Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2026
EORTC QLQ-C30 symptom components and their functional correlates during adjuvant chemotherapy for early breast cancer: a multivariate analysis. Data from GEICAM/2003-02 study.
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Blasco Andrea, Pastor-Barriuso Roberto, Zamora-Auñón Pilar, Martín Miguel, Salvador Bofill Javier, Reboredo Cristina, Marín María, Barnadas Agustín, Margeli Mireia, López-Vega José Manuel, Lahuerta Ainhara, Guerrero Angel, Servitja Sonia, Alvarez Isabel, Aranda Enrique, Martínez de Dueñas Eduardo, Carabantes Francisco, Lope Virginia
Аннотация
PURPOSE: Understanding how multiple symptoms jointly impact functioning is essential for interpreting patient-reported outcomes (PROs) in oncology. We aimed to characterize the main dimensions underlying change-from-baseline (CFB) in symptom scores during adjuvant chemotherapy for early breast cancer, and to examine their associations with functional outcomes.
PATIENTS AND METHODS: We analyzed EORTC QLQ-C30 CFB scores from 820 patients enrolled in the GEICAM/2003-02 trial. Principal component analysis (PCA) was used to summarize correlated symptom changes into a smaller number of components, and graphical LASSO network modelling was applied to explore relationships among Health-Related Quality of Life (HRQoL) domains. Associations between components and functional scales and global health status were assessed using Spearman correlations.
RESULTS: Three components were identified in the pooled sample, explaining 53.6% of the variance: a dominant general symptom burden component, a gastrointestinal component, and a diarrhea-specific component. The general component, primarily defined by fatigue, pain, appetite loss, insomnia, nausea/vomiting and dyspnea, showed consistent negative correlations with all functional scales and global health status. Similar patterns were observed across treatment arms, although gastrointestinal-related components differed. Graphical LASSO identified fatigue as the symptom most strongly connected to functional impairment.
CONCLUSION: Symptom changes during chemotherapy are not independent, but follow a multivariate structured pattern in which a general symptom burden, anchored by fatigue, plays a central role in functional decline. These findings suggest that multivariate approaches may provide a complementary exploratory framework for summarizing correlated patterns of treatment-related burden and generating hypotheses regarding PROs. Trial registration number ClinTrials.gov: GEICAM/2003-02: NCT00129389.
PATIENTS AND METHODS: We analyzed EORTC QLQ-C30 CFB scores from 820 patients enrolled in the GEICAM/2003-02 trial. Principal component analysis (PCA) was used to summarize correlated symptom changes into a smaller number of components, and graphical LASSO network modelling was applied to explore relationships among Health-Related Quality of Life (HRQoL) domains. Associations between components and functional scales and global health status were assessed using Spearman correlations.
RESULTS: Three components were identified in the pooled sample, explaining 53.6% of the variance: a dominant general symptom burden component, a gastrointestinal component, and a diarrhea-specific component. The general component, primarily defined by fatigue, pain, appetite loss, insomnia, nausea/vomiting and dyspnea, showed consistent negative correlations with all functional scales and global health status. Similar patterns were observed across treatment arms, although gastrointestinal-related components differed. Graphical LASSO identified fatigue as the symptom most strongly connected to functional impairment.
CONCLUSION: Symptom changes during chemotherapy are not independent, but follow a multivariate structured pattern in which a general symptom burden, anchored by fatigue, plays a central role in functional decline. These findings suggest that multivariate approaches may provide a complementary exploratory framework for summarizing correlated patterns of treatment-related burden and generating hypotheses regarding PROs. Trial registration number ClinTrials.gov: GEICAM/2003-02: NCT00129389.