Patient-reported outcomes in postmenopausal breast cancer survivors – comparisons with normative data

Figures & data

Table 1. Patient and treatment characteristics.

				Year after surgery
				≤1		1-2		2-3		3-4		4-5		5+
		N	%	N	%	N	%	N	%	N	%	N	%	N	%	p Value
All		1089	100%	318	29%	186	17%	162	15%	152	14%	144	13%	127	12%
Age at surgery	37-44	2	0%	0	0%	1	1%	1	1%	0	0%	0	0%	0	0%	<.001
(years)	45-54	129	12%	26	8%	22	12%	26	16%	18	12%	15	10%	22	17%
	55-64	470	43%	117	37%	78	42%	63	39%	73	48%	66	46%	73	57%
	65-74	377	35%	122	38%	65	35%	58	36%	55	36%	52	36%	25	20%
	75-84	104	10%	48	15%	19	10%	13	8%	6	4%	11	8%	7	6%
	85-88	7	1%	5	2%	1	1%	1	1%	0	0%	0	0%	0	0%
Year of surgery	2005-2009	35	3%	0	0%	0	0%	0	0%	0	0%	0	0%	35	28%	<.0001
	2010-2014	560	51%	0	0%	31	17%	141	87%	152	100%	144	100%	92	72%
	2015-2018	494	45%	318	100%	155	83%	21	13%	0	0%	0	0%	0	0%
Type of surgery	Mastectomy	343	31%	98	31%	67	36%	56	35%	47	31%	40	28%	35	28%	.49
	Lumpectomy	746	69%	220	69%	119	64%	106	65%	105	69%	104	72%	92	72%
ALND	No	589	54%	197	62%	93	50%	98	60%	77	51%	67	47%	57	45%	.012
	Partial intervention	135	12%	37	12%	26	14%	16	10%	22	14%	18	13%	16	13%
	Yes	365	34%	84	26%	67	36%	48	30%	53	35%	59	41%	54	43%
Positive	0	688	63%	219	69%	105	56%	102	63%	101	66%	82	57%	79	62%	.18
lymph nodes	1-3	287	26%	72	23%	56	30%	44	27%	37	24%	43	30%	35	28%
	4-9	77	7%	15	5%	16	9%	12	7%	8	5%	17	12%	9	7%
	10+	37	3%	12	4%	9	5%	4	2%	6	4%	2	1%	4	3%
HER2 status	Negative	958	88%	295	93%	159	85%	138	85%	130	86%	125	87%	111	87%	.068
	Positive	131	12%	23	7%	27	15%	24	15%	22	14%	19	13%	16	13%
ER status	Negative	62	6%	16	5%	19	10%	9	6%	3	2%	3	2%	12	9%	.035
	1-9% positive	21	2%	8	3%	4	2%	3	2%	2	1%	2	1%	2	2%
	> =10% positive	1006	92%	294	92%	163	88%	150	93%	147	97%	139	97%	113	89%
Type of	No	178	16%	44	14%	37	20%	30	19%	29	19%	22	15%	16	13%	.0029
radiotherapy	Locoregional after mastectomy	183	17%	56	18%	36	19%	30	19%	20	13%	23	16%	18	14%
	Regional after mastectomy	1	0%	0	0%	0	0%	0	0%	1	1%	0	0%	0	0%
	Locoregional after lumpectomy	139	13%	32	10%	26	14%	18	11%	21	14%	27	19%	15	12%
	Residual breast after lumpectomy	519	48%	148	47%	83	45%	77	48%	73	48%	64	44%	74	58%
	Partial breast irradiation	69	6%	38	12%	4	2%	7	4%	8	5%	8	6%	4	3%
Boost tumor bed	No	1065	98%	306	96%	180	97%	159	98%	151	99%	142	99%	127	100%	.055
	10Gy/5fx	4	0%	1	0%	0	0%	2	1%	0	0%	1	1%	0	0%
	16Gy/8fx	20	2%	11	3%	6	3%	1	1%	1	1%	1	1%	0	0%
Chemotherapy	No	619	57%	215	68%	82	44%	78	48%	86	57%	97	67%	61	48%	<.0001
	Yes	470	43%	103	32%	104	56%	84	52%	66	43%	47	33%	66	52%
HER2 targeted	No	974	89%	305	96%	160	86%	139	86%	131	86%	127	88%	112	88%	<.001
therapy	Yes	115	11%	13	4%	26	14%	23	14%	21	14%	17	12%	15	12%
Endocrine	No	80	7%	28	9%	24	13%	10	6%	3	2%	3	2%	12	9%	<.001
treatment	Yes	1009	93%	290	91%	162	87%	152	94%	149	98%	141	98%	115	91%

p Values tested with chi-squared test.

Table 2. Trend over time for QLQ-C30, QLQ-BR23 and CTCAE scores.

