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Comparison of neoadjuvant versus adjuvant chemotherapy for breast cancer patients prior to receiving radiation therapy using Edmonton Symptom assessment system (ESAS) scores

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Abstract

Background and purpose

Patients undergoing radiotherapy (RT) for breast cancer may receive adjuvant or neoadjuvant chemotherapy prior to the initiation of RT treatment. In the present study, baseline Edmonton Symptom Assessment System (ESAS) scores of patients who received neoadjuvant and adjuvant chemotherapy were collected prior to RT and compared to assess the association of each chemotherapy intent with pre-RT symptom burden.

Material and methods

The ESAS and Patient-Reported Functional Status (PRFS) tools were used to collect patient-reported symptoms at baseline. Patient and treatment-related factors were collected prospectively from February 2018 to September 2020. Univariate general linear regression analysis was applied to compare baseline scores between adjuvant and neoadjuvant chemotherapy patients.

Results

A total of 338 patients were included for analysis. Comparison of baseline ESAS scores revealed that patients who received adjuvant chemotherapy were more likely to report higher scores, reflecting higher symptom burden, compared to patients receiving neoadjuvant chemotherapy, including tiredness (p = 0.005), lack of appetite (p = 0.0005), shortness of breath (p < 0.0001), and PRFS (p = 0.012).

Conclusion

This study suggests an association between patients who have received adjuvant chemotherapy for breast cancer and higher RT baseline ESAS scores when compared to patients who received neoadjuvant chemotherapy. Due to these findings, considerations should be made by healthcare providers of the symptom burden during RT for patients who receive adjuvant chemotherapy.

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Data availability

The data that support the findings of this study are available from the corresponding author (E.C) upon reasonable request.

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada

    Shereen Akkila, Saba Shariati, Lauren Milton, Tara Behroozian, Emily Lam, Gina Wong, Irene Karam & Edward Chow

  2. MacroStat Inc., Toronto, ON, Canada

    Liying Zhang

  3. McMaster University, Hamilton, ON, Canada

    Julia Lou

Authors
  1. Shereen Akkila
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  2. Saba Shariati
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  3. Lauren Milton
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  4. Tara Behroozian
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  5. Liying Zhang
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  6. Julia Lou
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  7. Emily Lam
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  8. Gina Wong
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  9. Irene Karam
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  10. Edward Chow
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Contributions

Edward Chow and Irene Karam contributed to the design of the study. Lauren Milton, Tara Behroozian, Emily Lam, and Gina Wong contributed to data collection. Julia Lou and Liying Zhang contributed to data analysis and preparation of tables. Shereen Akkila and Saba Shariati contributed equally to the writing of this manuscript and are joint primary authors. All authors have reviewed and approved the contents of the manuscript.

Corresponding author

Correspondence to Edward Chow.

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Competing interests

The authors have no relevant financial or non-financial interests to disclose.

Ethics approval

Approval for this study was granted by Sunnybrook Health Science Centre’s Research Ethics Board.

Consent to participate

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

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Shereen Akkila and Saba Shariati are joint first authors.

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Supplementary file1 (DOCX 47 KB)

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Akkila, S., Shariati, S., Milton, L. et al. Comparison of neoadjuvant versus adjuvant chemotherapy for breast cancer patients prior to receiving radiation therapy using Edmonton Symptom assessment system (ESAS) scores. Support Care Cancer 31, 236 (2023). https://doi.org/10.1007/s00520-023-07700-y

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  • DOI: https://doi.org/10.1007/s00520-023-07700-y

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