Early and late Toxicity and side effects with relevance for social medicine in patients with breast cancer – Time-dependent analysis of 5800 breast cancer patients

Aim:

As a result of the improved prognosis long-term toxicities gain more importance for social life and work ability in women with/after breast cancer (BC). Aim of this retrospective study was the analysis of time-dependent course of treatment-related side effects after therapy for BC.

Methods:

Between 2013 – 2017 clinical and pathological data of 5800 patients with BC (55.3 ± 10.2y) who underwent oncologic connecting rehabilitation (so-called „AHB”; n = 4195, 72.3%; 6.8 ± 4.2 m after diagnosis) or oncologic in-door rehabilitation (routine rehabilitation; n = 1605, 27.7%; 11.2 ± 5.6 m after diagnosis) were analyzed.

Results:

In 4105 women (75.5%) ER+ BC were noted, whereas in 865 cases (14.9%) triple-negative and in 830 cases (14.3%) Her2neu positive BC was seen. In 23.5% a mastectomy (vs. 75.5% breast-conservating therapy) was performed. In 59.9% (n = 3342) a systemic chemotherapy was carried out, in 87.3% (n = 5065) radiotherapy. 462 (7.9%) women suffered from recurrent or metastatic BC. While AHB patients typically showed significantly more CTX-induced hematologic toxicity (leucopenia; < 0.0001, anemia; < 0.0001) and polyneuropathy (36.4% vs. 20%; < 0.0001), chronic lymphedema (20% vs. 11.4%; < 0.0001), status after mastectomy (30% vs. 20.6%; < 0.0001), younger age (< 0.0001) and recurrent or metastatic disease were significantly more often documented (11.3% vs. 4.4%; < 0.0001) during routine rehabilitation.

Conclusions:

Time-dependent significantly different impairments and toxicities were documented in BC. Occurrence of lymph edema and CTX-induced polyneuropathy and status after mastectomy are still common one year after treatment. These observations and a higher percentage of younger women with prolonged duration of illness underline the importance of oncological rehabilitation.