Physical functioning after treatment for breast cancer and the impact of age

Abstract

Background: Breast cancer is the most frequently diagnosed cancer in England and treatment can be multimodal (surgery, radiotherapy, chemotherapy, targeted therapy and/or hormone treatment) [1]. Robust data is needed on the impact of treatment on physical functioning to inform shared decision-making. Aim: To explore physical functioning amongst older and younger patients after treatment for early-stage breast cancer, and the moderating effects of the type of treatment , comorbidities, fatigue, pain, anxiety and depression. Methods: Data from the CANcer surVeillance And Support (CANVAS) project in Leeds and national TACT-2 randomised controlled trial (RCT) was analysed via Multilevel Modelling [2, 3, 4]. The CANVAS project included patients who had completed multimodal treatment representing standard clinical practice [2]. The TACT-2 RCT involved patients with moderate to high-risk breast cancer during and after intensive adjuvant chemotherapy [3, 4]. Results: Analysis of CANVAS data (N=401, N=189 aged ≥60 years) found that age was significantly associated with EORTC QLQ-C30 physical functioning after breast cancer treatment (p=.002), and EORTC QLQ-C30 fatigue and pain had significant moderating effects (p<.001). Participants aged ≥60 years reported worse physical functioning than those <60 years. Analysis of TACT-2 data (N=1,170, N=247 aged ≥60 years) revealed that age was significantly associated with EORTC QLQ-C30 physical functioning during and after chemotherapy (p<.001), and EORTC QLQ-C30 fatigue and pain, and HADS anxiety and depression had significant moderating effects (p<.001). Participants aged ≥50 years reported worse physical functioning than participants aged <50 years, but there was no significant difference between older age groups (50-59 and ≥60 years). Conclusion: Physical functioning declined with increasing age during and after breast cancer treatment, and fatigue and pain consistently moderated the relationship. Significant changes occurred after typical treatment regimens at the age of ≥60 years. However, an intensive form of chemotherapy appears to accelerate physical functioning declines to age ≥50 years [3, 4].

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