Early effects of contemporary breast radiation on health-related quality of life – Predictors of radiotherapy-related fatigue

Figures & data

Figure 1. Flowchart of patient recruitment for the study.

Table Ia. Patient and treatment characteristics (n = 248).

	mean (SD)	n (% )	range
Age (years)	58.1 (9.9)		28–89
Body mass index (BMI)	26.5 (4.5)		16.7–44.8
Weeks from surgery to RT	16.0 (8.3)		17–45
Treatment:
BCS/mastectomy		180 (73)/68 (27)
ChT + RT/RT		102 (41)/146 (59)
RT local/locoregional		167 (67)/81 (33)
Boost to 64 Gy		28 (11)
Axillary RT		38 (15)
Hormones (concomitant)*		14 (6)
Lung doses/volumes:
D25 (Gy)	12.5 ± 11.0		1.7–45.1
Mean (Gy)	10.1 ± 3.7		1.8–19.6
V20 (%)	19.5 ± 8.5		5.7–37.9
V30 (%)	16.6 ± 6.4		3.9–33.9
Total dose volumes:		95% CI
V40 (cm^3) -whole sample	1730 ± 723		474–4796
-local RT	1557 ± 710	1449–1667	474–4796
-locoregional RT	2084 ± 616	1948–2221	996–4462
V5(cm^3) -whole sample	3285 ± 1738		803–12 369
-local RT	2423 ± 1096	2255–2591	802–8259
-locoregional RT	5055 ± 1448	4735–5375	2806–12 369

ChT = (adjuvant + neoadj. chemotherapy): FEC60 (55%), FEC100 (25%), FEC/Taxanes (18%), other (2%).

*Endocrine treatment was normally scheduled to after finishing RT, but 14 patients received it concomitant to RT. D25, dose to 25% of the lung volume; V20/V30, volume of the lung receiving 20/30 Gy or more; V40/V5, volume of the body receiving 40 Gy/5 Gy or more.

Table Ib. Clinical and sociodemographic characteristics (n = 248).

Tumor localization*	n (% )
left side	125(50)
right side	122(49)
Histology
IDC	189(76)
ILC	25(10)
DCIS	23(9)
Others	11(4)
Grade
I	51(21)
II	105(42)
III	83(33)
T-stage
T1	164(66)
T2	48(19)
T3-4	16(7)
Tis	20(8)
N-stage
N0	175(71)
N1	59(24)
N2-3	13(5)
ER
positive	189(76)
negative	39(16)
not accomplished^†	20(8)
PgR
positive	132(53)
negative	94(38)
not accomplished^†	22(9)
HER2	n (%)
positive	49(20)
negative	168(68)
not accomplished	31(12)
Risk groups
low	171(69)
high	77(33)
Comorbidity
one or more	58(23)
none	190(77)
Marital status
Married/cohabited	187(75)
Single/widow	59(24)
Education
low	181(73)
high	65(26)
Employment
in work	52(21)
on sick leave	102(41)
old-age pensioners	46(19)
disabled pensioners	35(14)
others	13(5)
Houshold income
low	118(48)
high	105(42)

HER 2, Human Epidermal growth factor Receptor 2; ER, estrogen receptor; PgR, progesterone receptor.

*One patient had bilateral location.

^†DCIS in 18 of these patients.

Table II. Mean values (95% CI) of the EORTC QLQ-C30 + QLQ-BR23 functional- and symptom scales at baseline and after RT.

