Akkila Shereen, Mahal Simran, Dawdy Krista, Cao Xingshan, Szumacher Ewa
Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
University of Waterloo, Waterloo, Ontario, Canada.
J Geriatr Oncol. 2023 Apr;14(3):101476. doi: 10.1016/j.jgo.2023.101476. Epub 2023 Mar 28.
Radiotherapy (RT) as an adjuvant, post-lumpectomy treatment has been shown to improve local control and survival in people with breast cancer. While adverse events because of cancer treatments are common, many older adults have demonstrated the ability to return to their baseline levels of physical functioning. There are limited reports on the functional decline and recovery of older patients undergoing RT. The primary objective of this study was to investigate physical function at various time points during RT in people with breast cancer over age 70 and their ability to recover post-decline.
Seventy-nine patients with breast cancer aged 70+ undergoing adjuvant RT at Sunnybrook Health Science Centre, Toronto, Ontario, Canada were enrolled for a prospective observational study. Participants completed the EORTC QLQ-C30 quality of life questionnaire before their first RT, after their final RT, and at three- and six-months post-RT to assess changes in physical function. Descriptive statistics were utilized to evaluate EORTC QLQ-C30 scores. A higher score was indicative of poorer physical function. Physical decline was a 10+ point increase in EORTC QLQ-C30 score from baseline to the last RT, and resilience was a return to <10 points from the baseline score within six months post-RT. Resistance was a post-RT change from the baseline score by fewer than 10 points.
Nine patients (11%) experienced physical decline following their last RT, and two of them (22%) displayed resilience within six months. There were no demographic or symptom variables associated with functional decline from the baseline to post-RT, nor with resilience. Nausea, pain, and diarrhea post-RT were associated with functional decline at six months post-RT (P = 0.0185, P = 0.0449, P = 0.0007, respectively). Nausea and diarrhea at baseline were associated with resistance to decline (P = 0.0055, P = 0.019, respectively), and with decline at the six-month follow-up (P ≤0.0001, P = 0.0235, respectively).
This study highlights the incidence of physical decline in patients over age 70 receiving RT for breast cancer and identifies risk factors for decline. Future research with a larger sample, longer follow-up period, and incorporating geriatric assessments pre-RT is warranted to better understand functional decline and resilience in this population.
放疗作为保乳术后的辅助治疗手段，已被证明可提高乳腺癌患者的局部控制率和生存率。虽然癌症治疗引起的不良事件很常见，但许多老年人已表现出恢复到基线身体功能水平的能力。关于接受放疗的老年患者功能衰退和恢复的报道有限。本研究的主要目的是调查70岁以上乳腺癌患者在放疗期间不同时间点的身体功能及其衰退后恢复的能力。
在加拿大多伦多桑尼布鲁克健康科学中心接受辅助放疗的79例70岁及以上乳腺癌患者被纳入一项前瞻性观察研究。参与者在首次放疗前、末次放疗后以及放疗后3个月和6个月完成欧洲癌症研究与治疗组织（EORTC）QLQ-C30生活质量问卷，以评估身体功能的变化。采用描述性统计方法评估EORTC QLQ-C30评分。分数越高表明身体功能越差。身体功能衰退定义为从基线到末次放疗EORTC QLQ-C30评分增加10分及以上，恢复能力定义为放疗后6个月内恢复到比基线评分低10分以内。抵抗能力定义为放疗后与基线评分相比变化少于10分。
9例患者（11%）在末次放疗后出现身体功能衰退，其中2例（22%）在6个月内表现出恢复能力。从基线到放疗后，没有人口统计学或症状变量与功能衰退或恢复能力相关。放疗后恶心、疼痛和腹泻与放疗后6个月的功能衰退相关（分别为P = 0.0185、P = 0.0449、P = 0.0007）。基线时的恶心和腹泻与抵抗功能衰退相关（分别为P = 0.0055、P = 0.019），也与6个月随访时的功能衰退相关（分别为P≤0.0001、P = 0.0235）。
本研究强调了70岁以上接受乳腺癌放疗患者身体功能衰退的发生率，并确定了衰退的风险因素。未来有必要进行更大样本、更长随访期且纳入放疗前老年评估的研究，以更好地了解该人群的功能衰退和恢复能力。
