The Impact of AC and AC-T Chemotherapy’s Toxicities on Quality of Life Among Women with Breast Cancer in Ethiopia: A Prospective Patient-Reported Outcomes Study

Figures & data

Table 1 Socio-Demographic and Clinical Characteristics of Women with Breast Cancer on AC and AC-T Chemotherapy at TASH, N=146

	Category	N (%)	Mean ± Standard Deviation
Age (Year)	20–34	30(20.5)	42.2 ±11.5
	35–49	76(52.1)
	50–64	31(21.2)
	≥65	9(6.2)
Body Mass Index (BMI)(kgm^−2)	<18.5	14(9.6)	25.2±10.32
	18.5–24.99	74(50.7)
	25–29.99	30(23.3)
	≥30	24(16.4)
Body Surface Area (BSA)(m^2)	1–1.49	31(21.2)	1.6±0.19
	1.5–1.99	110(75.3)
	≥2	5(3.4)
Chemotherapy cycles	4 cycles	46(31.5)	6.4±1.78 (median = 8 cycles)
	6 cycles	25(17.1)
	8 cycles	75(51.4)
Histological classification	Ductal	131(89.7)
	Lobular	6(4.1)
	Mixed	3(2.1)
	Papillary	3(2.1)
	Mucinous	2(1.4)
	Metaplastic	1(0.7)
Stage	I	6(4.1)
	II	48(32.8)
	III	64(43.8)
	IV	28(19.2)
Comorbidity	Yes	22(15.1)
	No	124(84.9)
Eastern Cooperative Oncology Group (ECOG) Performance	0	3(2.1)
	I	135(92.5)
	II	5(3.4)
	III	3(2.1)
Marital status	Having no spouse	48(32.9)
	Having a spouse	98(67.1)
Educational status	Illiterate	58(39.7)
	Literate	88(60.3)
Having children	Yes	115(78.80)
	No	31(21.20)
Baseline laboratory values	Serum Creatinine (mg/dl)		1.0(0.18)
(Mean ± Standard Deviation)	Aspartate Aminotransferase (U/L)		27.7 (21.87)
	Alanine Aminotransferase (U/L)		23.5(29.25)
	Alkaline Phosphatase (U/L)		227.9(212.11)
	White Blood Cell counts (10^3/mm^3)		7.3(2.40)
	Hemoglobin (gm/dL)		13.9(1.36)
	Platelet (10^3/mm^3)		314.1(110.58)
	Absolute Neutrophil Counts (10^3/mm^3)		4.1(1.97)
	Lymphocyte Counts (10^3/mm^3)		2.4(0.80)

Table 2 EORTC QLQ-C30 Global Health Status and Functional Scales Score Over Time Among Breast Cancer Patients on AC and AC-T Chemotherapy, from January 1 to September 30, 2017 GC (Using a Linear Mixed Model)