Function scales QLQ-C30	Baseline (n = 245)			After RT (n = 242)			Change score (n = 239)
	Mean	95% CI	Cronbach's α	Mean	95% CI	Cronbach's α	Mean	95% CI
QOL/Global health	74.3	71.8–76.9	0.90	73.4	70.9–75.9	0.95	−0.7	−2.9–1.6
Physical function	85.3	83.2–87.5	0.77	84.2	82.2–86.3	0.74	−1.3	−2.6–0.1
Role function	78.3	74.8-81.8	0.90	77.2	74.0-80.4	0.86	−1.3	−4.4–1.7
Emotional function	81.4	78.9–83.8	0.84	81.9	79.4–84.3	0.84	0.4	−1.4–2.2
Cognitive function	86.2	83.9–88.5	0.65	84.5	82.3–87.3	0.73	−1.3	−3.2–0.6
Social function	78.4	75.4–81.4	0.78	78.2	75.2–81.2	0.81	0.1	−2.3–2.7
QLQ-BR23
Body image	83.2	80.2–86.1	0.90	83.6	80.8–86.4	0.89	0.4	−1.5–2.3
Sexual function	24.3	21.4–27.2	0.91	23.6	20.6–26.6	0.95	−1.3	−3.6–0.9
Sexual enjoyment*	62.7	58.1–67.2	–	66.4	61.6–71.2	–	1.4	−3.4–6.2
Future perspective	59.9	56.5–63.3	–	65.9	62.9–69.1	–	5.5	3.0–8.1
Symptom scales	Baseline			After RT			Change score
QLQ-C30	Mean	95% CI	Cronbach's α	Mean	95% CI	Cronbach's α	Mean	95% CI
Fatigue (whole group)	27.1	24.2–30.1	0.90	35.7	32.8–38.7	0.88	8.6	5.8–11.4
- group received chemo	34.4	29.5–39.4	–	35.4	31.1–39.8	–	0.6	−3.6–4.8
- group without chemo	22.0	18.5–25.5	–	35.9	31.8–40.1	–	14.3	10.9–17.7
Nausea and vomiting	4.9	3.5–6.3	0.18	4.2	3.1–5.6	0.28	−0.7	−2.3–0.9
Pain	16.4	13.4–19.4	0.86	16.3	13.6–19.0	0.85	−0.1	−2.6–2.5
Dyspnoea	13.6	10.7–16.5	–	16.3	13.6–19.1	–	2.7	−0.1–5.4
Insomnia	25.3	21.4–28.8	–	23.3	20.5–27.2	–	−1.4	−4.6–1.8
Appetite loss	9.8	7.3–12.3	–	9.5	6.9–12.1	–	−0.1	−2.8–2.5
Constipation	13.4	10.3–16.5	–	11.8	8.9–14.7	–	−2.0	−4.2–0.3
Diarrhea	10.8	8.5–13.2	–	10.8	8.2–13.4	–	−0.7	−3.5–2.1
Financial difficulties	7.0	4.6–9.4	–	8.8	4.6–9.0	–	0.1	−1.5–1.8
QLQ-BR23
Arm symptoms	12.3	9.8–14.7	0.76	13.4	11.2–15.5	0.68	0.9	−1.2–3.0
Breast symptoms	13.5	11.6–15.4	0.71	27.3	24.9–29.7	0.76	13.5	11.3–15.8
Syst.ter side eff.	18.6	16.4–20.8	0.76	18.5	16.9–20.1	0.55	0.0	−1.9–1.8
Upset by hair loss^†	17.4	10.4–24.4	–	16.2	7.2–25.1	–	−5.3	−14.8–4.1

*Only those who were sexually active answered this question (n=155, 150 and 121) at baseline, after RT and change score, respectively.

^†Only those who experienced hair loss answered this question (n = 83, 80 and 55).

Figure 2. Distribution of fatigue by surgery, chemotherapy, RT-technique, comorbidity, age and risk groups at baseline and after radiotherapy.

Table III. The prediction of change in fatigue during radiotherapy, adjusted for chemotherapy, comorbidity and age.

Model (n = 237)	B	SE B	β	p-value
Constant	28.485	10.96		0.006
V40	0.004	3.20	−0.19	0.035
Chemotherapy	−17.537	4.11	−0.23	0.000
Comorbidity	−8.999	0.22	−0.19	0.005
Age	−0.294	0.17	−0.13	0.068

R² = 0.161