Impact of Breast Cancer Treatment on Employment: Results of a Multicenter Prospective Cohort Study (CANTO)

PURPOSE Adverse effects of breast cancer treatment can negatively affect survivors’ work ability. Previous reports lacked detailed clinical data or health-related patient-reported outcomes (PROs) and did not prospectively assess the combined impact of treatment and related sequelae on employment. METHODS We used a French prospective clinical cohort of patients with stage I-III breast cancer including 1,874 women who were working and ≥ 5 years younger than legal retirement age (≤ 57 years) at breast cancer diagnosis. Our outcome was nonreturn to work (non-RTW) 2 years after diagnosis. Independent variables included treatment characteristics as well as toxicities (Common Toxicity Criteria Adverse Events [CTCAE] v4) and PROs (European Organization for Research and Treatment of Cancer [EORTC] Quality of life Questionnaires, Breast cancer module [QLQ-BR23] and Fatigue module [QLQ-FA12], Hospital Anxiety and Depression Scale) collected 1 year after diagnosis. Logistic regression models assessed correlates of non-RTW, adjusting for age, stage, comorbidities, and socioeconomic covariates. RESULTS Two years after diagnosis, 21% of patients had not returned to work. Odds of non-RTW were significantly increased among patients treated with combinations of chemotherapy and trastuzumab (odds ratio [OR] v chemotherapy-hormonotherapy: for chemotherapy-trastuzumab, 2.01; 95% CI, 1.18 to 3.44; for chemotherapy-trastuzumab-hormonotherapy, 1.62; 95% CI, 1.10 to 2.41). Other significant associations with non-RTW included grade ≥ 3 CTCAE toxicities (OR v no, 1.59; 95% CI, 1.15 to 2.18), arm morbidity (OR v no, 1.59; 95% CI, 1.19 to 2.13), anxiety (OR v no, 1.47; 95% CI, 1.02 to 2.11), and depression (OR v no, 2.29; 95% CI, 1.34 to 3.91). CONCLUSION Receipt of systemic therapy combinations including trastuzumab was associated with increased odds of non-RTW. Likelihood of unemployment was also higher among patients who reported severe physical and psychological symptoms. This comprehensive study identifies potentially vulnerable patients and warrants supportive interventional strategies to facilitate their RTW.

Patient-Reported Satisfaction Following Radiation of Implant-Based Breast Reconstruction

Background: Little is known with regard to patient-reported outcomes (PROs) in the setting of implant-based reconstruction (IBR) with post-mastectomy radiation therapy (PMRT). Methods: We identified patients who underwent immediate IBR from a prospectively compiled database. The Breast Reconstruction Satisfaction Questionnaire (BRECON-31) was scored and compared between patients with and without PMRT. Results: Sixty-four women met the study criteria. Forty-eight did not receive PMRT and 16 did. Nine women had an unanticipated indication for PMRT. The PMRT group was similar to the control group with regard to baseline characteristics (ie, age, marital status, body mass index, tobacco use, and comorbidities). However, treatment and oncologic characteristics (eg, diagnosis, tumour characteristics, systemic therapy use) differed. Of all complications, only capsular contracture rates differed (1.2% vs 13%; P = .01). Of the 9 subscales, 7 showed no difference in satisfaction between the groups. Radiated women scored lower in the arm concerns and breast appearance subscales. Scores were similar whether the indication for PMRT had been anticipated or not. Discussion: Women with immediate IBR scored similarly to their nonradiated counterparts across 7 of 9 domains of satisfaction. Arm concerns and breast appearance scores are lower with PMRT, likely secondarily to more extensive nodal procedures in higher stage patients and to the side effect profile of radiotherapy. Our findings are in line with the few available studies using other PRO tools to evaluate the impact of PMRT on patient satisfaction and studies objectively measuring the effect of PMRT on arm morbidity and cosmetic outcomes.

Mulheres com neoplasia mamária em quimioterapia adjuvante: avaliação da qualidade de vida [Women with breast cancer in adjuvant chemotherapy: assessment of quality of life] [Mujeres con neoplasia mamaria en la quimioterapia adyuvante: evaluación de la calidad de vida]

Objetivo: avaliar a qualidade de vida de mulheres com neoplasia mamária e em quimioterapia adjuvante. Método: estudo descritivo, transversal e quantitativo desenvolvido com 25 mulheres em tratamento em uma Unidade de Assistência de Alta Complexidade em Oncologia de uma cidade do Brasil, por meio do questionário Functional Assessment of Cancer Therapy – Breast plus Arm Morbidity (FACTB +4). Pesquisa aprovada no Comitê de Ética em Pesquisa da Universidade Federal de Alfenas (UNIFAL-MG), por meio do Protocolo: 208/2011. Resultados: verificaram- se, em âmbito geral, bons resultados de qualidade de vida nos domínios e para o FACT B Total. Encontraram-se menores médias de escores nos domínios preocupações adicionais com o câncer de mama (22,68±4,96/36) e bem-estar funcional (16,92±4,60/28). Conclusão: destaca-se a necessidade de cuidados referentes às modificações da imagem corporal, ao estresse sobre a doença e anseios de um familiar vir a ter câncer.ABSTRACTObjective: to evaluate the quality of life of women with breast cancer in adjuvant chemotherapy. Method: this descriptive, quantitative, cross-sectional study examined 25 women undergoing treatment at a High Complexity Oncology Unit in a Brazilian city, in 2012, using the Functional Assessment of Cancer Therapy - Breast plus Arm Morbidity (FACT B +4) questionnaire. The study was approved by the research ethics committee of Alfenas Federal University (UNIFAL-MG), under Protocol 208/2011. Results: by and large, good quality of life was found in the domains and for Total FACT B. Lower mean scores were observed in the additional concerns with breast cancer (22.68 ± 4.96/36) and functional well-being (16.92 ± 4.60/28) domains. Conclusion: the findings highlighted the need for care relating to changes in body image, disease-related stress and anxiety that a family member may come to have cancer.RESUMENObjetivo: evaluar la calidad de vida de mujeres con neoplasia mamaria y en quimioterapia adyuvante. Método: estudio descriptivo, transversal y cuantitativo desarrollado junto a 25 mujeres en tratamiento en una Unidad de Asistencia de Alta Complejidad en Oncología de una ciudad de Brasil, en 2012; por medio del cuestionario Functional Assessment of Cancer Therapy - Breast plus Arm Morbidity (FACTB +4). Investigación aprobada en el Comité de Ética en Investigación de la Universidad Federal de Alfenas (UNIFAL-MG), a través del Protocolo: 208/2011. Resultados: se verificaron, en general, buenos resultados de calidad de vida en los dominios y para el FACT B Total. Se encontraron menores promedios de escores en los dominios ‘preocupaciones adicionales con el cáncer de mama (22,68/36) y bienestar funcional (16,92/28)’. Conclusión: se destaca la necesidad de cuidados referentes a las modificaciones de la imagen corporal, al estrés sobre la enfermedad y preocupaciones con la posibilidad de que un familiar vaya a tener cáncer.