Global Health Status/Overall Quality of Life of EORTC QLQ C-30
Parameters		B		SE		Sig.	95% CI
							LB		UB
Intercept		57.51		1.65		0.000	54.24		60.78
Cycle 2		−15.78		2.02		0.000	−19.78		−11.79
Cycle 4		−9.90		1.89		0.000	−13.66		−6.16
Cycle 6		−1.75		2.16		0.420	−6.02		2.52
Cycle 8		6.85		2.16		0.002	2.56		11.14
Baseline		0^b		0.00
Functional Scales EORTC QLQ C-30
Role Functioning						Emotional Functioning
Parameters	B	SE	Sig.	95% CI		B	SE	Sig.	95% CI
				LB	UB				LB	UB
Intercept	52.74	3.21	0.000	46.38	59.09	80.02	1.87	0.000	76.33	83.72
Cycle 2	−28.99	3.17	0.000	−35.26	−22.73	−12.21	2.20	0.000	−16.56	−7.87
Cycle 4	−28.08	3.46	0.000	−34.91	−21.24	−9.25	2.65	0.001	−14.49	−4.00
Cycle 6	−22.67	4.18	0.000	−30.94	−14.41	−6.58	2.81	0.021	−12.14	−1.02
Cycle 8	−8.11	3.88	0.039	−15.79	−.43	−4.44	3.10	0.155	−10.59	1.71
Baseline	0^b	0.00				0^b	0.00
Cognitive Functioning						Social Functioning
Parameters	B	SE	Sig.	95% CI		B	SE	Sig.	95% CI
				LB	UB				LB	UB
Intercept	86.42	1.65	0.000	83.15	89.68	74.89	2.53	0.000	69.88	79.89
Cycle 2	−9.02	2.21	0.000	−13.39	−4.65	−16.67	2.58	0.000	−21.77	−11.56
Cycle 4	−14.95	4.41	0.001	−23.67	−6.24	−30.48	2.89	0.000	−36.19	−24.77
Cycle 6	−11.59	2.88	0.000	−17.29	−5.89	−32.70	3.36	0.000	−39.35	−26.04
Cycle 8	−17.24	3.67	0.000	−24.58	−9.91	−22.80	3.67	0.000	−30.09	−15.52
Baseline	0^b	0.00				0^b	0.00
Physical Functioning
Parameters	B	SE	Sig.	95% CI
				LB	UB
Intercept	68.63	2.16	0.000	64.37	72.89
Cycle 2	−17.63	2.03	0.000	−21.64	−13.61
Cycle 4	−17.08	2.06	0.000	−21.15	−13.00
Cycle 6	−18.58	2.86	0.000	−24.24	−12.92
Cycle 8	−11.39	2.87	0.000	−17.08	−5.70
Baseline	0^b	0.00

Note: 0^b = reference category.

Abbreviations: CI, confidence interval; B, estimated marginal means; LB, lower bound; SE, standard error; Sig, significance; UB, upper bound.

Figure 1 Patterns of quality of life (EORTC QLQ C-30 scales) score over time among women with breast cancer on chemotherapy, from January 1 to September 30, 2017 GC, N=146 (using GLM repeated measures). *Those quality of life domains score with both statistically and clinically significant deterioration at least once from baseline score.

Table 3 EORTC QLQ C-30 Items/Symptom Scales Score Over Time Among Breast Cancer Patients on AC and AC-T Chemotherapy, from January 1 to September 30, 2017 GC (Using a Linear Mixed Model)

