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Age-stratified analysis of health-related quality of life in patients with early-stage breast cancer receiving adjuvant radiation therapy and endocrine therapy

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Abstract
Introduction: Health-related quality of life (HRQoL) in older patients with breast cancer (BC) (>= 70 years) is not well studied. This study assesses aging-related differences in patient-reported outcomes among estrogen receptorpositive (ER+) patients with BC treated with breast conservation surgery (BCS), radiation therapy (RT), and endocrine therapy (ET). Materials and Methods: Among the 2,057 patients with ER+ early-stage BC enrolled in the prospective multicenter REQUITE study, 1,003 patients receiving adjuvant RT + ET as the only systemic therapy constitute our study population. Patients were stratified by age into younger (<70 years, n = 810 patients) and older (>= 70 years, n = 193 patients) groups. Prospectively collected HRQoL was measured using the validated European Organization for Research and Treatment of Cancer (EORTC) quality of life of cancer patients (QLQ-30) and breast cancer-specific quality of life (QLQ-BR23), and Multidimensional Fatigue Inventory (MFI-20) measures at baseline following BCS and pre-adjuvant treatment, post-RT, and at one-year, two-year, and three-year intervals. Statistical analysis involved a mixed model analysis of variance, weighted by propensity scoring. Results: Older patients had a higher burden of comorbidities, larger tumor size, and higher rates of N1 disease compared to the younger group. RT boost to the lumpectomy site was more often delivered in younger participants (72 %) compared to older (50 %). Younger patients predominately received tamoxifen (63.5 %), while older patients more commonly received aromatase inhibitors (67.4 %). Throughout the follow-up, we observed that the younger patients showed greater recovery in QoL domains including sexual enjoyment, systemic side effects, breast symptoms, global health status, and emotional, physical, and social functioning compared to the older group. Cognitive function, which declined from baseline in both groups, improved over time in younger participants but persisted at lower levels in older patients at the three-year follow-up period. Discussion: Adjuvant treatments differentially impacted HRQoL, with older patients experiencing greater and more persistent adverse effects compared to younger counterparts. These findings underscore the need for tailored interventions that address the unique challenges in HRQoL recovery among older BC survivors.
Keywords
Health-related quality of life, Patient-reported outcomes, Early-stage breast cancer, estrogen receptor positive, Older women, Lumpectomy, Endocrine therapy, Radiation therapy, CONSERVING SURGERY, RADIOTHERAPY, TAMOXIFEN

