Publication

Abstract : Introduction Invasive ductal carcinoma (IDC) is the most common form of breast cancer in females, often treated with chemotherapy, either in the adjuvant or neoadjuvant setting. Malignancy as well as chemotherapy have a profound impact on the quality of life (QOL), with prognosis and survival largely dependent on early identification and treatment. Understanding the determinants of QOL is crucial to addressing its impact on physical, emotional, and social well-being. Aim This study aimed to determine the health-related quality of life (HRQOL) of patients with invasive ductal carcinoma after receiving chemotherapy and to explore factors contributing to a reduction in their HRQOL. Methods This was a prospective cohort study conducted among 294 women aged between 30 and 70 years who were histopathologically diagnosed with IDC and received chemotherapy from a Comprehensive Cancer Centre, Kerala. QOL was assessed using the Functional Assessment of Cancer Therapy-Breast+4 (FACT-B+4) questionnaire version 4.0, and sociodemographic and clinical data were collected through questionnaires, direct measurements, and from electronic medical records (EMR). The Mann-Whitney U test was used to compare the reduction (change) in QOL, and multiple logistic regression analysis was used to explore the factors contributing to the reduction in QOL after chemotherapy. Results The patients had a mean age of 51.56 ± 10.06 years, with the majority being 50 years and above (56.4%). Of 294 women who received chemotherapy, 228 (77.6%) developed chemotherapy-induced peripheral neuropathy (CIPN) of mild to moderate grades. Emotional well-being (EWB) had the lowest mean score before starting chemotherapy (those who developed CIPN: 14.46 ± 5.07 and those who did not develop CIPN: 13.72 ± 4.73). After chemotherapy, the maximum reduction in QOL occurred in physical well-being (PWB), with mean scores of 9.49 ± 5.57 and 3.49 ± 5.62, respectively, for those who developed and did not develop CIPN. Furthermore, in all domains, the reduction in QOL was greater in patients who developed CIPN than in those who did not. However, the difference in QOL change between the two groups was significant only for two domains: PWB (p < 0.001) and EWB (p = 0.013). The breast cancer subscale (BCS) (p < 0.001), arm (ARM) subscale (p = 0.033), and total scores (FACT-B TOI, FACT-G Total, and FACT-B Total) were also significantly lower in women who developed CIPN than in those who did not (p < 0.001). The factors contributing to the reduction in QOL were the presence of CIPN (OR = 3.623, 95% CI: 1.072-12.228, p = 0.038), age <50 years (OR = 4.016, CI: 1.236-12.987, p = 0.007), a higher number of chemotherapy cycles (eight cycles - OR = 38.488, 95% CI: 2.086-710.055, p = 0.053 and 12 cycles - OR = 70.655, 95% CI: 2.067-2415.638, p = 0.018), metastasis in the ipsilateral lymph nodes (OR = 3.623, CI: 1.204-10.902, p = 0.022), use of statins (OR = 7.608, CI: 1.269-45.617, p = 0.026), endocrine drugs (OR = 14.073, CI: 2.180-90.864, p = 0.005), and anaemia (OR = 30.606, CI: 1.867-15.001, p = 0.008). Conclusion The study highlights the significant impact of CIPN on the QOL of patients, along with factors such as age, number of chemotherapy cycles, presence of regional metastasis, histopathological subtypes, and anaemia. The study findings suggest the need for risk stratification and tailoring treatment strategies appropriately to minimise the risk of CIPN and optimise the QOL.