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The Effects of Surgery Type and Chemotherapy on Early-Stage Breast Cancer Patients’ Quality of Life Over 2-Year Follow-up

  • Breast Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

We examined the effects of surgery type and adjuvant chemotherapy on change in early-stage breast cancer patients’ quality of life (QOL) over time.

Methods

A cohort of 549 patients (33.5 % ductal carcinoma in situ, 66.5 % stages I/IIA) were interviewed a mean 6.1 weeks (Time1), and 6.2 (Time2), 12.3 (Time3), and 24.4 (Time4) months following definitive breast-conserving surgery (BCS) or mastectomy. QOL was measured using the total Functional Assessment of Cancer Therapy-Breast (FACT-B). Adjusting for demographic, psychosocial, and clinical variables, multiple linear regression models estimated the associations between QOL and each of surgery type, chemotherapy, and their 2-way interaction at each interview. Adjusted generalized estimating equation (GEE) models tested Time1–Time4 change in QOL.

Results

At Time2, chemotherapy (P < .001) and BCS (P < .001) were independently associated with worse QOL in adjusted linear regression, and the adverse effect of chemotherapy was prominent among patients who received BCS compared with those who received mastectomy (P interaction = .031). In the GEE model, QOL significantly improved over time among patients who received BCS (P trend = .047), mastectomy (P trend = .024), and chemotherapy (P trend < .001), but not among patients who did not receive chemotherapy (P trend = .720). All patients completed adjuvant chemotherapy and radiation by Time3. Regardless of surgery type, patients receiving chemotherapy reported lower QOL following surgery, and QOL improved after completion of adjuvant treatment.

Conclusions

Chemotherapy had a short-term negative impact on QOL after definitive surgical treatment regardless of surgery type. QOL rebounded after completion of adjuvant treatment.

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Acknowledgment

This study was supported by grants from the National Cancer Institute (NCI) and Breast Cancer Stamp Fund (R01 CA102777; PI: Jeffe, DB) and the NCI Cancer Center Support Grant (P30 CA091842; PI: Eberlein, T) to the Alvin J. Siteman Cancer Center. Contents of this paper are solely the responsibility of the authors; the funders did not influence the study design, data collection, analysis, or manuscript preparation. Views expressed herein do not necessarily represent the official views of the NCI or Breast Cancer Stamp Fund. We thank our participants, the interviewers, and the Siteman Cancer Center’s Health Behavior, Communication, and Outreach Core for data management services. We also thank the physicians who helped us recruit their patients for this study, including Drs. Barbara Monsees, Jill Dietz, Julie Margenthaler, Virginia Herrmann, Timothy Eberlein, Matthew Ellis, Imran Zoberi, Marie Taylor, Michael Naughton, Antonella Rastelli, Donald Lombardi, Cynthia Ma, Loren Michel, and Rama Suresh at Washington University School of Medicine and Dr. Eddie Hsueh and Pam Hunborg, RN, at Saint Louis University School of Medicine.

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Authors and Affiliations

  1. Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA

    Donna B. Jeffe PhD & Maria Pérez MA

  2. Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA

    Donna B. Jeffe PhD

  3. Department of Internal Medicine, University of Missouri School of Medicine, Columbia, MO, USA

    Emily F. Cole MD

  4. Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Ying Liu MD, PhD

  5. College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA

    Mario Schootman PhD

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  1. Donna B. Jeffe PhD
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Correspondence to Donna B. Jeffe PhD.

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Jeffe, D.B., Pérez, M., Cole, E.F. et al. The Effects of Surgery Type and Chemotherapy on Early-Stage Breast Cancer Patients’ Quality of Life Over 2-Year Follow-up. Ann Surg Oncol 23, 735–743 (2016). https://doi.org/10.1245/s10434-015-4926-0

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