Older patients with early breast cancer (EBC) are heterogenous and more vulnerable to chemotherapy toxicities, which makes assessing quality of life (QoL) key in the curative setting. However, data on QoL in this age group are limited. We aimed to investigate the impact of chemotherapy on QoL in older EBC patients enrolled in the Bridging the Age Gap study.
A prospective, multicentre, observational study of women over 70 with EBC was conducted in 2013-2018 at 56 UK Institutions. Demographics, patient and tumour characteristics, treatments, adverse events and QoL were recorded for up to 24 months. QoL was analysed at each time point using baseline adjusted linear regression for high-risk patients.
3416 patients were enrolled and 2811 (82.3%) having surgery were included in the analysis. EBC was N+ in 837 (29.8%), ER+ in 2354 (83.7%) and HER2+ in 332 (11.8%). Patients had median age of 76.5 years (range 69-95). A full comprehensive geriatric assessment was performed at baseline including validated tools. In these 2811 patients, 1520 (54.1%) were high risk and 376 (24.7%) received chemotherapy. Compared with patients not receiving cytotoxics, at 6 months after diagnosis chemotherapy had a significant impact on several EORTC-QLQ-C30 domains, including global health score (61.7 [22.3] versus 69.5 [19.2], p<0.001), fatigue (44.3 [26.2] versus 33.3 [22.7], p<0.001), appetite loss (26.2 [32.6] versus 12.7 [22.7], p<0.001). Physical functioning, role functioning, cognitive functioning, social functioning, nausea, dyspnoea, constipation, diarrhoea and financial problems were also influenced. Similar trends were documented on other scales (EORTC-QLQ-BR23, EORTC-QLQ-ELD15 and EQ-5D-5L). However, differences were no longer significant at 18-24 months.
The impact of chemotherapy use on QoL outcomes in this population is relevant at 6 months and becomes more limited until resolving at 18 months. These are important information to share with older patients contemplating chemotherapy to describe its short- and long-term impact on QoL.
Clinical trial identification
Legal entity responsible for the study
National Institute for Health Research (NIHR).
All authors have declared no conflicts of interest.