Early hematologic dynamics and their association with patient-reported symptom burden in breast cancer pharmacotherapy: a prospective cohort study

Systemic pharmacotherapy for breast cancer frequently induces hematologic toxicity and inflammatory changes that may affect symptom burden and treatment tolerance. This study evaluated baseline hematologic profiles, early treatment-related changes, and their association with patient-reported outcomes during the first cycle of therapy.
In this prospective cohort study, 106 women receiving systemic pharmacotherapy at two secondary referral centers in Indonesia were enrolled. Hematologic parameters and inflammatory indices—including neutrophil–lymphocyte ratio (NLR), platelet–lymphocyte ratio (PLR), monocyte–lymphocyte ratio (MLR), and pan-immune-inflammation value (PIV)–were measured. Patient-reported outcomes were assessed using the EORTC QLQ-C30.
The mean age was 51.9 ± 9.7 years, with most patients presenting with locally advanced disease and invasive ductal carcinoma. Early pharmacotherapy caused marked hematologic suppression, with leukocyte and neutrophil nadirs at week 1 and partial recovery by week 3 (p < 0.001). PLR, MLR, and PIV changed significantly over time (p < 0.001). Anemia increased from 51.9% to 74.0%, while neutropenia rose to 41.7% at week 1 before declining to 1.1% by week 3. Selected hematologic biomarkers correlated with patient-reported symptom burden, and only baseline MLR differed between survival subgroups (p = 0.043).
Early breast cancer pharmacotherapy induces dynamic hematologic and inflammatory changes associated with patient-reported symptoms, supporting integrated monitoring to improve toxicity management.
Breast cancer treatments such as chemotherapy and targeted medicines can affect the body in many ways, including changes in blood cells that help fight infection. In this study, we examined how blood cell levels change during the first few weeks of breast cancer treatment and whether these changes are related to symptoms reported by patients. We followed 106 women receiving breast cancer treatment at two hospitals in Indonesia. Blood tests were performed before treatment started, one week after treatment began, and again three weeks later. Patients also completed a questionnaire about common symptoms such as fatigue, pain, nausea, and digestive problems. We found that many blood cell counts dropped sharply during the first week of treatment, especially white blood cells that help protect the body from infection. These levels generally improved by the third week. Anemia (low red blood cells) became more common over time, while low white blood cells were most frequent during the first week. We also looked at several blood markers that reflect inflammation in the body. These markers changed significantly during treatment. When we compared blood results with patient-reported symptoms, we found only modest links. Some immune cell levels were related to symptoms such as diarrhea and fatigue, but most blood measures were not strongly connected with how patients felt. In addition, one inflammation marker appeared higher in patients who did not survive during the study period.