Symptoms Scales/Items EORTC QLQ C-30
Fatigue						Nausea and Vomiting
Parameters	B	SE	Sig	95% CI		B	SE	Sig.	95% CI
				LB	UB				LB	UB
Intercept	28.69	2.52	0.000	23.72	33.66	3.31	0.98	0.001	1.37	5.25
Cycle 2	43.38	2.68	0.000	38.09	48.67	50.23	2.80	0.000	44.69	55.76
Cycle 4	40.41	3.05	0.000	34.38	46.44	52.51	2.94	0.000	46.71	58.31
Cycle 6	30.81	3.38	0.000	24.14	37.49	15.46	3.02	0.000	9.48	21.44
Cycle 8	18.09	3.91	0.000	10.32	25.86	−1.27	1.21	0.295	−3.66	1.12
Baseline	0^b	0.00				0^b	0.00
Pain						Dyspnea
Parameters	B	SE	Sig	95% CI		B	SE	Sig.	95% CI
				LB	UB				LB	UB
Intercept	32.53	2.53	0.000	27.54	37.53	19.41	2.46	0.000	14.54	24.27
Cycle 2	9.47	3.06	0.002	3.42	15.53	9.36	2.89	0.002	3.64	15.08
Cycle 4	−7.42	3.13	0.019	−13.60	−1.24	4.11	3.11	0.188	−2.03	10.25
Cycle 6	−2.78	3.85	0.472	−10.40	4.84	−2.32	3.39	0.495	−9.01	4.38
Cycle 8	−7.55	3.69	0.043	−14.86	−0.25	−5.36	2.67	0.047	−10.65	−0.06
Baseline	0^b	0.00				0^b	0.00
Insomnia						Appetite Loss
Parameters	B	SE	Sig.	95% CI		B	SE	Sig.	95% CI
				LB	UB				LB	UB
Intercept	27.85	2.86	0.000	22.20	33.51	17.81	2.45	0.000	12.97	22.65
Cycle 2	7.76	3.38	0.023	1.08	14.45	53.42	3.23	0.000	47.04	59.81
Cycle 4	4.34	3.51	0.218	−2.60	11.27	49.54	3.32	0.000	42.97	56.11
Cycle 6	2.43	4.30	0.573	−6.08	10.93	33.05	3.34	0.000	26.45	39.66
Cycle 8	4.70	4.83	0.333	−4.88	14.27	19.57	4.09	0.000	11.45	27.69
Baseline	0^b	0.00				0^b	0.00
Constipation						Diarrhea
Parameters	B	SE	Sig.	95% CI		B	SE	Sig.	95% CI
				LB	UB				LB	UB
Intercept	10.27	1.82	0.000	6.68	13.87	2.74	1.00	0.007	0.77	4.71
Cycle 2	12.56	2.73	0.000	7.16	17.96	14.16	2.49	0.000	9.24	19.07
Cycle 4	7.76	2.22	0.001	3.37	12.15	10.73	2.53	0.000	5.73	15.73
Cycle 6	3.07	2.43	0.210	−1.75	7.88	4.32	1.96	0.030	0.43	8.21
Cycle 8	1.16	2.56	0.651	−3.92	6.24	3.13	1.88	0.100	−0.61	6.86
Baseline	0^b	0.00				0^b	0.00
Financial Difficulties
Parameters	B	SE	Sig.	95% CI
				LB	UB
Intercept	61.19	3.04	0.000	55.18	67.20
Cycle 2	4.34	2.77	0.120	−1.14	9.82
Cycle 4	10.27	3.33	0.002	3.69	16.85
Cycle 6	9.45	3.69	0.012	2.13	16.76
Cycle 8	17.13	4.06	0.000	9.07	25.19
Baseline	0^b	0.00

Note: 0^b = reference category.

Abbreviations: CI, confidence interval; B, estimated marginal means; LB, lower bound; SE, standard error; Sig, significance; UB, upper bound.

Table 4 EORTC QLQ-BR23 Functional Scales Score Over Time Among Breast Cancer Patients on Chemotherapy, from January 1 to September 30, 2017 GC (Using a Linear Mixed Model)

Functional Scales of EORTC QLQ-BR23
Body Image						Sexual Functioning
Parameters	B	SE	Sig.	95% CI		B	SE	Sig.	95% CI
				LB	UB				LB	UB
Intercept	72.55	3.51	0.000	65.60	79.49	21.12	3.06	0.000	15.08	27.16
Cycle 2	0.06	3.03	0.985	−5.94	6.05	−8.90	3.04	0.004	−14.92	−2.89
Cycle 4	−0.17	3.57	0.962	−7.23	6.89	−9.59	3.41	0.006	−16.33	−2.84
Cycle 6	5.57	3.83	0.150	−2.06	13.20	−8.15	3.55	0.023	−15.17	−1.13
Cycle 8	7.29	3.29	0.031	0.69	13.89	−1.53	4.46	0.732	−10.38	7.31
Baseline	0^b	0.00				0^b	0.00
Future Perspectives
Parameters	B	SE	Sig.	95% CI
				LB	UB
Intercept	69.63	2.77	0.000	64.17	75.10
Cycle 2	−5.94	2.96	0.047	−11.79	−0.08
Cycle 4	−6.62	3.36	0.051	−13.26	0.02
Cycle 6	6.38	3.58	0.077	−0.70	13.46
Cycle 8	−0.47	4.35	0.915	−9.09	8.16
Baseline	0^b	0.00

Note: 0^b = reference category.

