{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T05:08:29Z","timestamp":1779253709750,"version":"3.51.4"},"reference-count":48,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,5,10]],"date-time":"2026-05-10T00:00:00Z","timestamp":1778371200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Objective: Patient-reported outcomes (PROs) provide direct insight into symptom burden and functional status, yet their utility in early pharmacotherapy outcomes in breast cancer remains underexplored. This study investigated whether baseline PROs from the EORTC QLQ-C30 and BR23 questionnaires are associated with and demonstrate discriminative ability for short-term survival during the first pharmacotherapy cycle in breast cancer patients. Methods: We conducted a prospective cohort study at two secondary referral hospitals in Indonesia from January to October 2025. Women with breast cancer initiating systemic pharmacotherapy were enrolled and followed through completion of the first treatment cycle. The primary outcome was survival of the first cycle, defined as a combined endpoint of death or treatment discontinuation due to adverse effects. Baseline demographic, clinical, and tumor characteristics, along with PROs (EORTC QLQ-C30 and BR23), were compared between survivors (n = 99) and non-survivors (n = 7). Statistical comparisons used Mann\u2013Whitney U tests for PROs. Receiver operating characteristic (ROC) curve analyses were performed to evaluate the discriminative performance of PRO domains. Results: Non-survivors were more likely to present with metastatic disease (71.4% vs. 25.3%). Baseline PROs showed marked differences, with survivors reporting higher global health (83.3 vs. 41.7; p &lt; 0.001) and better physical, role, emotional, and social functioning (all p &lt; 0.05). Symptom burden\u2014including pain, appetite loss, constipation, systemic side effects, arm symptoms, and financial difficulty\u2014was higher among non-survivors (all p &lt; 0.05). ROC analysis demonstrated strong discriminative performance for global health status (AUC 0.907; p &lt; 0.001), emotional functioning (AUC 0.846; p = 0.002), and social functioning (AUC 0.843; p = 0.003), with moderate performance for physical functioning (AUC 0.737; p = 0.037). Symptom domains showed lower and inverse AUC values, reflecting scale directionality and limited discriminative capacity. Conclusions: Baseline PROs using EORTC QLQ-C30 and BR23 were strongly associated with early pharmacotherapy survival and demonstrated meaningful discriminative ability, particularly in global and functional domains. Integrating PRO assessments before treatment initiation may enhance early risk stratification, guide supportive care, and improve treatment continuity in breast cancer.<\/jats:p>","DOI":"10.3390\/medsci14020247","type":"journal-article","created":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T13:10:42Z","timestamp":1778505042000},"page":"247","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patient-Reported Quality of Life Predicts First-Cycle Pharmacotherapy Survival in Breast Cancer: A Prospective Cohort Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5730-2013","authenticated-orcid":false,"given":"Henry","family":"Sutanto","sequence":"first","affiliation":[{"name":"Internal Medicine Specialist Study Program, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia"},{"name":"Department of Internal Medicine, Dr. Soetomo General Academic Hospital, Surabaya 60286, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Merlyna","family":"Savitri","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Dr. Soetomo General Academic Hospital, Surabaya 60286, Indonesia"},{"name":"Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Een","family":"Hendarsih","sequence":"additional","affiliation":[{"name":"Division of Hematology and Medical Oncology, Department of Internal Medicine, Haji General Hospital, Surabaya 60116, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ami","family":"Ashariati","sequence":"additional","affiliation":[{"name":"Division of Hematology and Medical Oncology, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia"},{"name":"Integrated Oncology Unit, Universitas Airlangga Hospital, Surabaya 60115, Indonesia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,10]]},"reference":[{"key":"ref_1","first-page":"1568","article-title":"Breast Cancer in Low-Middle Income Countries: Abnormality in Splicing and Lack of Targeted Treatment Options","volume":"10","author":"Francies","year":"2020","journal-title":"Am. J. Cancer Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"115665","DOI":"10.1016\/j.ejca.2025.115665","article-title":"Impact of Early Discontinuation of Adjuvant Endocrine Therapy on Survival in Breast Cancer: A Target Trial Emulation","volume":"227","author":"Zuo","year":"2025","journal-title":"Eur. J. Cancer"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1007\/s10549-010-1132-4","article-title":"Early Discontinuation and Non-Adherence to Adjuvant Hormonal Therapy Are Associated with Increased Mortality in Women with Breast Cancer","volume":"126","author":"Hershman","year":"2011","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"432","DOI":"10.1007\/s42399-025-02195-6","article-title":"Quality of Life Following Breast Cancer Chemotherapy: A Narrative Review of Patient-Reported Outcomes and Supportive Care","volume":"7","author":"Savitri","year":"2025","journal-title":"SN Compr. Clin. