Quality of life trajectories in breast cancer survivors up to one year after treatment: a prospective study in a lower-middle-income country.

[PURPOSE] Measuring quality of life (QoL) in breast cancer survivors is a key 'patient-reported outcome' to optimize survivorship care, however, evidence from low- and middle-income countries is limited. Our prospective study aimed to identify QoL trajectory patterns and their determinants in Moroccan breast cancer patients from diagnosis up to one year post-treatment.

[METHODS] We recruited 830 stage I-III breast cancer patients registered at the two major oncology centres. QoL was assessed using validated EORTC QLQ-C30 and QLQ-BR23 questionnaires at pre-treatment, after treatment completion, and at one year post-treatment. Trajectory patterns were identified through group-based modelling.

[RESULTS] Three distinct QoL trajectories were identified: consistently high (36.1%), moderate (56.4%), and low (7.5%). Stage III disease (OR 6.63, 95% CI 2.35-18.71) was significantly associated with patients in the consistently low trajectory group. Being married (OR 0.40, 95% CI 0.19-0.84), receiving treatment at comprehensive cancer centers (OR 0.12, 95% CI: 0.05-0.27), and management according to international guidelines on breast cancer care (OR 0.44, 95% CI 0.24-0.80) reduced the likelihood of being in the consistently low trajectory group. Younger patients (aged < 50) were also more likely to be in the low trajectory pattern. While global health status improved over time (74.8-83.7, p = 0.018), multiple domains showed deterioration, particularly in the low trajectory group. Financial hardship persisted in all groups despite health insurance coverage.

[CONCLUSION] We identified three distinct QoL trajectories. Advanced stage of disease increased risk of poor QoL outcomes, while older age, treatment at comprehensive cancer centers, and protocol-appropriate management were protective determinants. Many women survive breast cancer, but we know little about how their quality-of-life changes during and after treatment, especially in countries with fewer resources like Morocco. Our study followed breast cancer patients for over a year after treatment to understand these changes. Our objective was to identify different patterns in how quality of life changes over time for breast cancer survivors and determine what factors influence these patterns. We found three distinct patterns: some women maintained good quality of life (36%), others had moderate levels (56%), and a smaller group consistently struggled with poor quality of life outcomes (7.5%). Younger patients and those with more advanced cancer were more likely to have poor quality of life outcomes. Receiving treatment according to internationally accepted guidelines at comprehensive cancer centers that provide cancer services - from diagnosis through surgery, chemotherapy, radiotherapy, and follow-up all in one location significantly improved quality of life outcomes. Despite most patients having health insurance, many faced financial difficulties throughout treatment and recovery periods. Our findings help identify which patients need extra support and show that comprehensive care centers and appropriate treatment improve quality of life for breast cancer survivors in Morocco.