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| |  Hypofractionated Radiotherapy Can Result in Better Quality of Life for Patients With Breast Cancer NEW YORK -- February 8, 2010 -- In patients with breast cancer, hypofractionated radiotherapy does not seem to increase adverse symptoms or result in worse body image compared with the international standard treatment, according to a study published online first and appearing in an upcoming issue of The Lancet Oncology. These 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 provides better quality of life for patients. Quality of life has been extensively studied in patients with breast cancer. 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. To provide more evidence, Penelope Hopwood, Institute of Cancer Research, and the Royal Marsden NHS Foundation Trust, London, United Kingdom, and colleagues examined patients’ experience of adverse breast, arm, and shoulder symptoms and functional outcomes and body image after different radiotherapy regimens up to 5 years after treatment. A total of 2,208 women given radiotherapy after primary surgery for early-stage breast cancer recruited from the Standardisation of Breast Radiotherapy (START) trials completed quality-of-life questionnaires and self-assessments of body image and radiotherapy effects on healthy tissues at regular intervals for 5 years after treatment. Over 5 years, the most frequently reported adverse effects were breast hardness (41%) and change in breast appearance (39%). In addition, up to a third of patients experienced arm and shoulder pain, while the 5-year rate of moderate or marked shoulder stiffness was about 20%. 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 most adverse effects was similar, with lower or similar rates for the hypofractionated schedules compared with the international standard treatment. The team found that 40% of women reported moderate or striking concerns for at least one body-image item up to 5 years following treatment. The most common concerns were feeling physically less attractive (23%) and dissatisfaction with body (23%). However, reported body image concerns did not differ between radiotherapy schedules. “Considerable morbidity still arises due to effects on normal [healthy] tissues of treatment for early breast cancer, and patients’ self-assessments are important to ascertain the extent and duration of these effects,” the authors wrote. “These ratings by patients…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.” In an accompanying comment, Julie Schnur, MD, Mount Sinai School of Medicine, New York, New York said the findings should make: “The understanding and assessment of patients’ experiences a top priority.” In particular, she said, they highlight the need for the development of a scale designed to assess breast body image rather than just overall body image, and broader interventions to improve body image such as cognitive and behavioural therapy.
SOURCE: The Lancet Oncology
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