Radiation pneumonitis (RP) and radiation fibrosis (RF) are common side effects after breast cancer (BC) radiotherapy (RT). However, there is a great variation in the frequency of RP and RF. This st...

Background and purpose. The aim of this study was to report on early effects of contemporary radiotherapy (RT) on health-related quality of life (HRQOL) and explore treatment-related contributors to the development of fatigue during RT in breast cancer (BC) patients. Material and methods. Consecutive BC patients (n = 248) referred for postoperative RT at St. Olavs University Hospital in Trondheim, Norway were enrolled from February 2007 to October 2008. Clinical- and treatment data were recorded, and HRQOL were assessed before starting (baseline) and immediately after ending RT using the “EORTC QLQ-C30” and the breast module “EORTC QLQ-BR23”. Change scores from baseline were calculated. Predictors of increased fatigue during RT were explored with multiple regression analysis adjusted for relevant confounders. Results. The global QOL- and all functional scales remained stable, except for “future perspective” which improved significantly during RT. Breast symptoms and fatigue increased significantly during RT. Groups with elevated baseline fatigue remained more stable during RT than those with lower levels at baseline. The body volume receiving 40 Gy or more (V40) was a significant predictor of increased fatigue during RT adjusted for chemotherapy, comorbidity and age (p = 0.035). Conclusion. Contemporary RT has limited early effects on HRQOL. V40 is a significant predictor of RT-related fatigue.

Introduction. Fatigue after treatment for breast cancer (BC) is common, but poorly understood. We examined the fatigue levels during first year after radiotherapy (RT) according to the extent of RT (local or locoregional), hormonal therapy (HT) and chemotherapy (CT). The impact of comorbidity was also explored. Moreover, we compared fatigue levels in patients with the general population (GenPop) data. Material and methods. BC patients (n = 250) referred for post-operative RT at St. Olavs Hospital, Trondheim, Norway, were enrolled. Fatigue was measured by the EORTC QLQ-C30-fatigue subscale, ranging from 0 to 100, before RT (baseline), after RT, and at three, six, and 12 months. Clinical and treatment-related factors were recorded at baseline. GenPop data was available from a previous survey (n = 652). Linear mixed models and analysis of covariance were applied. Results. Compliance ranged from 87% to 98%. At baseline, mean value (SD) of fatigue in BC patients was 26.8 (23.4). The level increased during RT (mean change 8.3, 95% CI 5.5–11.1), but declined thereafter and did not differ significantly from pre-treatment levels at subsequent time points. In age-adjusted analyses, locoregional RT accounted for more overall fatigue than local RT (mean difference 6.6, 95% CI 1.2–12.0), but the association was weakened and not statistical significant when adjusting for CT and HT. Similar pattern was seen for CT and HT. The course of fatigue differed significantly by CT (p < 0.001, interaction test). At baseline, fatigue levels were higher in patients with than without CT, but at subsequent time points similar levels were evident, indicating a temporary adverse effect of CT. Comorbidity was significantly associated with increased level of fatigue, independent of other factors (mean difference 8.1, 95% CI 2.2–14.1). BC-patients were not significantly more fatigued than GenPop, except for immediately after ending RT, and then only among those without comorbidity (mean 35.9 vs. 25.8, p < 0.001). Conclusion. Comorbidity seems to be a more important determinant for fatigue levels than the cancer treatment.

