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Accelerated partial breast irradiation compared with whole breast radiation therapy: a breast cancer cohort study measuring change in radiation side-effects severity and quality of life

  • Epidemiology
  • Published:
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Abstract

Purpose

Radiotherapy (RT) after breast-conserving surgery for early-stage breast cancer patients has similar survival benefits with whole breast RT (WBRT) or accelerated partial breast irradiation (APBI). However, the impact of RT type and side-effects severity on change in quality of life (QOL) is unknown. We examined changes in RT side-effects severity and QOL by RT type.

Methods

We analyzed data from a cohort of 285 newly diagnosed early-stage breast cancer patients with tumor size ≤3.0 cm and lymph node-negative disease. Patients (93 [32.6%] stage 0; 49 [17.2%] non-white; mean age = 59.3 years) completed four interviews (6 weeks, 6, 12, and 24 months) after definitive surgical treatment. We measured severity of RT side effects, fatigue and skin irritation, using a 5-point scale (1 “not at all” to 5 “all the time”) and measured QOL using the Functional Assessment of Cancer Therapy-Breast (FACT-B) and RAND 36-item Health Survey Vitality subscale. Repeated-measures analysis of covariance of each outcome controlled for demographic, clinical/treatment, and psychosocial factors.

Results

Patients initiated RT by 6 months (113 received APBI; 172 received WBRT) and completed RT by 12 months. Patients receiving WBRT (vs. APBI) reported greater increase in fatigue and skin irritation severity from 6-week to 6-month interviews (each P < 0.001). Improvement in neither total FACT-B nor Vitality differed significantly by RT type over 2-year follow-up.

Conclusions

Findings suggest that early-stage breast cancer patients can benefit from less-severe, short-term side effects of APBI with no differential impact on QOL change within 2-year follow-up.

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Acknowledgements

This study was supported by a Grant from the National Cancer Institute (NCI) and Breast Cancer Stamp Fund (R01 CA102777; PI: Jeffe, DB). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the NCI or Breast Cancer Stamp Fund. We thank our participants, the interviewers, and services provided by Ms. Lori Grove in Oncology Data Services and the Health Behavior, Communication and Outreach Core, which were supported, in part, by the National Cancer Institute Cancer Center Support Grant to the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, Missouri (P30 CA091842; PI: Timothy Eberlein). 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. The Beck Anxiety Inventory ® and BAI ® (copyright 1990, 1993 by Aaron T. Beck), are trademarks of The Psychological Corporation, a Harcourt Assessment Company. The BAI ® was adapted and used by permission of the publisher, The Psychological Corporation. All rights reserved.

Funding

This study was funded by a grant from the National Cancer Institute (NCI) and Breast Cancer Stamp Fund (R01 CA102777; PI: Jeffe, DB) and by the NCI Cancer Center Support Grant to the Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, Missouri (P30 CA091842; PI: Timothy Eberlein), for services provided by the Health Behavior, Communication and Outreach Core.

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Authors and Affiliations

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

    M. Pérez & D. B. Jeffe

  2. Saint Louis University College for Public Health and Social Justice, St. Louis, Missouri, USA

    M. Schootman

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

    M. Schootman, L. E. Hall & D. B. Jeffe

  4. Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri, USA

    L. E. Hall

Authors
  1. M. Pérez
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  2. M. Schootman
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  3. L. E. Hall
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  4. D. B. Jeffe
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Corresponding author

Correspondence to M. Pérez.

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Conflict of Interest

The authors declare that they have no conflicts of interest, financial or otherwise.

Ethical approval

The IRBs at both Washington University and Saint Louis University approved this study. All procedures performed were in accordance with the ethical standards of the 1964 Helsinki declaration and its later amendments and the institutional review boards (IRBs) at both Washington University and Saint Louis University.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Pérez, M., Schootman, M., Hall, L.E. et al. Accelerated partial breast irradiation compared with whole breast radiation therapy: a breast cancer cohort study measuring change in radiation side-effects severity and quality of life. Breast Cancer Res Treat 162, 329–342 (2017). https://doi.org/10.1007/s10549-017-4121-z

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  • DOI: https://doi.org/10.1007/s10549-017-4121-z

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