Patient-reported Symptom Resolution After Neoadjuvant Versus Adjuvant Chemotherapy for Early Breast Cancer: A Prospective Observational Cohort Study

Neoadjuvant chemotherapy (NAC) and adjuvant chemotherapy (AC) provide similar long-term survival in early breast cancer (BC), but their comparative impacts on the trajectory and resolution of symptomatic adverse events (AEs) in routine practice are not well defined.

We conducted a prospective observational study of perioperative BC chemotherapy. Symptomatic AEs were graded using a patient reported outcome (PRO)-based questionnaire prepared for this study and aligned with the CTCAE system at the end of chemotherapy and at six months after completion. We compared AE severity distributions between patients treated with NAC and those treated with AC.

Ninety-three patient cases were analyzed (NAC: n=48, AC: n=45). The two groups' baseline stage distributions were not significantly different (p=0.106), but the subtype compositions were (p=0.002). Multiple AEs at the end of chemotherapy were common in both groups. At chemotherapy completion, significant between-group differences in severity distributions were observed for peripheral sensory neuropathy (p=0.049) and nail loss (p=0.011), with higher symptom burdens in the NAC group. At six months post-completion, no statistically significant between-group differences in severity distributions were detected across the assessed AEs.

In this real-world prospective cohort, no statistically significant between-group differences in medium-term symptomatic AE severity distributions were detected between patients receiving NAC and those receiving AC.