Abstract
Background and purpose
Regional nodal irradiation (RNI) is commonly administered in patients with breast cancer with node-positive disease to prevent cancer recurrence. The purpose of this study is to identify whether RNI is associated with greater acute symptom burden from baseline to 1 to 3 months post completion of radiotherapy (RT) when compared to localized RT.
Materials and methods
Patient and treatment characteristics were collected prospectively for breast cancer patients with and without RNI from February 2018 to September 2020. The Edmonton Symptom Assessment System (ESAS) and Patient-Reported Functional Status (PRFS) tool were completed by patients at baseline, weekly during RT, and at a 1- to 3-month follow-up visit. The Wilcoxon rank-sum or Fisher exact tests were used to compare variables between patients with or without RNI.
Results
A total of 781 patients were included in the analysis. Baseline symptom reporting was similar between cohorts, with the exception of PRFS scores (p = 0.0023), which were worse in patients receiving RNI. Across all time points, differences in outcomes between cohorts were minimal, except for lack of appetite (p = 0.03) and PRFS scores (p = 0.049), which were significantly aggravated in patients treated with RNI.
Conclusion
There is insufficient evidence to suggest that RNI is associated with greater symptom burden as assessed with the ESAS. Further research should be conducted over a longer time period to determine the impact of late effects of RNI on patient-reported symptoms.
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Data availability
The datasets will become available upon request.
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Acknowledgements
We thank the support of the breast radiation oncologists and radiation review nurses.
Funding
Generous support provided by Bratty Family Fund, Michael and Karyn Goldstein Cancer Research Fund, Joey and Mary Furfari Cancer Research Fund, Pulenzas Cancer Research Fund, Joseph and Silvana Melara Cancer Research Fund, and Ofelia Cancer Research Fund.
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Contributions
Irene Karam and Edward Chow contributed to the design of the study. Tara Behroozian and Lauren Milton assisted in data collection. Liying Zhang and Julia Lou contributed to the data analysis and prepared the tables and figures. Tara Behroozian, Lauren Milton, Saba Shariati, and Edward Chow contributed to the drafting of the manuscript. All the authors contributed to the review and editing of the manuscript.
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This study was approved by the Sunnybrook Health Sciences Centre Research Ethics Board.
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Informed consent was obtained from all individual participants included in the study.
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The authors declare no competing interests.
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Appendices
Appendix 1 Outcome assessment tools
A1. Edmonton Symptom Assessment System (ESAS)
A2. Patient-Reported Functional Status (PRFS) Tool
Over the past month, I would generally rate my activity as:
х Normal with no limitations (0)
х Not my normal self, but able to be up and about with fairly normal activities (1)
х Not feeling up to most things, but in bed or chair less than half the day (2)
х Able to do little activity & spend most of the day in bed or chair (3)
х Pretty much bedridden, rarely out of bed (4)
Appendix 2
Appendix 3
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Behroozian, T., Milton, L., Zhang, L. et al. A comparison of acute patient-reported outcomes in breast cancer patients with and without regional nodal irradiation using the ESAS and PRFS tool. Support Care Cancer 31, 279 (2023). https://doi.org/10.1007/s00520-023-07728-0
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DOI: https://doi.org/10.1007/s00520-023-07728-0