Breast Cancer Quality of Life and Health-state Utility at a Brazilian Reference Public Cancer Center

ABSTRACT

Objectives: To evaluate health-related-quality-of-life and derive health-state-utility (HSU) from breast cancer patients, before and after routine therapy at a Brazilian reference public cancer center.

Methods: In a prospective cohort study, a consecutive sample of outpatients newly diagnosed with breast cancer was submitted to two interviews (baseline, 6-month) to complete EQ-5D-3L/VAS and EORTC-QLQ-C30/BR23 questionnaires. Demographic and clinical information was reviewed from medical records.

Results: For 196 patients, EQ-5D domains of pain/discomfort and anxiety/depression were mainly affected, but partially improved overtime, while mobility/usual activities/self-care worsened after therapy. EORTC-QLQ-C30/BR23 scales mostly affected were emotional functioning, insomnia, pain, sexual enjoyment and future self-health perspective at baseline, while financial difficulties, insomnia, fatigue and therapy side-effects at follow-up. Overtime mean scores were 71.4 (_95%CI68.5–74.4) and 76.1 (_95%CI73.3–78.8) for EQ-5D-VAS, and 0.712 (_95%CI0.686–0.737) and 0.732 (_95%CI0.707–0.757) for HSU. HSU was 0.689 (_95%CI0.648–0.730) in stages III-IV, and 0.692 (_95%CI0.652–0.731) under two/three chemotherapy regimens.

Conclusion: In a context of impairments in emotional functioning, sexual enjoyment, symptoms burden, and poor future self-health perspective, breast cancer produced a mean HSU of 0.712. After routine care, there was a small improvement in quality of life, with lower HSU particularly in advanced disease and multiple chemotherapy regimens.

KEYWORDS:

• Breast neoplasm
• patient reported outcome measures
• health-related quality of life
• health status
• utility

Article Highlights

• Breast cancer is the most prevalent and lethal malignant tumor in women worldwide, and patients experience impairments in physical, social and psychological functioning, and overwhelming symptoms.

• In the context of an oncology decision-making process, the appraisal of interventions exclusively based on clinical outcomes may neglect the substantial impact on HRQOL produced by the disease itself and the therapy-related toxicity.

• Generic and disease-specific PRO measures, such as EQ-5D and EORTC-QLQ, are used to capture patients’ perspectives on different domains of health outcomes. The EQ-5D may also derive HSU based on the general population preferences, which is used to estimate QALYs, the health benefit measure of cost-utility analysis.

• In our study, breast cancer patients HRQOL was mainly affected by impairments in mental functioning, sexual enjoyment, symptoms of pain, fatigue, and insomnia, and poor future self-health perspective. After a period of routine care, there was a small improvement in quality of life, however financial difficulties and therapy side-effects emerged as impacted domains.

Acknowledgments

The authors would like to thank all participants who took part in this study, and the hospital staff for the administrative and logistic support for the study. We also would like to thank Andréa Libório Monteiro for the technical contributions and the data collection team (Evaneide Aquino de Moraes, Elisângela Siqueira Costa Cabral, Elaine Masson and Luciana Castaneda Ribeiro) for the valuable work.

Authors contribution statement

RLG, FMC, MMF, RRAF, MCC, RMA, SC, MS and LMA were involved in the conception and design of the study; NBR and RLG were involved in the analysis and interpretation of the data; RLG and NBR drafted the paper; FMC, MMF, RRAF, MCC, RMA, SC, MS, LMA revised it critically for intellectual content; all authors approved the paper final version, and agreed to be accountable for all aspects of the work.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This study was supported by the 54° technical cooperation term between the Brazilian National Institute of Cancer/Ministry of Health and the Pan-American Health Organization/World Health Organization.