Breast cancer survivors who received chemotherapy experience greater long-term physical health declines compared to those treated with endocrine therapy alone, according to a new study published in JAMA Network Open. The research highlights the importance of considering treatment-specific long-term effects when planning breast cancer care.
The study, led by Clara Bodelon, PhD, MS, senior principal scientist of survivor research at the American Cancer Society, found that patients treated with endocrine therapy maintained physical health profiles similar to women who never had breast cancer. In contrast, chemotherapy recipients showed notable declines in physical functioning within two years of treatment, with effects persisting beyond five years.
"What we wanted to see is if cancer survivors of younger ages had those abilities [and if] they could do those types of things similar to cancer-free women of a similar age," explained Dr. Bodelon. "For those who did have endocrine therapy, they did have those abilities, similar to the women who were cancer-free, but not with those who received chemotherapy."
Physical Health Impacts of Cancer Treatments
The researchers defined physical health as encompassing mobility, self-care abilities, pain levels, and fatigue—essentially all non-mental health aspects of wellbeing. The study revealed that chemotherapy's negative impact on these measures could affect survivors' ability to perform daily activities as they age.
"Physical health is the aspect of health that is not mental health. What that includes is the ability to move, the ability to get dressed and bathe yourself, not having pains, and not having fatigue," Dr. Bodelon noted. "What we see is that, as we age, some of these aspects may be declining, and so older people may have some pains, they may have some fatigue, and they may not be able to do all the activities of daily living."
The findings underscore the importance of treatment de-escalation strategies and personalized medicine approaches that consider both cancer control and long-term quality of life.
Implications for Clinical Practice
Dr. Bodelon emphasized that these results should inform both patient education and clinical practice. "We need to inform patients, as well as primary care physicians, because someone could receive chemotherapy or a combination of chemotherapy with endocrine therapy, but if they have chemotherapy, it doesn't matter if they have other treatments, they may suffer this decline."
The study suggests that incorporating supportive care measures, such as physical therapy, into treatment plans could help mitigate some of the long-term physical health effects associated with chemotherapy.
"It may inform physicians that these women may need help long-term, going to physical therapy, for instance, and having it as part of their health care plan. They need these providers to help them offset some of the consequences of the treatment," Dr. Bodelon added.
Moving Toward Personalized Treatment Approaches
The research highlights the need for more nuanced approaches to breast cancer treatment that consider individual patient factors and long-term outcomes.
"We are starting to try to think about personalized medicine and long-term outcomes—it's going to be a consequence of that personalized medicine. Not all breast cancer survivors are the same and not all necessarily need the same care," said Dr. Bodelon.
She noted that the study represents an important step in understanding the differential impacts of cancer treatments. "One of the big topics in oncology is the escalation of treatment, and as we learn what the specific treatments are and as we personalize the treatments, the consequences of the treatments may be different, so this is a way for us to understand what those outcomes are."
As cancer care continues to evolve, these findings suggest that treatment decisions should balance immediate cancer control with consideration of long-term physical health impacts, particularly for patients who might be candidates for chemotherapy.
