INSERM Unit 981, Gustave Roussy, Cancer Campus, Villejuif, France; Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal.
INSERM Unit 981, Gustave Roussy, Cancer Campus, Villejuif, France.
Ann Oncol. 2019 Nov 1;30(11):1784-1795. doi: 10.1093/annonc/mdz298.
In early breast cancer (BC), there has been a trend to escalate endocrine therapy (ET) and to de-escalate chemotherapy (CT). However, the impact of ET versus CT on the quality of life (QoL) of early BC patients is unknown. Here, we characterize the independent contribution of ET and CT on patient-reported outcomes (PROs) at 2 years after diagnosis.
We prospectively collected PROs in 4262 eligible patients using the European Organization for Research and Treatment of Cancer QLQ-C30/BR23 questionnaires inside CANTO trial (NCT01993498). The primary outcome was the C30 summary score (C30-SumSc) at 2 years after diagnosis.
From eligible patients, 37.2% were premenopausal and 62.8% postmenopausal; 81.9% received ET and 52.8% CT. In the overall cohort, QoL worsened by 2 years after diagnosis in multiple functions and symptoms; exceptions included emotional function and future perspective, which improved over time. ET (Pint = 0.004), but not CT (Pint = 0.924), had a persistent negative impact on the C30-SumSc. In addition, ET negatively impacted role and social function, pain, insomnia, systemic therapy side-effects, breast symptoms and further limited emotional function and future perspective recovery. Although CT had no impact on the C30-SumSc at 2-years it was associated with deteriorated physical and cognitive function, dyspnea, financial difficulties, body image and breast symptoms. We found a differential effect of treatment by menopausal status; in premenopausal patients, CT, despite only a non-significant trend for deteriorated C30-SumSc (Pint = 0.100), was more frequently associated with QoL domains deterioration than ET, whereas in postmenopausal patients, ET was more frequently associated with QoL deterioration, namely using the C30-SumSc (Pint = 0.004).
CONCLUSION(S): QoL deterioration persisted at 2 years after diagnosis with different trajectories by treatment received. ET, but not CT, had a major detrimental impact on C30-SumSc, especially in postmenopausal women. These findings highlight the need to properly select patients for adjuvant ET escalation.
在早期乳腺癌（BC）中，内分泌治疗（ET）的升级和化疗（CT）的降级已经成为一种趋势。然而，ET 和 CT 对早期 BC 患者生活质量（QoL）的影响尚不清楚。在这里，我们描述了 ET 和 CT 对诊断后 2 年患者报告结局（PRO）的独立贡献。
我们前瞻性地使用欧洲癌症研究和治疗组织的 EORTC QLQ-C30/BR23 问卷在 CANTO 试验（NCT01993498）中收集了 4262 名合格患者的 PRO 数据。主要结局是诊断后 2 年的 C30 总评分（C30-SumSc）。
在合格患者中，81.9%接受了 ET，52.8%接受了 CT。在总体队列中，多项功能和症状的 QoL 在诊断后 2 年内恶化；例外情况包括情绪功能和未来前景，这些功能随着时间的推移而改善。ET（Pint=0.004），而不是 CT（Pint=0.924），对 C30-SumSc 有持续的负面影响。此外，ET 对角色和社会功能、疼痛、失眠、全身治疗副作用、乳房症状和进一步限制情绪功能和未来前景的恢复有负面影响。尽管 CT 在 2 年内对 C30-SumSc 没有影响，但它与身体和认知功能、呼吸困难、经济困难、身体形象和乳房症状的恶化有关。我们发现治疗方法对绝经期状态有不同的影响；在绝经前患者中，尽管 C30-SumSc 恶化的趋势不显著（Pint=0.100），但 CT 比 ET 更频繁地与 QoL 恶化相关，而在绝经后患者中，ET 比 CT 更频繁地与 QoL 恶化相关，尤其是 C30-SumSc（Pint=0.004）。
不同治疗方法导致的 QoL 恶化在诊断后 2 年内持续存在，轨迹不同。ET，而不是 CT，对 C30-SumSc 有主要的不利影响，尤其是在绝经后女性中。这些发现强调了需要为辅助 ET 升级适当选择患者。
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