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MLA
Li, Keva, et al. “Age-Stratified Analysis of Health-Related Quality of Life in Patients with Early-Stage Breast Cancer Receiving Adjuvant Radiation Therapy and Endocrine Therapy.” JOURNAL OF GERIATRIC ONCOLOGY, vol. 16, no. 2, 2025, doi:10.1016/j.jgo.2025.102195.
APA
Li, K., Chadha, M., Moshier, E., Rosenstein, B. S., Jandu, H. K., Veal, C. D., … REQUITE Consortium, [missing]. (2025). Age-stratified analysis of health-related quality of life in patients with early-stage breast cancer receiving adjuvant radiation therapy and endocrine therapy. JOURNAL OF GERIATRIC ONCOLOGY, 16(2). https://doi.org/10.1016/j.jgo.2025.102195
Chicago author-date
Li, Keva, Manjeet Chadha, Erin Moshier, Barry S. Rosenstein, Harkeran K. Jandu, Colin D. Veal, Laura Fachal, et al. 2025. “Age-Stratified Analysis of Health-Related Quality of Life in Patients with Early-Stage Breast Cancer Receiving Adjuvant Radiation Therapy and Endocrine Therapy.” JOURNAL OF GERIATRIC ONCOLOGY 16 (2). https://doi.org/10.1016/j.jgo.2025.102195.
Chicago author-date (all authors)
Li, Keva, Manjeet Chadha, Erin Moshier, Barry S. Rosenstein, Harkeran K. Jandu, Colin D. Veal, Laura Fachal, Craig Luccarini, Miguel E. Aguado-Barrera, Manuel Altabas, David Azria, Adinda Baten, Celine Bourgier, Renée Bultijnck, Riccardo R. Colciago, Marie-Pierre Farcy-Jacquet, Jenny Chang-Claude, Ananya Choudhury, Alison Dunning, Rebecca M. Elliott, Sheryl Green, Sara Gutiérrez-Enríquez, Carsten Herskind, Maarten Lambrecht, Christel Monten, Tiziana Rancati, Victoria Reyes, Dirk De Ruysscher, Maria Carmen De Santis, Petra Seibold, Elena Sperk, Marlon R. Veldwijk, R. Paul Symonds, Hilary Stobart, Begoña Taboada-Valladares, Ana Vega, Liv Veldeman, Adam J. Webb, Caroline Weltens, Catharine M. West, Tim Rattay, Christopher J. Talbot, and [missing] REQUITE Consortium. 2025. “Age-Stratified Analysis of Health-Related Quality of Life in Patients with Early-Stage Breast Cancer Receiving Adjuvant Radiation Therapy and Endocrine Therapy.” JOURNAL OF GERIATRIC ONCOLOGY 16 (2). doi:10.1016/j.jgo.2025.102195.
Vancouver
1.
Li K, Chadha M, Moshier E, Rosenstein BS, Jandu HK, Veal CD, et al. Age-stratified analysis of health-related quality of life in patients with early-stage breast cancer receiving adjuvant radiation therapy and endocrine therapy. JOURNAL OF GERIATRIC ONCOLOGY. 2025;16(2).
IEEE
[1]
K. Li et al., “Age-stratified analysis of health-related quality of life in patients with early-stage breast cancer receiving adjuvant radiation therapy and endocrine therapy,” JOURNAL OF GERIATRIC ONCOLOGY, vol. 16, no. 2, 2025.
@article{01K9EN3AEHWDW86D11N748SBMW,
  abstract     = {{Introduction: Health-related quality of life (HRQoL) in older patients with breast cancer (BC) (>= 70 years) is not well studied. This study assesses aging-related differences in patient-reported outcomes among estrogen receptorpositive (ER+) patients with BC treated with breast conservation surgery (BCS), radiation therapy (RT), and endocrine therapy (ET). Materials and Methods: Among the 2,057 patients with ER+ early-stage BC enrolled in the prospective multicenter REQUITE study, 1,003 patients receiving adjuvant RT + ET as the only systemic therapy constitute our study population. Patients were stratified by age into younger (<70 years, n = 810 patients) and older (>= 70 years, n = 193 patients) groups. Prospectively collected HRQoL was measured using the validated European Organization for Research and Treatment of Cancer (EORTC) quality of life of cancer patients (QLQ-30) and breast cancer-specific quality of life (QLQ-BR23), and Multidimensional Fatigue Inventory (MFI-20) measures at baseline following BCS and pre-adjuvant treatment, post-RT, and at one-year, two-year, and three-year intervals. Statistical analysis involved a mixed model analysis of variance, weighted by propensity scoring. Results: Older patients had a higher burden of comorbidities, larger tumor size, and higher rates of N1 disease compared to the younger group. RT boost to the lumpectomy site was more often delivered in younger participants (72 %) compared to older (50 %). Younger patients predominately received tamoxifen (63.5 %), while older patients more commonly received aromatase inhibitors (67.4 %). Throughout the follow-up, we observed that the younger patients showed greater recovery in QoL domains including sexual enjoyment, systemic side effects, breast symptoms, global health status, and emotional, physical, and social functioning compared to the older group. Cognitive function, which declined from baseline in both groups, improved over time in younger participants but persisted at lower levels in older patients at the three-year follow-up period. Discussion: Adjuvant treatments differentially impacted HRQoL, with older patients experiencing greater and more persistent adverse effects compared to younger counterparts. These findings underscore the need for tailored interventions that address the unique challenges in HRQoL recovery among older BC survivors.}},
  articleno    = {{102195}},
  author       = {{Li, Keva and Chadha, Manjeet and Moshier, Erin and Rosenstein, Barry S. and Jandu, Harkeran K. and Veal, Colin D. and Fachal, Laura and Luccarini, Craig and Aguado-Barrera, Miguel E. and Altabas, Manuel and Azria, David and Baten, Adinda and Bourgier, Celine and Bultijnck, Renée and Colciago, Riccardo R. and Farcy-Jacquet, Marie-Pierre and Chang-Claude, Jenny and Choudhury, Ananya and Dunning, Alison and Elliott, Rebecca M. and Green, Sheryl and Gutiérrez-Enríquez, Sara and Herskind, Carsten and Lambrecht, Maarten and Monten, Christel and Rancati, Tiziana and Reyes, Victoria and De Ruysscher, Dirk and De Santis, Maria Carmen and Seibold, Petra and Sperk, Elena and Veldwijk, Marlon R. and Symonds, R. Paul and Stobart, Hilary and Taboada-Valladares, Begoña and Vega, Ana and Veldeman, Liv and Webb, Adam J. and Weltens, Caroline and West, Catharine M. and Rattay, Tim and Talbot, Christopher J. and REQUITE Consortium, [missing]}},
  issn         = {{1879-4068}},
  journal      = {{JOURNAL OF GERIATRIC ONCOLOGY}},
  keywords     = {{Health-related quality of life,Patient-reported outcomes,Early-stage breast cancer, estrogen receptor positive,Older women,Lumpectomy,Endocrine therapy,Radiation therapy,CONSERVING SURGERY,RADIOTHERAPY,TAMOXIFEN}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{8}},
  title        = {{Age-stratified analysis of health-related quality of life in patients with early-stage breast cancer receiving adjuvant radiation therapy and endocrine therapy}},
  url          = {{http://doi.org/10.1016/j.jgo.2025.102195}},
  volume       = {{16}},
  year         = {{2025}},
}

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