improved 6 weeks after RT (69.9) before decreasing to baseline level at the 10-year follow-up (66.7). Most functional domains deteriorated or remained stable at 10 years post-diagnosis compared to post-RT scores, except for role functioning which improved, while dyspnea and diarrhea significantly deteriorated between those two time points. There were no significant differences in long-term GHS/QoL between BC survivors 10 years post-RT and controls for all age groups (p > 0.05). However, deficits in specific HRQoL domains such as emotional burden, sleep problems or fatigue were found to more strongly affect survivors, in particular those younger than 65 years, compared to controls. In the determinant analysis, being overweight was associated with lower GHS/QoL and physical functioning, while living with others was found to be associated with better physical functioning, and decreased dyspnea and pain levels. Certain comorbidities such as depression had a strong association with multiple HRQoL domains, including lower GHS/QoL and functioning as well as a higher level of fatigue, pain, sleep/intestinal problems, and financial difficulties. Side effects such as lymphedema/ pain and fibrosis were associated with worse physical and social functioning, respectively. Conclusion The long-term GHS/QoL remained comparable when compared with the control population while restrictions in certain functional and symptoms domains in long-term BC survivors persisted over 10 years, in particular among younger survivors. Targeted screening to identify cancer survivors at risk for psychosocial/other impairment accounting also for comorbidities and treatment side effects may be warranted in long-term aftercare to address unmet health needs. Keywords Breast cancer · Survivorship · Health-related quality of life · Adjuvant radiotherapy · Long-term symptoms · Sleep problems Plain English summary * Petra Seibold Extended author information available on the last page of the article Late effects after cancer treatment might lead to impaired health-related quality of life in cancer survivors. However, knowledge on quality of life among long-term breast cancer survivors is limited. This study describes the time changes 13 Vol.:(0123456789) Quality of Life Research of health-related quality of life during the treatment period as well as after 10 years in a unique cohort of breast cancer survivors from Germany who were treated with radiotherapy after surgery without chemotherapy. This study found that the self-reported quality of life decreased during radiotherapy but improved after cancer treatment. Ten years after cancer diagnosis, global quality of life was comparable to that of an unaffected control population, yet deficits in specific fields such as sleeping problems, fatigue, and emotional burden persisted for more than a decade, in particular in younger survivors and patients with certain comorbidities and/or treatment-related side effects. Findings from this study suggest more comprehensive long-term follow-up care may be warranted, with specific focus to identify psychosocial and other unmet health needs. Follow-up care for BC survivors usually ends at around 5 years past diagnosis [27–29]. Studies of HRQoL in BC survivors with long-term follow-up more than 10 years are rare. Therefore, we took advantage of the data prospectively collected as a cohort of BC patients who were treated with radiotherapy (RT) after breast-conserving surgery and followed up for 10 years. We aimed to (1) examine changes in mean HRQoL scores between early treatment measurements and 10 years post-treatment, to (2) evaluate differences in HRQoL between long-term BC survivors and a control population of the same geographical region and to (3) identify determinants of long-term HRQoL in this specific cohort of breast cancer survivors. Introduction Data collection and study population Prevalence of breast cancer (BC) survivors is increasing with 5-year and 10-year survival rates of 79% and 66%, respectively, due to earlier detection and improved cancer treatments [1–3]. Although BC prognosis has improved in recent years, late effects, such as psychosocial problems, insomnia, or other symptoms may still persist years after treatment [4, 5]. BC and treatment-related symptoms are important dimensions of health-related quality of life (HRQoL) and can adversely affect HRQoL of cancer survivors. Thus, the investigation of HRQoL of long-term BC survivors has become a major interest of BC survivorship studies. Previous studies have shown that many BC survivors may feel unable to cope with life, family, and work expectations due to reduced physical, emotional, or cognitive capacity years after treatment [6–9]. Although overall HRQoL in medium/long-term (≤ 10 years) and also very-long-term survivors (> 20 years) has been reported to be comparable to a control population, restrictions in certain functional performances, and symptoms persisted [4, 10–13]. Fatigue, sleeping problems, cognitive problems, physical dysfunctions, and pain were shown to be long-lasting symptoms in medium-term (< 5 years) survivors [4, 14] and were similarly found in a cross-sectional study of very long-term BC survivors 14–24 years after diagnosis [13]. Restrictions of HRQoL were consistently found to be more common among younger survivors [15–18] who usually reported a higher level of (...truncated)