Sutanto, Henry and Savitri, Merlyna and Hendarsih, Een and Ashariati, Ami (2026) Early hematologic dynamics and their association with patient-reported symptom burden in breast cancer pharmacotherapy: a prospective cohort study. Future Oncology, 22 (10). 1197 - 1212.

Abstract

Background: 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. Methods: In this prospective cohort study, 106 women receiving systemic pharmacotherapy at two secondary referral centers in Indonesia were enrolled. Hematologic parameters and inflammatory indicesâincluding neutrophilâlymphocyte ratio (NLR), plateletâ lymphocyte ratio (PLR), monocyteâlymphocyte ratio (MLR), and pan-immune-inflammation value (PIV)âwere measured. Patient-reported outcomes were assessed using the EORTC QLQ-C30. Results: 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). Conclusion: Early breast cancer pharmacotherapy induces dynamic hematologic and inflammatory changes associated with patient-reported symptoms, supporting integrated monitoring to improve toxicity management. © 2026 Informa UK Limited, trading as Taylor & Francis Group.

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