Chemo Tied to Long-Lasting Health Decline in Breast Cancer

TOPLINE:

Breast cancer survivors who received chemotherapy, endocrine therapy, or both showed a significant decline in physical health during the first 2 years after diagnosis compared with those without cancer, but this decline only remained significant in those who received chemotherapy after the 2-year mark.

METHODOLOGY:

• Breast cancer survivors are known to experience a decline in physical health, but whether the decline is associated with the type of treatment they receive remains unclear.
• The analysis included 2566 women with breast cancer (median age at diagnosis, 56.3 years) who received chemotherapy, endocrine therapy, or both and 12,826 age-matched women without cancer.
• Among women with breast cancer, 47.7% received endocrine therapy, 10.8% received chemotherapy, and 24.7% received both. Among those who received endocrine therapy, 31.8% used tamoxifen and 47.8% used aromatase inhibitors.
• Researchers compared women’s physical health before their breast cancer diagnosis and at 3 intervals after to that of age-matched women without cancer. Physical health was assessed using the Patient-Reported Outcomes Measurement Information System Global Health instrument.

TAKEAWAY:

• Within 2 years of diagnosis, breast cancer survivors who received chemotherapy had a greater decline in physical health compared to women without cancer (β, –3.13), as did those who received endocrine therapy (β, –1.12) or both therapies (β, –3.26).
• However, between 2 and 5 years, a decline persisted only in those who received chemotherapy (β, −1.20) or chemotherapy plus aromatase inhibitors (β, −1.43).
• At 5 years and beyond, the reported decline in physical health was even greater in those who received chemotherapy (β, −4.09) and those who received both (β, −1.65). This pattern held for the subset of women with invasive breast cancer.
• Among survivors with localized estrogen receptor–positive tumors, a greater decline in physical health was observed with endocrine therapy (β, −1.40) and chemotherapy plus endocrine therapy (β, −2.89) within 2 years of diagnosis. After 5 years, this decline persisted only in those who received chemotherapy.

IN PRACTICE:

“Our cohort study found a greater physical health decline in women receiving chemotherapy, with or without endocrine therapy, which persisted more than 5 years after the diagnosis, compared with age-matched women without cancer. In contrast, the physical health decline observed in women who received endocrine therapy without chemotherapy was restricted to the first 2 years after diagnosis,” the authors wrote.

SOURCE:

This study, led by Clara Bodelon, PhD, MA, MS, the Department of Population Science, American Cancer Society, Atlanta, Georgia, was published online in JAMA Network Open.

LIMITATIONS:

This study lacked information on specific chemotherapy types and targeted therapies or immunotherapies, which could have affected physical health outcomes. Small sample sizes for certain treatment groups limited the statistical power of the analysis. Additionally, the noncompletion of follow-up surveys by some participants potentially affected long-term health assessment accuracy. 

DISCLOSURES:

The American Cancer Society funded the creation, maintenance, and updating of the patient cohort. The authors reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.