Henry N Lynn, Kim Sungjin, Hays Ron D, Diniz Marcio A, Tighiouart Mourad, Gresham Gillian, Luu Michael, Cecchini Reena S, Yothers Greg, Rogatko André, Ganz Patricia A
Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
Biostatistics and Bioinformatics Research Center, Cedars-Sinai Cancer Center, Los Angeles, CA, USA.
NPJ Breast Cancer. 2022 Nov 19;8(1):123. doi: 10.1038/s41523-022-00489-9.
Adjuvant chemotherapy improves breast cancer survival but is associated with bothersome short- and long-term toxicity. Factors associated with toxicity, especially subacute toxicity up to 2 years following chemotherapy, have not been fully elucidated. The NRG Oncology/NSABP B-30 clinical trial compared 3 different doxorubicin-, cyclophosphamide-, and docetaxel-based chemotherapy regimens given over 3-6 months. Patients with hormone receptor-positive breast cancer received subsequent adjuvant endocrine therapy. From baseline through 24 months, 2156 patients completed questionnaires serially. We used multivariable probabilistic index models to identify factors associated with acute (>0-12 months) and subacute (>12-24 months) difficulties with pain, cognition, vasomotor symptoms, and vaginal symptoms. For all symptom domains, presence of symptoms prior to chemotherapy initiation were associated with symptoms in the subacute period (all p < 0.001). In addition, different combinations of patient factors and breast cancer treatments were associated with increased likelihood of pain, vasomotor, and vaginal symptoms in the subacute period. Consideration of pre-treatment symptoms and patient factors, as well as treatments for breast cancer, can facilitate identification of groups of patients that may experience symptoms following completion of chemotherapy. This information may be important for treatment-decision-making when alternative regimens are equivalent in benefit.
辅助化疗可提高乳腺癌患者的生存率,但会伴有令人困扰的短期和长期毒性。与毒性相关的因素,尤其是化疗后长达2年的亚急性毒性,尚未完全阐明。NRG肿瘤学/NSABP B-30临床试验比较了在3至6个月内给予的3种不同的基于阿霉素、环磷酰胺和多西他赛的化疗方案。激素受体阳性乳腺癌患者接受后续辅助内分泌治疗。从基线到24个月,2156例患者连续完成问卷调查。我们使用多变量概率指数模型来确定与急性(>0至12个月)和亚急性(>12至24个月)疼痛、认知、血管舒缩症状和阴道症状困难相关的因素。对于所有症状领域,化疗开始前出现的症状与亚急性期的症状相关(所有p<0.001)。此外,患者因素和乳腺癌治疗的不同组合与亚急性期疼痛、血管舒缩和阴道症状的可能性增加相关。考虑治疗前症状、患者因素以及乳腺癌治疗方法,有助于识别化疗完成后可能出现症状的患者群体。当替代方案在获益方面相当时,这些信息对于治疗决策可能很重要。
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