Vaca-Cartagena Bryan F, Ferrigno Guajardo Ana S, Azim Hatem A, Rotolo Federico, Olivas-Martinez Antonio, Platas Alejandra, Fonseca Alan, Mesa-Chavez Fernanda, Cruz-Ramos Marlid, Rodriguez Ana, Mohar Alejandro, Villarreal-Garza Cynthia
Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza García, Mexico.
Department of Medicine, Yale University School of Medicine, New Haven, CT, USA.
Breast. 2025 Feb;79:103866. doi: 10.1016/j.breast.2024.103866. Epub 2024 Dec 21.
Cancer treatments have a detrimental impact on the quality of life (QoL) of young women with breast cancer (YWBC). Research exploring QoL trajectories has been mostly centered on postmenopausal women. Here we report longitudinal changes across all QoL domains and associated factors in YWBC.
In this prospective longitudinal cohort study, women aged ≤40 with stage I-III BC completed the European Organization for the Research and Treatment of Cancer Core QoL questionnaire at diagnosis and during 4 follow-up visits over 5 years, alongside demographic and clinical data collection. Group-based multivariate trajectory modeling was used to identify patient groups based on their functional and symptom scores, finding 3 groups (best, good, and poor). Factors associated with each trajectory pattern were identified with multinomial logistic models.
A total of 477 women (median age: 36; IQR: 32-38) were clustered into the best (n = 259, 54 %), good (n = 79, 17 %), or poor trajectory groups (n = 139, 29 %). Throughout the disease, patients with a poor QoL experienced clinically significant impairment in emotional functioning, nausea and vomiting, and pain. They also had significant cognitive impairment, dyspnea, and diarrhea. Patients with a good QoL had clinically meaningful diarrhea for the first 7 months, while those with the best QoL had clinically important nausea and vomiting during the first 2 months since diagnosis. Noteworthy, all groups experienced significant financial difficulties throughout their follow-up. Regular alcohol consumption at diagnosis (aOR [adjusted odds ratio] 1.64; 95 % CI [confidence interval] 1.02-2.65) and HER2-positive BC (aOR 2.53; 95 % CI 1.35-4.73) were independent factors associated with classification to the poor and good groups, respectively.
This study underscores the variability in QoL among YWBC and the importance of ongoing monitoring. Strategies to improve access to economic resources, manage treatment-related adverse effects, and support patients in discontinuing modifiable risk factors are needed.
癌症治疗对年轻乳腺癌女性（YWBC）的生活质量（QoL）有不利影响。探索生活质量轨迹的研究大多集中在绝经后女性。在此，我们报告YWBC所有生活质量领域的纵向变化及相关因素。
在这项前瞻性纵向队列研究中，年龄≤40岁的I - III期乳腺癌女性在诊断时及5年中的4次随访期间完成了欧洲癌症研究与治疗组织核心生活质量问卷，同时收集了人口统计学和临床数据。基于组的多变量轨迹建模用于根据功能和症状评分确定患者组，发现了3组（最佳、良好和较差）。使用多项逻辑模型确定与每种轨迹模式相关的因素。
共有477名女性（中位年龄：36岁；四分位间距：32 - 38岁）被分为最佳轨迹组（n = 259，54%）、良好轨迹组（n = 79，17%）或较差轨迹组（n = 139，29%）。在整个疾病过程中，生活质量较差的患者在情绪功能、恶心呕吐和疼痛方面经历了临床上显著的损害。他们还存在明显的认知障碍、呼吸困难和腹泻。生活质量良好的患者在最初7个月有临床上有意义的腹泻，而生活质量最佳的患者在诊断后的前2个月有临床上重要的恶心呕吐。值得注意的是，所有组在随访期间都经历了严重的经济困难。诊断时经常饮酒（调整后的优势比[aOR] 1.64；95%置信区间[CI] 1.02 - 2.65）和HER2阳性乳腺癌（aOR 2.53；95% CI 1.35 - 4.73）分别是与分类到较差组和良好组相关的独立因素。
本研究强调了YWBC生活质量的变异性以及持续监测的重要性。需要采取策略来改善经济资源的获取、管理与治疗相关的不良反应，并支持患者消除可改变的风险因素。
