TY - JOUR
T1 - Quality of life and quality adjusted survival for breast cancer patients receiving adjuvant therapy
AU - Fairclough, Diane L.
AU - Fetting, John H.
AU - Cella, David
AU - Wonson, Wendy
AU - Moinpour, Carol M.
N1 - Funding Information:
This investigation was coordinated by the Eastern Cooperative Oncology Group and supported by Grant CA-23318, awarded by the National Cancer Institute, DHHS. We would especially like to thank the patients that participated in this study. Finally, we thank Bernard Cole for use of the program to perform the Q-TWiST analyses (supported by grant PBR-53 from the American Cancer Society).
PY - 1999
Y1 - 1999
N2 - Purpose: The objective was to compare health related quality of life (QOL) in hormone receptor negative, node-positive breast cancer patients receiving adjuvant chemotherapy to determine whether a more intensive chemotherapy regimen has an adverse effect upon QOL that is not balanced by improvements in disease control or survival. Increased physical symptoms, including fatigue and the inconvenience of the dose intensive 16-week regimen, were expected to have a negative impact on QOL. Design: QOL was measured in 163 patients, randomized to either a standard cyclophosphamide, doxorubicin and 5-flurouracil (CAF) or a 16-week multidrug regimen, using the Breast Chemotherapy Questionnaire (BCQ). The 30 item BCQ was self- administered prior to therapy, during therapy, and 4 months post treatment. Results: BCQ scores decreased (worsened) more during therapy on the 16-week regimen, median change -1.4, than on CAF, median change -0.8 (p < 0.001). By 4 months post treatment, BCQ scores were higher than pre-treatment and equal in the two arms (CAF: 8.1 and 16 weeks: 8.2, p = 0.6). Over a period of 48 months, patients on the 16-week regimen averaged 1.4 fewer months of treatment with toxicity, 4.0 more months without symptoms and 0.7 fewer months post recurrence compared to patients on the CAF regimen. Given typical values for these health states, the gain in Q-TWiST observed for the CAF regimen during treatment shifted to the 16-week regimen after 1 year, with a gain of 2.0 to 2.4 months after 4 years. Conclusions: The hypothesized negative impact of the dose intensive 16-week regimen was confirmed by the BCQ assessments. However, Q-TWiST analysis suggests a small gain for the 16- week regimen. The later results should be interpreted with caution with the limited follow-up of 4 years.
AB - Purpose: The objective was to compare health related quality of life (QOL) in hormone receptor negative, node-positive breast cancer patients receiving adjuvant chemotherapy to determine whether a more intensive chemotherapy regimen has an adverse effect upon QOL that is not balanced by improvements in disease control or survival. Increased physical symptoms, including fatigue and the inconvenience of the dose intensive 16-week regimen, were expected to have a negative impact on QOL. Design: QOL was measured in 163 patients, randomized to either a standard cyclophosphamide, doxorubicin and 5-flurouracil (CAF) or a 16-week multidrug regimen, using the Breast Chemotherapy Questionnaire (BCQ). The 30 item BCQ was self- administered prior to therapy, during therapy, and 4 months post treatment. Results: BCQ scores decreased (worsened) more during therapy on the 16-week regimen, median change -1.4, than on CAF, median change -0.8 (p < 0.001). By 4 months post treatment, BCQ scores were higher than pre-treatment and equal in the two arms (CAF: 8.1 and 16 weeks: 8.2, p = 0.6). Over a period of 48 months, patients on the 16-week regimen averaged 1.4 fewer months of treatment with toxicity, 4.0 more months without symptoms and 0.7 fewer months post recurrence compared to patients on the CAF regimen. Given typical values for these health states, the gain in Q-TWiST observed for the CAF regimen during treatment shifted to the 16-week regimen after 1 year, with a gain of 2.0 to 2.4 months after 4 years. Conclusions: The hypothesized negative impact of the dose intensive 16-week regimen was confirmed by the BCQ assessments. However, Q-TWiST analysis suggests a small gain for the 16- week regimen. The later results should be interpreted with caution with the limited follow-up of 4 years.
KW - Adjuvant chemotherapy
KW - Breast neoplasms
KW - Quality of life
KW - Randomized clinical trial
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U2 - 10.1023/A:1008806828316
DO - 10.1023/A:1008806828316
M3 - Article
C2 - 10855346
AN - SCOPUS:0033510731
VL - 8
SP - 723
EP - 731
JO - Quality of Life Research
JF - Quality of Life Research
SN - 0962-9343
IS - 8
ER -