Abbreviations: CI, confidence interval; B, estimated marginal means; LB, lower bound; SE, standard error; Sig, significance; UB, upper bound.

Table 5 EORTC QLQ-BR23 Symptom Scales Score Over Time Among Breast Cancer Patients on Chemotherapy, from January 1 to September 30, 2017 GC (Using a Linear Mixed Model)

Symptom Scales of EORTC QLQ-BR23
Systemic Therapy Side Effects						Upset by Hair Loss**
Parameters	B	SE	Sig.	95% CI		B	SE	Sig.	95% CI
				LB	UB				LB	UB
Intercept	12.88	1.25	0.000	10.42	15.35	16.28	3.18	0.000	9.97	22.59
Cycle 2	37.83	1.84	0.000	34.20	41.47	13.40	3.73	0.000	6.02	20.79
Cycle 4	38.88	1.77	0.000	35.37	42.38	−3.72	2.97	0.214	−9.63	2.19
Cycle 6	29.68	1.73	0.000	26.25	33.10	−10.90	3.19	0.001	−17.24	−4.55
Cycle 8	25.74	1.92	0.000	21.93	29.54	0^b	0.00
Baseline	0^b	0.00
Breast Symptoms						Arm Symptoms
Parameters	B	SE	Sig.	95% CI		B	SE	Sig.	95% CI
				LB	UB				LB	UB
Intercept	22.49	1.85	0.000	18.83	26.14	26.03	2.16	0.000	21.76	30.29
Cycle 2	−4.85	1.34	0.000	−7.49	−2.21	−7.23	2.02	0.000	−11.22	−3.24
Cycle 4	−12.10	1.74	0.000	−15.55	−8.66	−14.69	1.99	0.000	−18.62	−10.76
Cycle 6	−13.48	1.83	0.000	−17.10	−9.87	−17.11	2.11	0.000	−21.28	−12.94
Cycle 8	−14.25	1.94	0.000	−18.10	−10.40	−19.79	2.26	0.000	−24.26	−15.33
Baseline	0^b	0.00				0^b	0.00

Notes: **no hair loss score on the baseline. 0^b = reference category

Abbreviations: CI, confidence interval; B, estimated marginal means; LB, lower bound; SE, standard error; Sig, significance; UB, upper bound.

Figure 2 Patterns of quality of life score (EORTC QLQ-BR23 scales) over time among women with breast cancer on chemotherapy, from January 1 to September 30, 2017 GC, N=146 (using GLM repeated measures). *Those quality of life domains score with both statistically and clinically significant deterioration (ie except breast and arm symptoms) at least once from baseline score.

Table 6 Socio-Demographic and Clinical Factors Associated with Deterioration of Quality of Life on Stepwise Linear Regression, from January 1 to September 30, 2017 GC

