Early best supportive care and quality of life trajectories in breast cancer: A multivariate analysis of treatment response patterns.

Abstract

29 Background: Early integration of palliative care may modify quality of life (QoL) trajectories in cancer patients, but multivariate evidence on treatment response heterogeneity remains limited. Methods: Prospective RCT (N=110) allocating breast cancer patients to early best supportive care (n=56) or on-demand palliative care (n=54). Primary outcomes: Global Health Status (GHS) via EORTC QLQ-C30 and Total Symptom Distress Score (TSDS) via ESAS at baseline and 3-month follow-up. Analysis: Repeated Measures ANOVA, ANCOVA adjusting for baseline covariates, MANOVA on six functional domains, and sensitivity analyses (LOCF, worst-case, per-protocol). Cohen's d with 95% CI reported. Results: 94 patients (85.5%) completed 3-month assessments. Time x Group interactions were significant for GHS (F=4.47, p=0.037) and TSDS (F=4.87, p=0.030). ANCOVA: GHS +6.19 points (95% CI: 0.5-11.9, p=0.034); TSDS -7.14 points (95% CI: -9.1 to -5.1, p<0.001). MANOVA confirmed multivariate QoL restructuring (Pillai's Trace=0.307, F=6.42, p<0.001). Large effects for Social Functioning (d=1.21, p<0.001), medium for Physical Functioning (d=0.66, p=0.002) and Fatigue (d=-0.55, p=0.017). Reliable improvement (Jacobson-Truax): 44.6% vs 14.8% (p=0.003); clinical recovery: 39.3% vs 5.6% (p<0.001). See table. Conclusions: Early best supportive care integration produces statistically significant and clinically meaningful QoL improvements with heterogeneous treatment response patterns. Subgroup analyses suggest selective benefit for patients on active treatment and with shorter disease duration. Clinical trial information: CTRI/2021/06/034136. Primary and secondary outcome measures at 3-month follow-up. Outcome Intervention Control p-value Cohen's d GHS Change +23.2 ± 22.0 +14.7 ± 15.6 0.037 0.44 TSDS Change -28.3 ± 15.7 -21.1 ± 15.6 0.030 0.46 Social Functioning +25.5 ± 22.9 -3.9 ± 25.9 <0.001 1.21 Physical Functioning +18.4 ± 16.5 +6.8 ± 18.9 0.002 0.66 Fatigue -23.1 ± 22.9 -10.3 ± 23.2 0.017 -0.55