Development and application of a weighted change score to evaluate interventions for vasomotor symptoms in patients with breast cancer using regression trees: a cohort study

• Published in: Breast cancer research and treatment Vol. 207; no. 2; pp. 313 - 321
• Main Authors: Cole, Katherine Marie, McGee, Sharon, Clemons, Mark, Liu, Michelle, MacDonald, Fiona, Vandermeer, Lisa, Ng, Terry L., Pond, Gregory, Emam, Khaled El
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-09-2024
• Subjects: Adult; Aged; Breast Neoplasms - complications; Breast Neoplasms - psychology; Breast Neoplasms - therapy; Female; Hot Flashes - etiology; Hot Flashes - therapy; Humans; Medicine; Medicine & Public Health; Middle Aged; Oncology; Prospective Studies; Quality of Life; Severity of Illness Index; Surveys and Questionnaires; Treatment Outcome; Vasomotor System - physiopathology; Vasomotor symptoms; Breast cancer; Regression trees; Hot flashes; Machine learning
• ISSN: 0167-6806; 1573-7217; 1573-7217
• DOI: 10.1007/s10549-024-07360-4

Purpose
Vasomotor symptoms (VMS) are common among individuals with breast cancer (BC) and poorly managed symptoms are associated with reduced quality of life, treatment discontinuation, and poorer breast cancer outcomes. Direct comparisons among therapies are limited, as prior studies evaluating VMS interventions have utilized heterogeneous change measures which may not fully assess the perceived impact of change in VMS severity.
Methods
We performed a prospective study where BC patients chose one of four categories of interventions to manage VMS. Change in VMS severity at 6 weeks was assessed using the validated Hot Flush Rating Scale (HFRS). A novel weighted change score integrating baseline symptom severity and directionality of change was computed to maximize the correlation between the change score and a perceived treatment effectiveness score. Variables influencing change in VMS severity were included in a regression tree to model factors influencing the weighted change score.
Results
100 baseline and follow-up questionnaires assessing VMS were completed by 88 patients. Correlations between treatment effectiveness and VMS outcomes strengthened following adjustment for baseline symptoms. Patients with low VMS severity at baseline did not perceive change in treatment effectiveness. Intervention category was predictive of change in HFRS at 6 weeks.
Conclusion
Baseline symptom severity and the directionality of change (improvement or deterioration of symptoms) influenced the perception of clinically meaningful change in VMS severity. Future interventional studies utilizing the weighted change score should target moderate-high baseline severity patients.