Comprehensive assessment of quality of life in patients during neoadjuvant chemotherapy

Relevance. Advances in cancer treatment over the past decades have improved long-term patient survival, but increased the incidence of chemotherapy-associated cardiotoxicity (CTA). The study of quality of life (QOL) indicators is becoming an important and integral subject of management for patients receiving high doses of anticancer therapy. In particular, CTA carries a high burden on the healthcare system and the habitual lifestyle of patients due to a decrease in the functional ability of the body. Due to the increase in the life expectancy of patients with oncological diseases, the issues of maintaining a high QoL are becoming increasingly important.

The aim of the study was to conduct a comprehensive assessment of QoL in patients during neoadjuvant chemotherapy.

Materials and methods. The study included 72 patients with breast cancer who underwent a comprehensive assessment of the cardiovascular system at the National Medical Research Centre for Cardiovascular Surgery n. a. A. N. Bakoulev as a continuous cardiac monitoring during neoadjuvant chemotherapy. To assess the QoL, all patients filled out a standardized questionnaire SF-36, EQ-5D-5L, as well as indicators according to the international Karnovsky and ECOG (Eastern Cooperative Oncology Group) scales. The possible relationship between various indicators of the questionnaire with internationally validated scales, as well as data on the clinical status of patients, were studied.

Results. Significant deterioration in the quality of life of patients receiving neoadjuvant chemotherapy was observed in all analyzed parameters: SF-36, Karnovsky scale, ECOG and EQ 5D-5L decreased sharply, the prevalence of general weakness, shortness of breath and decreased exercise tolerance increased. According to the SF-36, initially low rates were observed in a large number of patients, respectively, 80 and 82 %, at the intermediate and final stages, almost all patients showed a deterioration in condition compared to the outcome (p = 0.0002–0.0001). Predictors of a pronounced negative deviation of QoL indicators are the presence of initial reduced ECOG and Karnovsky scores, as well as the presence of an initial decrease in exercise tolerance, the presence of weakness and shortness of breath.

Conclusion. In the course of continuous cardiac monitoring, we demonstrated a deterioration in all QoL indicators, according to questionnaires and validated international scales during neoadjuvant chemotherapy. The predictors of a pronounced decrease in QoL indicators are the presence of initial reduced ECOG and Karnovsky scale, as well as the presence of an initial decrease in exercise tolerance, the presence of weakness and shortness of breath. The Karnovsky scale and ECOG can be adapted for an objective assessment of QoL indicators during neoadjuvant chemotherapy.

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