Survivors of Breast Cancer Treated With Chemotherapy Experience Long-Term Physical Health Decline, Study Finds

Survivors of breast cancer (BC) who were treated with chemotherapy experience long-lasting physical health decline, according to study authors in a paper published in JAMA Network Open. The author’s findings may provide more insight into the potential long-term consequences of chemotherapy, helping to guide treatment decisions and develop advanced approaches to mitigate adverse effects (AEs).

Survivor of breast cancer tired from exercise | Image Credit: © Liubomir - stock.adobe.com

BC is the most common cancer in women, estimated to affect over 5 million individuals in the United States by 2030. Treatment advancements have greatly improved patient outcomes, resulting in a 5-year survival rate of over 90%. Historically, chemotherapy and endocrine therapy (ET) have been the first line, standard of care for patients with BC but the use of combination therapies with chemotherapy have yielded superior benefits in prolonging survival. However, due to longer survival, many survivors of BC experience negative long-term health effects and have a higher incidence of subsequent chronic illness.

In a large, prospective cohort study, researchers investigate physical health decline in survivors of BC who received chemotherapy or ET compared with age-matched women without cancer. The study participants were enrolled across 35 states in the United States, the District of Columbia, and Puerto Rico between 2006 and 2013. These individuals were followed up with between May of 2023 and December of 2024.

The participants consisted of 2566 individuals diagnosed with BC and 12,826 age-matched women without cancer (median age at diagnosis 56.3 [49.9-61.9] years). In the BC cohort, 47.7% received ET, 10.8% received chemotherapy, and 24.7% received both. The study included 184 Asian (1.2%), 418 Black (2.7%), 731 Hispanic (all races; 4.8%), and 13758 White (89.4%) women.

The authors used the Patient-Reported Outcomes Measurement Information System Global Health Scale instrument to measure the participants’ physical health, which was evaluated 4 times after the diagnosis date. The median interval between diagnosis and assessment was 1.7 (0.9-2.7) years, while the median interval between diagnosis and evaluations was 1.1 (0.7-1.6), 3.3 (2.6-4.1), and 6.1 (5.5-7.0) years. Physical health treatment relationships (β) and 95% confidence intervals (CIs) were estimated using linear regression.

The study authors reported that survivors of BC saw a greater decline in physical health within 2 years of diagnosis. This was observed across those who received ET (β = −1.12; 95% CI, −1.64 to −0.60), chemotherapy (β = −3.13; 95% CI, −4.19 to −2.07), or both (β = −3.26; 95% CI, −3.97 to −2.55). Only women on aromatase inhibitors experienced the decrease in endocrine treatment usage, and those who received chemotherapy showed the drop more than 2 years after diagnosis.

These findings highlight the significant long-term impact of chemotherapy on the physical health of survivors of BC, reinforcing the need for treatment strategies that balance survival benefits with quality-of-life considerations. Future research should focus on identifying ways to mitigate these AEs, such as personalized treatment approaches, supportive care interventions, and long-term survivorship programs.

“Breast cancer is the most prevalent cancer among cancer survivors, accounting for more than 20% of all cancer survivors,” the authors wrote. “Understanding the survivorship care needs and management of late effects in BC survivors is critical. Continued efforts are needed to understand the specific survivorship care needs of BC survivors and improve their long-term quality of life.”

REFERENCES

Bodelon C, Masters M, Bloodworth DE, et al. Physical Health Decline After Chemotherapy or Endocrine Therapy in Breast Cancer Survivors. JAMA Netw Open. February 28, 2025. doi:10.1001/jamanetworkopen.2024.62365