2689 - Beyond Acute Toxicity: Persistent and Increasing Body Image Distress after Adjuvant Breast Radiotherapy

Purpose/Objective(s):

Adjuvant radiotherapy (RT) is a standard component of breast cancer management and may adversely impact long-term cosmesis. However, the natural history of patient-reported distress beyond 1-year post-RT remains undefined, and the interplay between body image (BI), sexual function (SF), and psychiatric distress is poorly characterized. We hypothesized that BI distress persists beyond the acute treatment period and co-activates with other clinically actionable distress domains.

Materials/Methods:

Women with unilateral breast cancer treated at a high-volume tertiary center (2016–2024) were identified from a prospectively maintained institutional registry. A standardized 15-domain distress instrument was administered longitudinally at in-person oncology visits. Patients with =1 completed distress screen post-surgery and =1 post-RT were included.

Clinically significant distress was defined a priori as either "moderate" or "severe" distress, and was evaluated at prespecified intervals relative to RT completion (<3, 3–6, 6–12, and 12–24 months). Multivariable logistic regression identified independent predictors of distress at each time point. Network analysis was performed to characterize co-activation patterns between BI distress and other domains.

Results:

2,032 patients were identified (Table), with 1,308 (71.6%) screened >1-year post-ART. Clinically significant BI/SF distress increased progressively over time: 20.6% pre-RT to 23.6%, 25.2%, 25.8%, and 31.5% at <3, 3–6, 6–12, and 12–24 months, respectively (all P<0.001 vs pre-RT), with the highest prevalence observed beyond 1-year post-RT.

On multivariable analysis, older age was independently associated with lower odds of BI/SF distress at all benchmarks (OR 0.70–0.81 per 10-year, all P<0.01). In contrast, post-mastectomy RT (PMRT) was independently associated with higher odds of late distress at 6–12 and 12–24 months versus whole breast RT (OR 1.47 and 1.60, respectively; P<0.01). Stage and RT dose were not associated.

Network analysis demonstrated that BI distress was correlated with SF distress (?=0.63), depression (?=0.53), anxiety/fear (?=0.53), and feeling like a burden (?=0.44).

Conclusion:

The prevalence of BI/SF distress increases over time following adjuvant breast RT, with one-third of women reporting significant distress beyond one year. Younger patients and those receiving PMRT are at highest risk. BI distress is linked with psychiatric and SF distress, suggesting it functions as a central survivorship toxicity. Surveillance past the first year post-RT may identify late-emerging psychosocial morbidity and inform targeted supportive care interventions.

Variable	N (%) or Median [IQR]
Age, Years	59 [48-67]
Radiotherapy Fields
Whole Breast Irradiation	1274 (62.7)
Partial Breast Irradiation	216 (10.6)
Postmastectomy Radiation Therapy	542 (26.7)
Any Regional Nodal Irradiation	643 (31.7)
Total Dose, Gy	52.5 [42.0-58.4]
Number of Post-RT Distress Screens	3 [2-6]