Medical Oncology, Gustave Roussy, Villejuif, France.
INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France.
J Clin Oncol. 2022 Sep 20;40(27):3190-3204. doi: 10.1200/JCO.21.00277. Epub 2022 Apr 21.
We aimed to characterize long-term quality of life (QOL) trajectories among patients with breast cancer treated with adjuvant chemotherapy and to identify related patterns of health behaviors.
Female stage I-III breast cancer patients receiving chemotherapy in CANTO (CANcer TOxicity; ClinicalTrials.gov identifier: NCT01993498) were included. Trajectories of QOL (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 Summary Score) and associations with trajectory group membership were identified by iterative estimations of group-based trajectory models and multivariable multinomial logistic regression, respectively.
Four trajectory groups were identified (N = 4,131): excellent (51.7%), very good (31.7%), deteriorating (10.0%), and poor (6.6%) QOL. The deteriorating trajectory group reported fairly good baseline QOL (mean [95% CI], 78.3/100 [76.2 to 80.5]), which significantly worsened at year-1 (58.1/100 [56.4 to 59.9]) and never recovered to pretreatment values through year-4 (61.1/100 [59.0 to 63.3]) postdiagnosis. Healthy behaviors were associated with better performing trajectory groups. Obesity (adjusted odds ratio [aOR] lean, 1.51 [95% CI, 1.28 to 1.79]; < .0001) and current smoking (aOR never, 1.52 [95% CI, 1.27 to 1.82]; < .0001) at diagnosis were associated with membership to the deteriorating group, which was also characterized by a higher prevalence of patients with excess body weight and insufficient physical activity through year-4 and by frequent exposure to tobacco smoking during chemotherapy. Additional factors associated with membership to the deteriorating group included younger age (aOR, 1-year decrement 1.01 [95% CI, 1.01 to 1.02]; = .043), comorbidities (aOR no, 1.22 [95% CI, 1.06 to 1.40]; = .005), lower income (aOR wealthier households, 1.21 [95% CI, 1.07 to 1.37]; = .002), and endocrine therapy (aOR no, 1.14 [95% CI, 1.01 to 1.30]; = .047).
This latent-class analysis identified some patients with upfront poor QOL and a high-risk cluster with severe, persistent postchemotherapy QOL deterioration. Screening relevant patient-level characteristics may inform tailored interventions to mitigate the detrimental impact of chemotherapy and preserve QOL, including early addressal of behavioral concerns and provision of healthy lifestyle support programs.
本研究旨在描述接受辅助化疗的乳腺癌患者的长期生活质量（QOL）轨迹，并确定相关的健康行为模式。
纳入在 CANTO（癌症毒性；临床试验.gov 标识符：NCT01993498）中接受化疗的 I-III 期乳腺癌女性患者。通过迭代估计基于群组的轨迹模型和多变量多项逻辑回归，分别确定 QOL 轨迹（欧洲癌症研究与治疗组织生活质量问卷-C30 总评分）和与轨迹组归属的关联。
确定了四个轨迹组（N=4131）：极好（51.7%）、非常好（31.7%）、恶化（10.0%）和较差（6.6%）QOL。恶化轨迹组报告了相当好的基线 QOL（平均[95%CI]，78.3/100[76.2 至 80.5]），在诊断后 1 年（58.1/100[56.4 至 59.9]）显著恶化，并且在诊断后 4 年（61.1/100[59.0 至 63.3]）都未恢复到治疗前的水平。健康行为与表现更好的轨迹组相关。肥胖（调整后的优势比[aOR]瘦，1.51[95%CI，1.28 至 1.79]；<0.0001）和当前吸烟（aOR从不，1.52[95%CI，1.27 至 1.82]；<0.0001）在诊断时与恶化组有关，该组还表现为更多的超重患者和在诊断后 4 年期间体力活动不足的患者比例较高，以及在化疗期间经常接触烟草。与恶化组相关的其他因素包括年龄较小（aOR，每 1 岁下降 1.01[95%CI，1.01 至 1.02]；=0.043）、合并症（aOR无，1.22[95%CI，1.06 至 1.40]；=0.005）、较低的收入（aOR较富裕家庭，1.21[95%CI，1.07 至 1.37]；=0.002）和内分泌治疗（aOR无，1.14[95%CI，1.01 至 1.30]；=0.047）。
本潜在类别分析确定了一些 QOL 初始较差的患者和一个具有严重、持续化疗后 QOL 恶化的高危聚类。筛查相关的患者水平特征可以为减轻化疗的不利影响和维持 QOL提供信息，包括早期解决行为问题和提供健康的生活方式支持计划。
