Stage-Dependent Differences in Quality of Life Among Breast Cancer Patients Prior to Systemic Therapy: A Cross-sectional Study

BackgroundDisease stage is a major determinant of health-related quality of life (HRQoL) in breast cancer, yet stage-stratified HRQoL data from low-and middle-income settings remain limited. Understanding baseline differences across stages is essential for optimizing supportive care before systemic therapy. MethodsIn this cross-sectional study conducted at two secondary referral centers in East Java, Indonesia, from January to October 2025, we consecutively enrolled women with histologically confirmed breast cancer prior to initiation of systemic therapy. Demographic and tumor characteristics were recorded, including histopathology, grade, and immunohistochemistry. HRQoL was assessed using validated versions of the EORTC QLQ-C30 and QLQ-BR23. Patients were categorized into early (n=14), locally advanced (n=62), and metastatic disease (n=30). Group differences were analyzed using the Kruskal-Wallis test. ResultsParticipants were exclusively female, with slightly younger age in advanced and metastatic groups. Invasive ductal carcinoma predominated across stages (80-100%). Higher-grade tumors were most frequent in locally advanced disease, while Luminal B and HER2-enriched subtypes were more common in advanced stages. HRQoL demonstrated clear stage-dependent decline. Global health status was highest in early disease (median 83.3) and lowest in metastatic disease (75.0; p = 0.004). Social functioning differed significantly across stages (p = 0.022). Symptom burden--including pain (p = 0.041) and systemic side effects (p = 0.025)--was greatest in metastatic disease. Emotional, cognitive, and body-image domains were similar between groups. ConclusionBreast cancer stage is strongly associated with baseline HRQoL impairment, particularly in global health, social functioning, pain, and treatment-related symptoms. These findings highlight the need for earlier diagnosis and stage-specific supportive care strategies in resource-constrained settings.