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e000783","DOI":"10.1136\/bmjonc-2025-000783","article-title":"Patient-Reported Outcomes (PROs) in Clinical Trials and in Clinical Practice: Report from the XXI National Conference of the Italian Association of Medical Oncology (AIOM)","volume":"4","author":"Puccini","year":"2025","journal-title":"BMJ Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2756","DOI":"10.1200\/JCO.1996.14.10.2756","article-title":"The European Organization for Research and Treatment of Cancer Breast Cancer-Specific Quality-of-Life Questionnaire Module: First Results from a Three-Country Field Study","volume":"14","author":"Sprangers","year":"1996","journal-title":"J. Clin. Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e70393","DOI":"10.1002\/pon.70393","article-title":"Beyond Physical Toxicities: Identifying Psychosocial Domains Requiring Integrated Support in Breast Cancer Pharmacotherapy","volume":"35","author":"Sutanto","year":"2026","journal-title":"Psycho-Oncology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e61","DOI":"10.1016\/j.clon.2021.10.007","article-title":"Association of Baseline Patient-Reported Health-Related Quality of Life Metrics with Outcome in Localised Prostate Cancer","volume":"34","author":"Roy","year":"2022","journal-title":"Clin. Oncol. (R. Coll. Radiol.)"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3770","DOI":"10.1200\/JCO.21.02163","article-title":"Pathway to Precision Patient-Reported Outcomes","volume":"39","author":"Kaufmann","year":"2021","journal-title":"J. Clin. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"103153","DOI":"10.1016\/j.eclinm.2025.103153","article-title":"Prognostic Value of Baseline EORTC QLQ-C30 Scores for Overall Survival across 46 Clinical Trials Covering 17 Cancer Types: A Validation Study","volume":"82","author":"Lim","year":"2025","journal-title":"eClinicalMedicine"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Aljurf, M., Majhail, N.S., Koh, M.B.C., Kharfan-Dabaja, M.A., and Chao, N.J. (2022). Cancer Management at Sites with Limited Resources: Challenges and Potential Solutions. The Comprehensive Cancer Center: Development, Integration, and Implementation, Springer.","DOI":"10.1007\/978-3-030-82052-7"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1080\/14796694.2026.2656388","article-title":"Early Hematologic Dynamics and Their Association with Patient-Reported Symptom Burden in Breast Cancer Pharmacotherapy: A Prospective Cohort Study","volume":"22","author":"Sutanto","year":"2026","journal-title":"Future Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Sutanto, H., Savitri, M., Hendarsih, E., and Ashariati, A. (2026). Interdependent Patient-Reported Outcome Patterns During Breast Cancer Pharmacotherapy: A Correlation-Based Analysis Using EORTC QLQ-C30 and QLQ-BR23. medRxiv, Available online: http:\/\/apjcp.ir\/journal\/index.php\/apjcb\/article\/view\/2556.","DOI":"10.64898\/2026.02.10.26345961"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"175","DOI":"10.3758\/BF03193146","article-title":"G*Power 3: A Flexible Statistical Power Analysis Program for the Social, Behavioral, and Biomedical Sciences","volume":"39","author":"Faul","year":"2007","journal-title":"Behav. Res. Methods"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Lim, Y.X., Lim, Z.L., Ho, P.J., and Li, J. (2022). Breast Cancer in Asia: Incidence, Mortality, Early Detection, Mammography Programs, and Risk-Based Screening Initiatives. Cancers, 14.","DOI":"10.20944\/preprints202208.0105.v1"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"102582","DOI":"10.1016\/j.ejon.2024.102582","article-title":"Health Literacy in Cancer Care: A Systematic Review","volume":"70","author":"Ryman","year":"2024","journal-title":"Eur. J. Oncol. Nurs."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"553","DOI":"10.31557\/apjcb.2024.9.4.553-560","article-title":"Assessing Health Literacy, Learning Needs, and Patient Satisfaction in Cancer Care: A Holistic Study in the Omani Context","volume":"9","author":"Ayaad","year":"2024","journal-title":"Asian Pac. J. Cancer Biol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1016\/j.ygyno.2021.06.008","article-title":"The Impact of Marital Status on Stage at Diagnosis and Survival of Female Patients with Breast and Gynecologic Cancers: A Meta-Analysis","volume":"162","author":"Yuan","year":"2021","journal-title":"Gynecol. