Heart Vessels and Transplantation (Jan 2024)
Comprehensive assessment of the quality of life in patients with breast cancer during neoadjuvant chemotherapy
Abstract
Objective: Advances in cancer treatment over the past decades have improved long-term patient survival but increased the incidence of chemotherapy-associated cardiotoxicity (CAC). The study of quality of life (QoL) indicators is becoming a relevant and integral subject for the management of patients receiving high doses of antitumor therapy. In particular, CAC carries a high burden on the healthcare system and the patient's daily lifestyle due to a decrease in the body's functional capacity. Due to the increasing life expectancy of patients with cancer, the issues of maintaining a high QoL are becoming increasingly important. The purpose of the study is to conduct a comprehensive assessment of QoL in patients with breast cancer during neoadjuvant chemotherapy (NAC). Methods: The study included 72 patients with breast cancer who underwent a comprehensive assessment of the cardiovascular system at the National Medical Research Center for Cardiovascular Surgery. A.N. Bakulev" as continuous cardiac monitoring during NAC. To assess the quality of life, all patients filled out the standardized questionnaire SF-36, EQ-5D-5L, as well as indicators on the international Karnofsky and ECOG (Eastern Cooperative Oncology Group) scales. The possible relationship between various indicators of the questionnaire with internationally validated scales, as well as data from the clinical status of patients, was studied. Results: A significant deterioration in the QoL of patients receiving NAC was observed in all analyzed indicators: mental and physical health indicators, Karnofsky scores, ECOG and EQ 5D-5L sharply decreased, the prevalence of general weakness, shortness of breath and decreased exercise tolerance increased. According to scale SF-36, initially low indicators were observed in a large number of patients (80 and 82%, respectively); at the intermediate and final stages, almost all patients showed a deterioration in their condition compared to the outcome (p = 0.0002–0.0001). Predictors of a pronounced negative deviation in QoL indicators are the presence of initial reduced ECOG and Karnofsky scores, as well as the presence of an initial decrease in exercise tolerance, the presence of weakness and shortness of breath. Conclusion: During continuous cardiac monitoring, we demonstrated a deterioration in all indicators of QoL, according to questionnaires and validated international scales during NAC in patient with breast cancer. Predictors of a pronounced decrease in QoL indicators are the presence of initial reduced ECOG and Karnofsky scores, as well as the presence of an initial decrease in exercise tolerance, the presence of weakness and shortness of breath. The Karnofsky scale and ECOG can be adapted for objective assessment of QoL indicators during NAC.
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