The aim of this study was to provide sex-, age-, and morbidity-specific Norwegian general population normative values for the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires QLQ-C30, the sexual health questionnaire QLQ-SHQ22 and the sexual domains of the breast modules QLQ-BR23 and QLQ-BR45. A random nationwide sample stratified by sex and age groups (18-29, 30-39, 40-49, 50-59, 60-69 and ≥70 years) was drawn from the Norwegian National Population Register. Participants were notified through national online health services (HelseNorge) and postal mail. The survey included sociodemographic background information, health-related quality of life assessed by the EORTC questionnaires, and morbidity assessed by the Self-Administered Comorbidity Questionnaire. Multivariable linear regression was carried out to estimate the associations of age, sex and morbidity with the EORTC scale and item scores. Of the 15,627 eligible individuals, 5135 (33%) responded. Women and persons with morbidities reported lower functioning and higher symptom burden than men and persons without morbidities, respectively, on nearly all EORTC scales. Sex differences were most prominent for emotional functioning, pain, fatigue and insomnia (QLQ-C30), body image, sexual functioning (QLQ-BR23/45), importance of sexual activity, libido and fatigue (QLQ-SHQ22). The score differences between persons with and without morbidity were highly significant and largest in the youngest and middle-aged groups. This is the first study to provide normative values for the EORTC sexual health questionnaire QLQ-SHQ22 and the sexual subscales of the QLQ-BR23 and QLQ-BR45 for all, separately in age groups by sex and morbidity.

The patient positioning in pelvic radiotherapy (RT) should be decided based on both reproducibility and on which position that yields the lowest radiation dose to the organs at risk (OAR), and thereby less side effects to patients. The present randomized study aimed to evaluate the influence of patient positioning on setup reproducibility and dose distribution to OAR in rectal cancer patients. Ninety-one patients were randomized into receiving RT in either supine or prone position. The recruitment period was from 2005 to 2008. Position deviations were derived from electronic portal image registrations, and setup errors were defined as deviations between the expected and the actual position of bony landmarks. Setup deviations were expressed into three table shift values (∆x, ∆y, ∆z) from which the deviation vector \( \left|\overrightarrow{v}\right| \) were calculated. The estimated lengths of \( \left|\overrightarrow{v}\right| \) defined the main outcome and were compared between prone and supine positions using linear mixed model statistics. The mean volume of each 5 Gy increments between 5 and 45 Gy was calculated for the small bowel and the total bowel, and the dose volumes were compared between prone and supine position. Data from 83 patients was evaluable. The mean \( \left|\overrightarrow{v}\right| \) was 5.8 mm in supine position and 7.1 mm in prone position (p = 0.024), hence the reproducibility was significantly superior in supine position. However, the difference was marginal and may have borderline clinical importance. The irradiated volumes of the small bowel and the total bowel were largest in the supine position for all dose levels, but none of those were significantly different. The patient positioning in RT of rectal cancer patients may therefore be decided based on other factors such as the most comfortable position for the patients.

Traditional methods measuring physical activity (PA) may misrepresent breast cancer survivors (BCSs) and low-socioeconomic status (SES) groups. This study identifies PA-levels, routines and experiences among BCSs, in general and by SES, and explores whether a mixed-methods approach might unveil diversities of PA in BCS across SES. 250 BCSs referred to postoperative radiation therapy in 2007-2008 participated in a longitudinal follow-up study examining health-related quality-of-life and late-effects. Subsample-data on SES and PA were collected by questionnaires (n = 52), activity-logs (n = 52) and interviews (n = 37). Parallel mixed analyses were conducted, in combination with sequential, full-sample analyses of questionnaires and contrasting case analyses of logs and interviews. Dependent on which measurement used, 23%, 35%, 54% and 63% of BCSs met PA guidelines. Questionnaire-data revealed no significant differences in PA levels between SES groups. Log-data showed more PA bouts in high-SES BCSs, but no difference in min/week across SES. Neighbourhood walking was preferred, while scheduled exercise was rare. Interview-data added that PA was medicating, normatively described and accompanied by unfulfilled ambitions, particularly in low-SES BCSs. Balancing duties and activities was demanding. PA constraints were similar across groups. Domestic PA was important in low-SES, while high-SES BCSs described more energy. Although PA levels among BCSs were similar across SES and equal to PA in the general population, SES differences became evident when measured by activity-logs and as stated in interviews. Future follow-up programs for BCSs could benefit from expanding the PA perspectives, thus better meet the needs of different SES groups.