Changes in health-related quality of life may predict recurrent breast cancer

Background: Patient-reported outcomes incorporated in cancer clinical trials, are increasingly hypothesized to be predictors of disease-free survival. Previous research supports health-related quality of life (HRQoL) as an independent predictor of survival in patients with advanced or metastatic breast cancer. In contrast, recent studies provide evidence that baseline HRQoL scores are not associated with increased risk of relapse or survival in women with early-stage breast cancer. One plausible assumption might be that baseline HRQoL scores are limited as predictors of a recurrence of breast cancer several years after the initial diagnosis. In this explorative study, we examined whether changes in HRQoL over time may predict breast cancer recurrence. As a supplement, we investigated whether baseline HRQoL predicted recurrence. Methods: The study sample consisted of 141 participants in the International Breast Cancer Study Group adjuvant Trial 12-93 and Trial 14-93, from the Western region of Sweden. HRQoL was assessed, during a 5-year follow up. Poisson regression analysis was used to estimate the hazard function of recurrence depending on time since primary diagnosis and on HRQoL variables. Results: According to the Poisson multivariable regression analysis changes in physical well-being (β = 0.00439, p-value = 0.0470), and nausea/vomiting (β = -0.00612, p-value = 0.0136) significantly predicted recurrence. Baseline HRQoL outcomes were not predictors of recurrence. Conclusions: Changes of HRQoL during adjuvant therapy may be associated with recurrence. This explorative finding needs prospective investigation.