Patient Reported Outcomes/Quality of Life

PV QA 4 - Poster Viewing Q&A 4

TU_44_3749 - Patient-reported Acute Fatigue in Elderly Breast Cancer Patients Treated with and without Regional nodal radiation

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Patient-reported Acute Fatigue in Elderly Breast Cancer Patients Treated with and without Regional nodal radiation
S. Misra1, G. Lee1, M. Swain1, Y. Korzets1, L. Le2, A. Lau2, C. A. Koch1, F. F. Liu1, A. Fyles1, A. S. Barry1, T. D. Conrad1, K. Han1, W. Levin1, J. M. Croke1, and J. Helou1; 1Radiation Medicine Program, University Health Network and Princess Margaret Cancer Centre, Toronto, ON, Canada, 2University Health Network Research,Princess Margaret Cancer Centre, Toronto, ON, Canada

Purpose/Objective(s): Although regional nodal irradiation (RNI) improves outcomes in breast cancer (BC) patients, it is associated with increased toxicity. Therefore, controversy still exist surrounding its indications. The purpose of this study was to evaluate and compare patient-reported acute fatigue in elderly BC patients with and without regional nodal radiation (RNI).

Materials/Methods: Elderly breast cancer patients (≥ 65 yrs) treated with adjuvant radiotherapy (RT) between 2012 and 2017 were identified from a prospective database. The validated Edmonton Symptom Assessment System (ESAS) questionnaire, which assesses fatigue, was completed prior to (baseline), during, at end of RT and first follow-up (6-12 weeks). Symptoms are rated on a 10-point Likert scale, with higher scores indicating higher fatigue. Patients and treatment characteristics were also recorded. Patients were divided into two cohorts: those who received RNI (cohort 1) and those who did not (cohort 2). A minimal clinically important difference (MCID) was defined using an anchor of ≥1-point compared to baseline. The proportion of patients reporting a change in fatigue at the end of RT was evaluated. Univariate and multivariable logistic regression were conducted to assess the association between RNI and MCID after adjusting for potential confounders. To test the robustness of the results, dynamic changes of fatigue scores over time were compared between the cohorts using a general linear mixed model after assuming individual patient with random effect. A two-tailed p-value ≤ 0.05 was considered statistically significant.

Results: Of the 1204 patients, 654 completed the ESAS at baseline and end of RT and were considered for this analysis (cohort 1 = 137, cohort 2 = 517). Mean age at diagnosis was similar between the groups: cohort 1 71± 6 vs. cohort 2 72± 5 years (total 72± 4). Overall, cohort 1 had higher stage and reception of chemotherapy (69% vs. 16%). Mean baseline fatigue was higher for cohort 1 vs. 2 (2.5 ± 2.4 vs. 2.1 ± 2.3, p=0.03). On univariate and multivariable analyses, RNI was not associated with an increased odd of MCID for fatigue at the end of RT (44% vs. 47%; OR: 0.89, 95 % CI: 0.61-1.30, p=0.56). After adjusting for confounders (age, duration of RT, endocrine therapy), higher baseline fatigue (OR: 0.86, 95% CI 0.80-0.92, p<0.001) and receipt of chemotherapy (OR: 0.53, 95 % CI:0.34-0.83, p=0.006) were the only factors associated with decreased odds of MCID. Dynamic changes showed a significant worsening of fatigue scores over time (p<0.001) with no difference between the cohorts (p=0.42); both experienced parallel worsening of fatigue levels over time (cohort*time p=0.18).

Conclusion: The addition of RNI in elderly BC patients is not associated with a significant worsening of patient-reported fatigue. Therefore, RNI should be considered in elderly BC patient with adverse factors.

Author Disclosure: S. Misra: Fellow; Princess Margaret Cancer Centre. G. Lee: None. M. Swain: None. Y. Korzets: None. L. Le: None. C.A. Koch: None. T.D. Conrad: None.

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