Pain, fatigue and quality of life in Hong Kong Chinese women with early stage breast cancer: before-versus-after adjuvant radiotherapy

Abstract

Background: Adjuvant radiotherapy (RT) is a common treatment for breast cancer for its benefit in reducing the risk of local recurrence. However, RT may induce substantial distress in patients and have an adverse impact on their quality of life. The purpose of this abstract was to compare the experiences of pain and fatigue, and the quality of life of Hong Kong Chinese women who had completed RT with those who were awaiting RT. Method: This analysis comprised of 70 Chinese women diagnosed with stage 0-III primary breast cancer who had joined a larger trial investigating the effects of a psychotherapy program. They were recruited consecutively from two government hospitals and three community centres in Hong Kong. The current data were collected before the program by self-administered questionnaires including the Brief Pain Inventory (BPI), Brief Fatigue Inventory (BFI) and Functional Assessment of Cancer Therapy-Breast (FACT-B). Women were age-matched and grouped by their RT status at enrollment: Pending (preRT, n=36), within a month post-RT (1-postRT, n=17), and over a month post-RT (>1-postRT, n=17, median length=91 days). Results: The three groups were similar clinically and demographically (mean age=50 years). All had breast surgery and 74% also had chemotherapy. In terms of severe pain and severe fatigue, respectively, 17% and 34% of preRT group vs. 18% and 41% of 1-postRT group vs. 29% and 29% of >1-postRT group had experienced these symptoms. The Kruskal-Wallis tests showed no significant overall group differences in the scores of BPI, BFI, Total FACT-B and subscales except for the FACT-B emotional well-being subscale (p=0.04). In all FACT-B scales, the >1-postRt group scored the highest, the preRT group slightly lower and the 1m-postRT the lowest. Conclusions: Before RT, a significant minority of women were fatigued and had experienced severe pain, suggesting the lingering effects of prior anti-cancer therapies. The occurrence of severe fatigue was more common than severe pain both before RT and shortly after RT completion. About one third of the women who had finished RT months ago still experienced fatigue and/or pain. Patients' quality of life might be undermined in the first month after treatment completion, but the longer-term quality of life after RT seemed comparable with that before RT. Research Implications: The results suggested that the potential impact of RT on quality of life might be minor and temporary. However, our small sample size implied a higher chance of a Type II error. Prospective research with a larger cohort is needed to better understand the effects of RT across the period of treatment and recovery. Research is also indicated to explore the possible causes of severe fatigue or pain in patients who have long completed treatment. Clinical Implications: Assessment of patients' symptom status prior to RT commencement is important for early intervention, if necessary, to prevent further deterioration of patients' condition as RT progresses. Such an assessment should continue into the post treatment period.