			Year after surgery
	N = 1089		≤1 (N = 318)		1-2 (N = 186)		2-3 (N = 162)		3-4 (N = 152)		4-5 (N = 144)		5+ (N = 127)
	Mean	(SD)	Mean	(SD)	Mean	(SD)	Mean	(SD)	Mean	(SD)	Mean	(SD)	Mean	(SD)	p Value
QLQ-C30
Global health status^a	75.2	(20.7)	71.6	(21.7)	74.4	(19.3)	79.6	(18.9)	74.3	(22.4)	79.0	(19.0)	76.4	(20.5)	<.001
Physical functioning^a	85.7	(17.5)	84.1	(18.5)	84.7	(17.6)	88.8	(15.6)	85.3	(19.2)	86.2	(16.3)	87.0	(16.1)	.098
Role functioning^a	83.1	(23.6)	80.2	(24.1)	82.9	(22.6)	84.8	(24.3)	83.0	(24.2)	86.1	(22.9)	85.6	(22.2)	.097
Emotional functioning^a	84.1	(18.8)	82.5	(18.1)	83.7	(17.3)	85.2	(20.2)	82.2	(21.5)	87.2	(17.6)	85.9	(18.1)	.093
Cognitive functioning^a	83.4	(20.3)	81.5	(21.5)	82.3	(18.7)	84.3	(20.2)	83.8	(22.0)	86.6	(17.5)	84.5	(20.2)	.17
Social functioning^a	88.6	(19.3)	86.7	(19.7)	89.0	(18.1)	89.6	(18.4)	87.3	(22.1)	90.5	(19.1)	90.7	(17.7)	.23
Fatigue^b	26.4	(22.6)	30.6	(22.7)	29.5	(22.0)	24.7	(23.0)	24.9	(24.7)	21.2	(20.5)	21.4	(20.3)	<.0001
Pain^b	20.9	(24.0)	22.5	(24.1)	22.2	(23.6)	18.8	(24.4)	19.7	(23.7)	20.8	(24.7)	19.1	(23.6)	.52
Insomnia^b	30.3	(30.0)	29.5	(27.9)	36.1	(31.3)	31.9	(30.5)	29.3	(32.4)	26.4	(29.6)	26.9	(29.5)	.042
QLQ-BR23
Body Image^a	86.2	(20.8)	86.5	(20.0)	83.9	(22.7)	87.3	(18.8)	83.2	(24.6)	88.4	(18.2)	88.0	(19.7)	.14
Sexual functioning^a	18.0	(21.9)	18.4	(22.3)	15.6	(21.6)	18.9	(22.1)	19.5	(21.8)	18.5	(21.2)	17.4	(22.0)	.67
Sexual enjoyment^a	50.9	(30.5)	49.6	(30.1)	51.1	(32.7)	52.0	(28.9)	48.7	(29.8)	49.7	(32.6)	59.3	(28.9)	.64
Future perspective^a	66.6	(27.0)	63.4	(26.7)	64.5	(28.7)	70.1	(22.8)	63.2	(30.4)	71.9	(25.9)	71.6	(25.2)	.0013
Systemic therapy side effects^b	16.4	(14.3)	17.5	(14.1)	16.7	(13.5)	16.2	(14.6)	16.7	(15.3)	15.5	(14.7)	13.8	(13.4)	.24
Breast symptoms^b	16.0	(17.1)	21.8	(17.9)	17.8	(19.6)	12.9	(14.3)	13.0	(15.9)	11.0	(14.2)	12.1	(14.1)	<.0001
Arm symptoms^b	16.0	(19.8)	16.5	(19.0)	18.1	(20.6)	13.6	(17.7)	16.3	(21.1)	16.5	(22.7)	13.4	(18.1)	.25
Upset by hair loss^b	38.8	(36.2)	37.5	(36.2)	35.0	(37.2)	35.1	(34.6)	41.4	(37.2)	41.5	(35.6)	44.1	(37.7)	.83
PRO-CTCAE
Neuropathy^b	16.0	(24.4)	15.5	(25.1)	19.8	(26.1)	13.5	(23.7)	15.7	(22.8)	14.2	(22.5)	17.1	(24.7)	.20
Arthralgia^b	32.3	(27.0)	32.3	(27.7)	33.1	(25.8)	31.9	(26.2)	33.3	(29.0)	33.0	(27.7)	29.7	(24.4)	.91
Myalgia^b	29.2	(26.9)	27.8	(27.2)	31.8	(25.7)	29.2	(26.8)	30.5	(29.1)	31.5	(28.1)	24.4	(23.3)	.17

All scores ranging from 0–100, with higher scores on functional domains^a representing higher HRQoL, whereas higher scores on symptom scales^b represents higher symptom burden.

Dyspnea, nausea, vomiting, appetite loss, constipation, diarrhea and financial difficulties were all low scoring items and not displayed.

QLQ-C30: EORTC Core Quality of Life Questionnaire; QLQ-BR23: EORTC Breast Cancer-specific Quality of Life Questionnaire; PRO-CTCAE: Patient Reported Outcome version of the Common Terminology Criteria for Adverse Events; SD: Standard Deviation. p Values tested with one-way analyses of variance (ANOVAs).

Figure 1. Changes in QLQ-C30 scores over time after surgery and compared to the Danish general population. The normative data of the reference group were adjusted for different age distributions at each time interval. Absolute effect sizes: white circle: <0.2; black circle: 0.2–0.4; black triangle: >0.4.

Figure 2. Subgroup analysis of cognitive functioning. The normative data of the reference group were adjusted for different age distributions at each time interval. Absolute effect sizes: circle: <0.4; triangle: >0.4.

Figure 3. Subgroup analysis of fatigue. The normative data of the reference group were adjusted for different age distributions at each time interval. Absolute effect sizes: circle: <0.4; triangle: >0.4.