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e26425","DOI":"10.2196\/26425","article-title":"Physical Comorbidities and Their Relationship with Cancer Treatment and Its Outcomes in Older Adult Populations: Systematic Review","volume":"7","author":"George","year":"2021","journal-title":"JMIR Cancer"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1038\/s41572-019-0111-2","article-title":"Breast Cancer","volume":"5","author":"Harbeck","year":"2019","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_21","first-page":"1","article-title":"Overview of Resistance to Systemic Therapy in Patients with Breast Cancer","volume":"Volume 608","author":"Hortobagyi","year":"2007","journal-title":"Breast Cancer Chemosensitivity; Advances in Experimental Medicine and Biology"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Zhang, W., Wu, S., Liu, J., Zhang, X., Ma, X., Yang, C., Cao, M., Zhang, S., and Liu, Y. (2022). Metastasis Patterns and Prognosis in Young Breast Cancer Patients: A SEER Database Analysis. Front. Oncol., 12.","DOI":"10.3389\/fonc.2022.872862"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1038\/s41379-020-00704-7","article-title":"Prognostic and Predictive Parameters in Breast Pathology: A Pathologist\u2019s Primer","volume":"34","author":"Allison","year":"2021","journal-title":"Mod. Pathol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1186\/s12967-018-1679-0","article-title":"Significance of Intrinsic Breast Cancer Subtypes on the Long-Term Prognosis after Neoadjuvant Chemotherapy","volume":"16","author":"Goto","year":"2018","journal-title":"J. Transl. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1186\/1477-7525-7-102","article-title":"Quality of Life Data as Prognostic Indicators of Survival in Cancer Patients: An Overview of the Literature from 1982 to 2008","volume":"7","author":"Montazeri","year":"2009","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"104952","DOI":"10.1016\/j.critrevonc.2025.104952","article-title":"Quality of Life Results and Survival Outcomes in Trials of Immunotherapy in Advanced Cancers: A Systematic Review and Meta-Research Study","volume":"216","author":"Avanzo","year":"2025","journal-title":"Crit. Rev. Oncol.\/Hematol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1177\/10732748231185047","article-title":"Baseline Quality of Life Is a Strong and Independent Prognostic Factor for Overall Survival in Metastatic Colorectal Cancer","volume":"30","author":"McGarrah","year":"2023","journal-title":"Cancer Control"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.ejca.2016.08.024","article-title":"The Use of EORTC Measures in Daily Clinical Practice\u2014A Synopsis of a Newly Developed Manual","volume":"68","author":"Wintner","year":"2016","journal-title":"Eur. J. Cancer"},{"key":"ref_29","first-page":"1267","article-title":"Predicting Survival in Prostate Cancer: The Role of Quality of Life Assessment","volume":"20","author":"Braun","year":"2012","journal-title":"Support. Care Cancer"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"102942","DOI":"10.1016\/j.eclinm.2024.102942","article-title":"Global Unmet Psychosocial Needs in Cancer Care: Health Policy","volume":"78","author":"Bergerot","year":"2024","journal-title":"eClinicalMedicine"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1093\/ndt\/gfy334","article-title":"The Dominant Prognostic Value of Physical Functioning among Quality of Life Domains in End-Stage Kidney Disease","volume":"35","author":"Torino","year":"2020","journal-title":"Nephrol. Dial. Transplant."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Schurr, T., Loth, F., Lidington, E., Piccinin, C., Arraras, J., Groenvold, M., Holzner, B., van Leeuwen, M., Petersen, M., and Schmidt, H. (2023). Patient-Reported Outcome Measures for Physical Function in Cancer Patients: Content Comparison of the EORTC CAT Core, EORTC QLQ-C30, SF-36, FACT-G, and PROMIS Measures Using the International Classification of Functioning, Disability and Health. BMC Med. Res. Methodol., 23.","DOI":"10.1186\/s12874-022-01826-z"},{"key":"ref_33","first-page":"e57364","article-title":"Physical Functional Impairment in Breast Cancer Patients: A Cross-Sectional Expert Survey","volume":"16","author":"Mehra","year":"2024","journal-title":"Cureus"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e111","DOI":"10.1200\/OP.20.00515","article-title":"Comparing Clinician-Assessed and Patient-Reported Performance Status for Predicting Morbidity and Mortality in Patients with Advanced Cancer Receiving Chemotherapy","volume":"17","author":"Wood","year":"2021","journal-title":"JCO Oncol. Pract."