EORTC QLQ-C30^#
Global Health Status/Overall QoL
Socio-Demographic and Clinical Variables	Unstandardized Coefficients (B)	Standard Error	P-value	95% Confidence Interval for B
				Lower Bound	Upper Bound
(Constant)	35.688	10.457	0.001	15.017	56.359
Tumor stage (½ ref. vs ¾)	−2.590	1.081	0.018	−4.726	−.454
Illiterate ref. vs literate	7.157	2.434	0.004	2.346	11.969
Physical Functioning Score
(Constant)	57.608	7.739	0.000	42.310	72.907
Age	−.529	0.133	0.000	−.792	−.267
Regimen (AC ref. vs AC-T)	8.255	2.994	0.007	2.336	14.173
Illiterate ref. vs literate	6.927	3.184	0.031	0.633	13.22
Role Functioning Score
(Constant)	54.867	8.954	0.000	37.164	72.569
Illiterate ref. vs literate	14.705	3.888	0.000	7.018	22.391
Tumor stage (½ ref. vs ¾)	−4.763	1.578	0.003	−7.883	−1.644
Age	−.475	0.166	0.005	−.803	−.147
Baseline Alkaline phosphatase	−.018	0.009	0.046	−.035	0.000
Emotional Functioning Score*
(Constant)	80.116	3.897	0.000	72.414	87.818
Tumor stage (½ ref. vs ¾)	−3.786	1.425	0.009	−6.602	−.969
Cognitive Functioning Score*
(Constant)	100.929	9.975	0.000	81.212	120.646
Baseline Serum Creatinine	−27.234	10.284	0.009	−47.560	−6.907
Social Functioning Score
(Constant)	54.358	5.319	0.000	43.844	64.872
Illiterate ref. vs literate	13.645	3.999	0.001	5.739	21.551
Baseline Alkaline phosphatase	−.020	0.009	0.037	−.039	−.001
Tumor stage (½ ref. vs ¾)	−3.558	1.696	0.038	−6.909	−.206
Fatigue Score
(Constant)	42.419	8.628	0.000	25.364	59.474
Illiterate vs literate	−10.282	3.726	0.007	−17.647	−2.917
Tumor stage (½ref. vs ¾)	5.158	1.480	0.001	2.232	8.084
Age	0.390	0.159	0.016	0.075	0.704
Nausea and Vomiting Score
(Constant)	68.943	3.578	0.000	61.871	76.015
Regimen (AC ref. vs AC-T)	−18.435	2.244	0.000	−22.871	−13.998
Pain Score
(Constant)	7.878	11.044	0.477	−13.954	29.709
Illiterate ref. vs literate	−9.064	3.825	0.019	−16.626	−1.502
Baseline Serum Creatinine	22.560	10.153	0.028	2.490	42.630
Children (No ref. vs Yes)	9.877	4.580	0.033	0.823	18.931
Dyspnea Score
(Constant)	10.484	18.499	0.572	−26.086	47.054
Regimen (AC ref. vs AC-T)	−12.021	3.645	0.001	−19.226	−4.816
Illiterate ref. vs literate	−8.520	3.700	0.023	−15.833	−1.206
Baseline Hemoglobin	2.598	1.309	0.049	0.010	5.185
Insomnia Score*
(Constant)	15.922	8.724	0.070	−1.321	33.166
Age	0.399	0.199	0.046	0.006	0.791
Appetite Loss Score
