Impact of radiotherapy on quality of life reported by elderly patients

To determine the impact of radical radiotherapy (RT) treatment on the quality of life reported by elderly patients.

A prospective multicenter study was conducted in 8 national centers. Patients over 70 years old who had an indication for radical RT were included. All patients were initially assessed with the Geriatric-8 (G8) scale, ECOG PS, Nutriscore, SARC_F (sarcopenia questionnaire), and completed two patient-reported outcomes measure (PROMs) questionnaires: the EORTC_QLQ_C30 and the EORTC_ELD_14 quality of life (QoL), at baseline, at the end of RT, and 3 months later.

A total of 156 patients with a mean age of 77 years (range 70-93) were included. The characteristics of the patients are as follows: 65.4% are men, 45.5% have prostate cancer, 20% breast cancer, and 12.2% lung cancer. The baseline PROMs show general health status of patients >70 years with some deterioration (73.5 ± 20.3). Patients also present deterioration in physical function (85.29 ± 19.94), emotional function (81.02 ± 21.28), and maintenance of purpose (70.94 ± 30.5), and the most frequent baseline symptoms are constipation, fatigue, insomnia, worries about others, future worries, disease burden, and joint stiffness. The prognostic factors that increase the risk of these alterations are ECOG PS >1, female sex, diabetes, dyslipidemia, pulmonary pathology, cognitive impairment, and especially the risk of sarcopenia. When comparing PROMs at the beginning and at the end of oncological treatment, a significant deterioration in role function (89.86 vs. 85.62, p = 0.004) and an increase in fatigue (19.89 vs. 25.78, p = 0.002) are observed. While the PROMs at 3 months show improvement in all functions and symptoms, statistically significant improvement was only found in emotional function (84 vs. 89.26, p = 0.000), fatigue (25.87 vs. 20.4, p = 0.001), loss of appetite (12.75 vs. 6.7, p = 0.003), and maintenance of purpose (68 vs. 73.6, p = 0.14).

Older patients, due to their comorbidities, already have alterations in QoL, with sarcopenia being an important factor. Cancer treatment further deteriorates QoL in a significant way, role function and fatigue, but 3 months after the treatment, improvements in QoL, significantly emotional function, fatigue, loss of appetite and maintenance of purpose are observed.