Quality of Life and ability to work in patients at different disease stages of HER2+ breast cancer

Objectives

Health-related quality of life (HRQoL) and ability to work in patients treated for HER2+ early breast cancer (EBC) are poorly understood. This study compared HRQoL and ability to work in 3 HER2+ patient cohorts: EBC during adjuvant treatment, EBC after treatment, and metastatic disease (MBC).

Methods

A cross-sectional observational cohort study of 299 female consenting patients with HER2+BC, from 14 UK secondary care centres. Group1 (n=89): receiving targeted HER2 therapy±chemotherapy for EBC; Group2 (n=108): in follow up post-targeted treatment for eBC; Group3 (n=102): MBC on treatment. Data collected between Dec 2016-Mar 2017: HRQoL, demographic and employment status data collected via patient-reported questionnaires (including EQ-5D-5L and Functional Assessment of Cancer Therapy [FACT-B]); clinical data collected from medical records. Inter-group differences were assessed using univariate Analysis of variance (ANOVA) and chi-square tests as appropriate.

Results

Table1 shows patient demographics, disease characteristics, employment status, and EQ-5D-5L scores. Group1 and Group2 patients did not differ in overall health utility or visual analogue scale (VAS) scores. However, Group3 patients reported significantly poorer health utility than Group1 (p<0.02) and Group2 (p<0.001), and significantly worse VAS scores than Group2 (p<0.001). Significantly fewer Group2 patients and more Group3 patients were unable to work (p<0.003), and fewer Group3 patients were employed than expected (by chi-square, p<0.003).

Conclusions

The results suggest that more patients with a target set at baseline are in remission at 12 months and at 24 months than those without a target set. Number of visits, number of DAS28 scores and starting dual therapy within 6 months do not appear to affect the proportion of patients in remission at 12 months, but active management in the first 12 months (>4 visits, >4 DAS28 scores) does appear to be associated with more patients in remission at 24 months. Thus we conclude that treating RA early and aggressively, in line with the T2T guidelines, leads to sustained clinical improvement.