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"432","DOI":"10.21037\/tlcr-21-938","article-title":"The Predictive Utility of Patient-Reported Outcomes and Performance Status for Survival in Metastatic Lung Cancer Patients Treated with Chemoimmunotherapy","volume":"11","author":"Badaoui","year":"2022","journal-title":"Transl. Lung. Cancer Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1016\/j.jpainsymman.2008.04.018","article-title":"A Review of the Prevalence and Impact of Multiple Symptoms in Oncology Patients","volume":"37","author":"Dodd","year":"2009","journal-title":"J. Pain Symptom Manag."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"102941","DOI":"10.1016\/j.esmoop.2024.102941","article-title":"Under-Reporting of Subjective Symptoms and Its Prognostic Value: A Pooled Analysis of 12 Cancer Clinical Trials","volume":"9","author":"Arenare","year":"2024","journal-title":"ESMO Open"},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Ulukal Karanci, E., G\u00fczel, H.G., and \u00d6zt\u00fcrk, B. (2025). Symptom Reporting Behaviors, Symptom Burden, and Quality of Life in Patients with Hormone Receptor\u2013Positive Breast Cancer Undergoing Adjuvant Endocrine Therapy. Curr. Oncol., 32.","DOI":"10.3390\/curroncol32110599"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"kaaf042","DOI":"10.1093\/abm\/kaaf042","article-title":"Resilience in Advanced Cancer Patients Who Obtain a Long-Term Response to Immunotherapy or Targeted Therapy: An Ecological Momentary Assessment Study","volume":"59","author":"Zwanenburg","year":"2025","journal-title":"Ann. Behav. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1093\/jncimonographs\/lgm005","article-title":"Symptom Burden: Multiple Symptoms and Their Impact as Patient-Reported Outcomes","volume":"2007","author":"Cleeland","year":"2007","journal-title":"J. Natl. Cancer Inst. Monogr."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1002\/pon.3846","article-title":"The Longitudinal Relationship between Quality of Life and Survival in Advanced Stage Cancer","volume":"25","author":"Kypriotakis","year":"2016","journal-title":"Psychooncology"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1001\/jamaoncol.2025.1002","article-title":"Overall Survival and Quality-of-Life Superiority in Modern Phase 3 Oncology Trials: A Meta-Epidemiological Analysis","volume":"11","author":"Sherry","year":"2025","journal-title":"JAMA Oncol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/j.breast.2022.07.006","article-title":"Progression-Free Survival and Quality of Life in Metastatic Breast Cancer: The Patient Perspective","volume":"65","author":"Mertz","year":"2022","journal-title":"Breast"},{"key":"ref_44","first-page":"61","article-title":"Patient-Reported Outcomes (PROs) and Patient-Reported Outcome Measures (PROMs)","volume":"6","author":"Weldring","year":"2013","journal-title":"Health Serv. Insights"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Santa Mina, D., van Rooijen, S.J., Minnella, E.M., Alibhai, S.M.H., Brahmbhatt, P., Dalton, S.O., Gillis, C., Grocott, M.P.W., Howell, D., and Randall, I.M. (2021). Multiphasic Prehabilitation Across the Cancer Continuum: A Narrative Review and Conceptual Framework. Front. Oncol., 10.","DOI":"10.3389\/fonc.2020.598425"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Gillis, C., Hasil, L., Kasvis, P., Bibby, N., Davies, S.J., Prado, C.M., West, M.A., and Shaw, C. (2021). Nutrition Care Process Model Approach to Surgical Prehabilitation in Oncology. Front. Nutr., 8.","DOI":"10.3389\/fnut.2021.644706"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"mzad098","DOI":"10.1093\/intqhc\/mzad098","article-title":"Using Patient-Reported Outcome Measures and Patient-Reported Experience Measures to Elevate the Quality of Healthcare","volume":"35","author":"Casaca","year":"2023","journal-title":"Int. J. Qual. Health Care"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e212","DOI":"10.1097\/OI9.0000000000000212","article-title":"Capturing Patient-Reported Outcomes: Paper versus Electronic Survey Administration","volume":"5","author":"Nguyen","year":"2022","journal-title":"OTA Int."}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/2\/247\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T04:32:45Z","timestamp":1779251565000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/2\/247"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,10]]},"references-count":48,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["medsci14020247"],"URL":"https:\/\/doi.org\/10.3390\/medsci14020247","relation":{},"ISSN":["2076-3271"],"issn-type":[{"value":"2076-3271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,10]]}}}