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Cited by 76Cancer survivorship and careChildhood Cancer Survivors' Quality of LifeCancer-related cognitive impairment studies

Dynamics of Long-Term Patient-Reported Quality of Life and Health Behaviors After Adjuvant Breast Cancer Chemotherapy

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Di Meglio, Antonio, Havas, Julie, Gbenou, Arnauld S., Martin, Elise, El-Mouhebb, Mayssam, Pistilli, Barbara, Menvielle, Gwenn, Dumas, Agnes +17 more·2022·Journal of Clinical Oncology
DOI 10.1200/jco.21.00277PMC PMC9509127
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Abstract

PURPOSE: 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. METHODS: 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. RESULTS: 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] v lean, 1.51 [95% CI, 1.28 to 1.79]; P < .0001) and current smoking (aOR v never, 1.52 [95% CI, 1.27 to 1.82]; P < .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]; P = .043), comorbidities (aOR v no, 1.22 [95% CI, 1.06 to 1.40]; P = .005), lower income (aOR v wealthier households, 1.21 [95% CI, 1.07 to 1.37]; P = .002), and endocrine therapy (aOR v no, 1.14 [95% CI, 1.01 to 1.30]; P = .047). CONCLUSION: 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.

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  • Previous data have demonstrated considerable interindividuality in the onset, persistence, and longitudinal evolution of treatment-related symptoms.

    “Previous data have demonstrated considerable interindividuality in the onset, persistence, and longitudinal evolution of treatment-related symptoms,5,61,62”

    From Implementing a PROACTive Care Pathway to Empower and Support Survivors of Breast Cancer (2023) · cites this paper as [61]

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Authors
Di Meglio, A., Havas, J., Gbenou, A. S., Martin, E., El-Mouhebb, M., Pistilli, B., Menvielle, G., Dumas, A., Everhard, S., Martin, A.-L., Cottu, P. H., Lerebours, F., Coutant, C., Lesur, A., Tredan, O., Soulie, P., Vanlemmens, L., Joly, F., Delaloge, S., Ganz, P. A., André, F., Partridge, A. H., Jones, L. W., Michiels, S., & Vaz-Luis, I.
Affiliations
  • Medical Oncology, Gustave Roussy, Villejuif, France
  • Inserm (FR)
  • INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
  • Université de Paris, ECEVE UMR 1123, INSERM, Paris, France
  • UniCancer Group (FR)
  • Institut Curie (FR)
  • Centre Georges François Leclerc (FR)
  • Institut de Cancérologie de Lorraine (FR)
  • Centre Léon Bérard, Lyon, France
  • Centre Paul Papin, Angers, France
  • Centre Oscar Lambret (FR)
  • Centre François Baclesse (FR)
  • Institut Gustave Roussy (FR)
  • University of California, Los Angeles (US)
  • Dana-Farber Cancer Institute (US)
  • Memorial Sloan Kettering Cancer Center (US)
ORCID
Venue
Journal of Clinical Oncology
Publisher
American Society of Clinical Oncology (ASCO)
Published
2022-09-20
Volume
40
Issue
27
Pages
3190-3204
ISSN
  • 0732-183X (ISSN-L)
  • 1527-7755
DOI
10.1200/jco.21.00277
PMC
PMC9509127
OpenAlex
W4224247641
Cited by
76
References
87
Citations by year
2026: 9 · 2025: 24 · 2024: 25 · 2023: 18
FWCI
7.01
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • Journal of Clinical Oncology (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • HAL (submittedVersion, cc-by-nc-nd)
  • eScholarship (California Digital Library) (submittedVersion, cc-by-nc-nd)
Funders
  • Agence Nationale de la Recherche (ANR-10-COHO-0004)
  • National Cancer Institute (P30CA008748)
Topics
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cancer-related cognitive impairment studies
Keywords
breast cancer, adjuvant chemotherapy, quality of life trajectories, health behavior, obesity, smoking, physical activity, body weight, comorbidities, socioeconomic status, quality of life deterioration, long-term outcomes, EORTC QLQ-C30, group-based trajectory modeling, age and income effects, cancer survivorship, psychosocial factors
MeSH terms
Patient Reported Outcome Measures, Breast Neoplasms, Female, Humans, Quality of Life, Health Behavior, Chemotherapy, Adjuvant

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