Patient-reported symptoms of late radiation toxicity in breast cancer patients

Abstract

Purpose or Objective To assess the prevalence of patient-reported symptoms of late radiation skin toxicity (LRT) in breast cancer patients and to determine the association between LRT and quality of life. Materials and Methods Within the prospective UMBRELLA cohort, a survey on self-reported LRT was sent to breast cancer patients with > 12 months interval since radiotherapy with curative intent. Symptoms of LRT were evaluated on a 4-point Likert scale. Based on the CTCAE version 4.03 and RTOG, LRT was defined as grade 3-4 (moderate-severe) breast or chest wall pain in combination with at least one other grade 2-4 (mild-severe) LRT symptom, i.e. breast or arm/hand lymphedema, firmness of the breast or impaired arm movement. Physical, role and social functioning were measured prior to, during, and after the LRT survey using EORTC QLQ-C30 and the thresholds for clinical importance (i.e. indicating clinically relevant impairment). Results 763/1048 patients (73%) responded to the LRT survey. After a median follow up of 44 months (range 12-71), 17% (n= 129) reported LRT. Moderate/severe breast or chest wall pain was reported by 138/763 (18%) patients and moderate/severe firmness of the breast was reported by 139/759 (18%) patients (Figure 1). Of all patients with LRT, 38-53% functioned below the clinical threshold for physical functioning compared to 21-27% of patients without LRT (Figure 2). A higher proportion of patients with LRT (23-43%) scored below the threshold for role functioning when compared to patients without LRT (7-21%). Patients with self-reported LRT significantly more often received analgesics, physiotherapy and lymphedema therapy compared to patients without LRT. Conclusion LRT was reported by 17% of the patients, and these patients reported lower scores for physical, role and social functioning compared to patients without LRT.