Radiotherapy for breast-cancer patients, given as a lower overall dose in fewer higher doses, does not seem to increase adverse symptoms or result in worse body image compared with the international standard treatment, according to a new study.
The results add to the evidence that shorter hypofractionated radiotherapy schedules do not cause more side effects in the breast, are equally effective at reducing the risk of further cancer in the breast, and thus provide better quality of life for patients.
Quality of life has been extensively studied in breast-cancer patients. But little is known about the patients’ perspective of quality of life after radiotherapy, particularly the effects of radiotherapy on adverse skin changes and body image, the researchers noted.
They examined patients’ experiences of adverse breast, arm and shoulder symptoms and functional outcomes and body image after different radiotherapy regimens up to five years after treatment.
Some 2,208 women given radiotherapy after primary surgery for early-stage breast cancer recruited from the START (Standardisation of Breast Radiotherapy) Trials completed quality-of-life questionnaires and self-assessments of body image and radiotherapy effects on healthy tissues at regular intervals for five years after treatment.
Over five years, the most frequently reported adverse effects were breast hardness and change in breast appearance. In addition, up to a third of patients experienced arm and shoulder pain, while the five-year rate of moderate or marked shoulder stiffness was about 20 per cent. However, many arm and shoulder symptoms were present at the start of the study and were associated with previous surgery.
Adverse change in skin appearance after radiotherapy was the only symptom to differ significantly between the radiotherapy schedules, but the overall pattern for all adverse effects was similar, with lower or similar rates for the schedules with a higher daily dose compared with the international standard treatment.
The team found that 40 per cent of women reported moderate or striking concerns for at least one body-image item up to five years following treatment. The most common concerns were feeling physically less attractive and dissatisfaction with their body. However, reported body image concerns did not differ between radiotherapy schedules.
“Considerable morbidity still arises due to effects on normal tissues of treatment for early breast cancer, and patients’ self-assessments are important to ascertain the extent and duration of these effects,” the researchers commented.
The researchers added that such findings “strengthen evidence in favour of hypofractionated regimens, [with the potential for] reduced adverse normal breast tissue effects reported… [and] have important implications for radiotherapy practice”.
The Lancet Oncology online, at http://press.thelancet.com/tlohopwood.pdf
About Greg Baxter
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