Quality of life and quality adjusted survival for breast cancer patients receiving adjuvant therapy

被引:35
作者
Fairclough, DL
Fetting, JH
Cella, D
Wonson, W
Moinpour, CM
机构
[1] AMC Canc Res Ctr, Denver, CO 80214 USA
[2] Johns Hopkins Oncol Ctr, Baltimore, MD 21287 USA
[3] Evanston NW Healthcare, Ctr Outcomes Res & Educ, Evanston, IL 60201 USA
[4] ECOG Coordinating Ctr, Brookline, MA 02445 USA
[5] SW Oncol Grp, Ctr Stat, Seattle, WA 98109 USA
关键词
adjuvant chemotherapy; breast neoplasms; quality of life; randomized clinical trial;
D O I
10.1023/A:1008806828316
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
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.
引用
收藏
页码:723 / 731
页数:9
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