Stage-Dependent Differences in Quality of Life Among Breast Cancer Patients Prior to Initiation of a Line of Systemic Therapy: A Cross-sectional Study

Abstract

Introduction: Disease stage is a key determinant of health-related quality of life (HRQoL) in breast cancer, yet stage-specific HRQoL data prior to systemic therapy remain limited in low- and middle-income countries (LMICs). Understanding baseline HRQoL variation across stages may support more tailored supportive care. This study aimed to evaluate stage-specific differences in baseline HRQoL among women with breast cancer prior to initiation of a line of systemic therapy.

Materials and Methods: In this cross-sectional study at two referral centers in East Java, Indonesia, we consecutively enrolled women with histologically confirmed breast cancer before initiating a new line of systemic therapy. Sociodemographic and tumor characteristics were documented, and HRQoL was assessed using validated Indonesian versions of the EORTC QLQ-C30 and QLQ-BR23. Patients were categorized as having early-stage (n=14), locally advanced (n=62), or metastatic disease (n=30). Group differences were examined using the Kruskal–Wallis test with Bonferroni-adjusted pairwise comparisons.

Results: Invasive ductal carcinoma predominated across stages (80–100%), with higher-grade tumors more frequent in locally advanced disease and Luminal B subtypes more common in advanced stages. Global health status differed significantly by stage (p=0.004), with both early-stage versus metastatic disease (p=0.009) and locally advanced versus metastatic disease (p=0.021) comparisons remaining significant after Bonferroni correction. Social functioning showed stage differences (p=0.022), though pairwise comparisons did not remain significant. Pain demonstrated significant overall variation (p=0.041), with early-stage versus metastatic disease showing a Bonferroni-adjusted difference (p=0.034). Systemic therapy–related side effects differed across stages (p=0.025), but no pairwise comparison met the corrected threshold. Emotional, cognitive, and body-image scores were similar across groups.

Conclusion: Prior to systemic therapy, women with metastatic breast cancer reported significantly lower global health status and higher pain compared with those with early-stage disease, while other differences across stages were more modest after adjusting for multiple comparisons. These findings underscore the value of incorporating baseline HRQoL assessment into oncology evaluation to identify patients with greater supportive-care needs, particularly those presenting with advanced disease.