(Constant)	88.783	5.740	0.000	77.436	100.130
Regimen (AC ref. vs AC-T)	−14.541	3.630	0.000	−21.716	−7.367
Illiterate ref. vs literate	−8.224	3.707	0.028	−15.552	−.896
Constipation Score*
(Constant)	−6.716	7.481	0.371	−21.504	8.072
Age	0.385	0.153	0.013	0.084	0.687
Tumor stage (½ ref. vs ¾)	3.407	1.480	0.023	0.482	6.333
Diarrhea Score*
(Constant)	−9.689	13.360	0.470	−36.098	16.721
Illiterate ref. vs literate	−8.808	3.215	0.007	−15.164	−2.452
Body Surface Area	17.050	8.254	0.041	0.735	33.366
Financial Difficulties Score*
(Constant)	39.448	10.619	0.000	18.457	60.440
Baseline Serum Creatinine	24.564	10.193	0.017	4.415	44.713
Children (No ref. vs Yes)	9.445	4.490	0.037	0.570	18.320
EORTC QLQ-BR23^#
Body Image Score*
(Constant)	75.916	10.768	0.000	54.632	97.201
Age	0.482	0.153	0.002	0.179	0.785
Baseline Serum Creatinine	−22.865	9.767	0.021	−42.171	−3.559
Sexual Functioning Score
(Constant)	10.964	5.100	0.033	0.881	21.047
Spouse (No ref. vs Yes)	10.754	3.608	0.003	3.621	17.888
Tumor stage (½ ref. vs ¾)	−3.902	1.435	0.007	−6.740	−1.065
Illiterate ref. vs literate	7.089	3.469	0.043	0.232	13.946
Sexual Enjoyment Score*
(Constant)	31.608	16.036	0.055	−.652	63.869
Baseline White Blood Cell Counts	4.720	2.268	0.043	0.158	9.282
Future Perspective Score
(Constant)	64.884	28.591	0.025	8.361	121.406
Age	0.567	0.179	0.002	0.213	0.922
Body Surface Area	26.350	10.845	0.016	4.911	47.789
Baseline Hemoglobin	−3.933	1.531	0.011	−6.960	−.906
Tumor stage (½ ref. vs ¾)	−4.354	1.768	0.015	−7.848	−.859
Systemic Therapy Side Effects Score*
(Constant)	35.985	6.304	0.000	23.525	48.445
Baseline Serum Creatinine	15.560	6.333	0.015	3.042	28.078
Illiterate ref. vs literate	−5.318	2.331	0.024	−9.926	−.710
Breast Symptoms Score
(Constant)	8.428	4.784	0.080	−1.029	17.885
Baseline Absolute Neutrophil Counts	1.811	0.472	0.000	0.877	2.744
Regimen (ACref. vs AC-T)	−5.183	2.018	0.011	−9.173	−1.193
Tumor stage (½ ref. vs ¾)	1.977	0.858	0.023	0.280	3.673
Arm Symptoms Score
(Constant)	14.384	5.021	0.005	4.459	24.310
Regimen (ACref. vs AC-T)	−7.224	2.277	0.002	−11.724	−2.723
Baseline White Blood Cells	1.334	0.476	0.006	0.393	2.275
Upset by Hair Loss Score
(Constant)	17.842	12.903	0.169	−7.665	43.349
Baseline Serum Creatinine	29. 455	10.752	0.007	8.199	50.710
Baseline lymphocytes	−5.523	2.429	0.024	−10.324	−.722
Age	−.366	0.170	0.033	−.701	−.031

