Beyond Physical Toxicities: Identifying Psychosocial Domains Requiring Integrated Support in Breast Cancer Pharmacotherapy

Psychooncology. 2026 Jan;35(1):e70393. doi: 10.1002/pon.70393.

Abstract

Background: Cancer pharmacotherapy imposes substantial physical and psychosocial burdens that affect patients' quality of life (QoL). While oncologic outcomes are well studied, the psychological dimensions-particularly future perspective, emotional resilience, and body image-remain underintegrated into routine care. The growing recognition of psycho-oncology highlights the need for synergistic collaboration between oncology and clinical psychology.

Aim: To evaluate changes in QoL before and after pharmacotherapy among women with breast cancer and identify domains most vulnerable to psychological distress, thereby informing the need for integrated psycho-oncologic care.

Methods: This prospective study included 106 women with breast cancer undergoing pharmacotherapy. Sociodemographic and clinical characteristics were collected, including cancer stage, treatment modalities, and baseline cardiometabolic parameters. QoL was assessed pre- and post-treatment using EORTC QLQ-C30 and BR23 instruments. Paired comparisons were performed using Wilcoxon signed-rank tests, and correlations with age were analyzed using Spearman or Pearson methods as appropriate.

Results: Global health status declined significantly after pharmacotherapy (83.3 to 66.7; p = 0.002). Functional domains-including physical, role, and social functioning-also worsened, while emotional functioning improved modestly. Symptom burden increased across fatigue, nausea, pain, appetite loss, and systemic side effects (all p < 0.001). Breast-cancer-specific domains such as body image and future perspective showed minimal change but remained highly variable, indicating psychosocial vulnerability. Distress related to hair loss demonstrated a modest inverse correlation with age (r = -0.296; p = 0.003).

Conclusion: Pharmacotherapy substantially reduces multiple QoL domains, highlighting symptom-function trade-offs and persistent psychological concerns. The patterns in emotional functioning and future perspective indicate unmet psychosocial needs. These findings underscore the imperative for integrated psycho-oncology models to enhance holistic survivorship care.

Keywords: breast neoplasms; chemotherapy‐induced adverse effects; patient‐reported outcome measures; psycho‐oncology; quality of life.

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Agents* / adverse effects
  • Antineoplastic Agents* / therapeutic use
  • Body Image / psychology
  • Breast Neoplasms* / drug therapy
  • Breast Neoplasms* / psychology
  • Fatigue / chemically induced
  • Female
  • Humans
  • Middle Aged
  • Prospective Studies
  • Psychological Distress*
  • Quality of Life* / psychology

Substances

  • Antineoplastic Agents