Notes: *R² ≤ 10%; ^#for all others 10.5%≤R²≤31.9%.

Abbreviation: ref, reference category.

Table 7 The Effect of AC and AC-T Regimen’s Toxicities on Quality of Life Among Women with Breast Cancer in Ethiopia, from January 1 to September 30, 2017 GC

EORTC QLQ-C30 ^#
Global Health status/Overall QoL
Chemotherapy Toxicity	Unstandardized Coefficients (B)	Standard Error	P-value	95% Confidence Interval for B
				Lower Bound	Upper Bound
(Constant)	84.105	10.182	0.000	63.973	104.238
Fatigue (G0/1 ref.vs G≥2)	−7.709	3.070	0.013	−13.778	−1.640
Dysgeusia (G0/1 ref. vs G2)	−10.544	3.451	0.003	−17.366	−3.721
Constipation (G0/1 ref.vs G≥2)	−8.291	3.069	0.008	−14.360	−2.222
Physical Functioning Score
(Constant)	85.039	10.918	0.000	63.446	106.632
Fatigue (G0/1 ref.vs G≥2)	−10.574	3.397	0.002	−17.292	−3.856
Peripheral neuropathy (G0/1 ref.vs G≥2)	−10.482	2.852	0.000	−16.123	−4.842
Vomiting (G0/1 ref.vs G≥2)	−6.853	2.282	0.003	−11.367	−2.339
Oral mucositis (G0/1 ref.vs G≥2)	−6.351	2.381	0.009	−11.061	−1.642
Role Functioning Score
(Constant)	70.813	13.511	0.000	44.098	97.529
Dysgeusia (G0/1 ref. vs G2)	−19.275	5.324	0.000	−29.802	−8.748
Alkaline phosphatase increment (G0 ref. vs G≥1)	−7.742	3.457	0.027	−14.577	−.907
Oral mucositis (G0/1 ref.vs G≥2)	−7.661	3.338	0.023	−14.263	−1.060
Emotional Functioning Score*
(Constant)	96.048	15.229	0.000	65.937	126.159
Fatigue (G0/1 ref.vs G≥2)	−14.635	4.381	0.001	−23.297	−5.973
Dysgeusia (G0/1 ref.vs G2)	−13.132	5.012	0.010	−23.042	−3.222
Constipation (G0/1 ref.vs G≥2)	−9.450	4.391	0.033	−18.132	−.768
Cognitive Functioning Score*
(Constant)	99.858	15.611	0.000	68.993	130.724
Fatigue (G0/1 ref.vs G≥2)	−20.385	4.846	0.000	−29.966	−10.803
Alkaline phosphatase increment (G0 ref. vs G≥1)	7.709	3.584	0.033	0.623	14.795
Social Functioning Score
(Constant)	64.558	13.898	0.000	37.081	92.035
Fatigue (G0/1 ref.vs G≥2)	−12.805	4.746	0.008	−22.188	−3.423
Dysgeusia (G0/1ref.vs G2)	−14.533	5.289	0.007	−24.990	−4.076
Fatigue Score
(Constant)	−28.929	15.012	0.056	−58.617	0.758
Fatigue (G0/1 ref.vs G≥2)	14.914	4.231	0.001	6.547	23.281
Dysgeusia (G0/1 ref. vs G2)	14.587	4.738	0.003	5.218	23.956
Oral mucositis (G0/1 ref.vs G≥2)	8.067	2.977	0.008	2.180	13.954
Constipation (G0/1 ref.vs G≥2)	8.598	4.120	0.039	0.450	16.745
Peripheral neuropathy (G0/1 ref.vs G≥2)	9.319	3.196	0.004	3.000	15.639
Anemia (G0/1 ref.Vs G≥2)	14.541	4.878	0.003	4.895	24.188
Pain Score
(Constant)	−71.259	15.011	0.000	−100.943	−41.576
Skin hyperpigmentation (G0/1 ref.vs G2)	10.959	3.243	0.001	4.545	17.372
Dysgeusia (G0/1 ref.vs G2)	16.821	5.063	0.001	6.809	26.833
Constipation (G0/1 ref.vs G≥2)	14.477	4.491	0.002	5.596	23.358
Arthralgia/myalgia (G0/1 ref.vs G≥2)	8.502	3.313	0.011	1.951	15.052
Dyspnea Score
(Constant)	−14.747	12.095	0.225	−38.665	9.171
Constipation (G0/1 ref.vs G≥2)	22.148	4.393	0.000	13.462	30.835
Dysgeusia (G0/1 ref. vs G2)	18.811	4.994	0.000	8.937	28.686
Peripheral neuropathy (G0/1 ref.vs G≥2)	9.557	3.832	0.014	1.979	17.134
Insomnia Score*
(Constant)	−57.184	17.475	0.001	−91.731	−22.636
Dysgeusia (G0/1 ref. vs G2)	22.962	6.760	0.001	9.597	36.327
Fatigue (G0/1 ref.vs G≥2)	11.973	5.867	0.043	0.376	23.571
Appetite Loss Score
(Constant)	25.482	14.679	0.085	−3.544	54.509
Dry mouth (G0/1 ref.vs G≥2)	20.016	3.869	0.000	12.365	27.668
Dysgeusia (G0/1 ref. vs G2)	15.642	4.911	0.002	5.930	25.353
Fatigue (G0/1 ref.vs G≥2)	9.620	4.421	0.031	0.878	18.361
Constipation Score*
(Constant)	−34.838	7.578	0.000	−49.819	−19.857
Constipation (G0/1 ref.vs G≥2)	26.451	4.089	0.000	18.367	34.535
Diarrhea Score*
(Constant)	−29.409	8.590	0.001	−46.392	−12.426
Diarrhea (G0/1 ref.vs G≥2)	19.552	3.775	0.000	12.089	27.015
Dry mouth (G0/1 ref.Vs G≥2)	9.065	3.531	0.011	2.084	16.046
Constipation (G0/1 ref.vs G≥2)	8.917	4.097	0.031	0.818	17.016
Financial Difficulties Score
(Constant)	−7.834	11.718	0.505	−31.003	15.336
Fatigue (G0/1 ref.vs G≥2)	11.572	4.182	0.006	3.303	19.841
Oral mucositis (G0/1 ref.vs G≥2)	7.963	3.032	0.010	1.967	13.958
EORTC QLQ-BR23^#
Body Image Score*
(Constant)	79.548	15.459	0.000	48.983	110.113
Dysgeusia (G0/1 ref. vs G2)	−11.406	5.050	0.025	−21.391	−1.421
Skin hyperpigmentation (G0/1 ref. vs G2)	−6.189	3.124	0.050	−12.366	−.013
Sexual Functioning Score
(Constant)	19.504	10.878	0.075	−2.004	41.012
Fatigue (G0/1 ref.vs G≥2)	−11.587	4.546	0.012	−20.576	−2.598
Gastritis (G0/1 ref.vs G≥2)	10.909	3.602	0.003	3.787	18.030
Dry mouth (G0/1 ref.vs G≥2)	−10.128	4.028	0.013	−18.093	−2.164
Sexual Enjoyment Score*
(Constant)	49.739	20.740	0.021	7.966	91.512
Fatigue (G0/1 ref.vs G≥2)	−25.320	8.346	0.004	−42.129	−8.512
Peripheral neuropathy (G0/1 ref.vs G≥2)	16.231	7.286	0.031	1.556	30.906
Future Perspective Score
(Constant)	32.397	26.130	0.217	−19.266	84.061
Dysgeusia (G0/1 ref. vs G2)	−15.859	5.881	0.008	−27.487	−4.231
Systemic Therapy Side Effects Score*
(Constant)	−21.726	8.765	0.014	−39.059	−4.392
Dry mouth (G0/1 ref. vs G≥2)	11.789	2.254	0.000	7.332	16.246
Dysgeusia (G0/1 ref. vs G2)	13.532	2.996	0.000	7.608	19.457
Constipation (G0/1 ref. vs G≥2)	8.355	2.484	0.001	3.443	13.267
Vomiting ((G0/1 ref.vs G≥2)	6.274	1.916	0.001	2.485	10.063
Peripheral neuropathy (G0/1 ref.vs G≥2)	4.819	1.854	0.010	1.152	8.486
Diarrhea (G0/1 ref.vs G≥2)	5.443	2.318	0.020	0.859	10.027
Nausea (G0/1 ref.vs G≥2)	−6.199	2.696	0.023	−11.531	−.867
Arm Symptoms Score
(Constant)	19.313	5.053	0.000	9.323	29.303
Lymphopenia (G0/1 ref.vs G≥2)	−6.607	2.507	0.009	−11.563	−1.652
Upset by Hair Loss Score
(Constant)	−17.564	17.139	0.307	−51.455	16.327
Dysgeusia (G0/1 ref. vs G2)	16.238	5.770	0.006	4.829	27.648
Skin hyperpigmentation (G0/1 ref. vs G2)	7.715	3.589	0.033	0.617	14.813

Notes: *R² ≤ 10%; ^#for all others: 23.6%≤R²≤55.6%. G0/1= Grade 0 or 1; G≥2=Grade 2 and above. The model was corrected/adjusted for baseline quality of life score, corresponding statistically significant sociodemographic and clinical variables.

Abbreviation: Ref, reference category.