Improving the Quality of Life during Chemotherapy for Advanced Breast Cancer

Abstract

Since chemotherapy for metastatic breast cancer is not curative, consideration of the quality of life is important in selecting a treatment regimen. We conducted a randomized trial comparing continuous chemotherapy, administered until disease progression was evident, with intermittent therapy, whereby treatment was stopped after three cycles and then repeated for three more cycles only when there was evidence of disease progression. Each approach was tested with doxorubicin combined with cyclophosphamide or with cyclophosphamide combined with methotrexate, fluorouracil, and prednisone. Intermittent therapy resulted in a significantly worse response (P = 0.02 by Mann-Whitney test), a significantly shorter time to disease progression (relative risk based on proportional-hazards model, 1.8; 95 percent confidence interval, 1.4 to 2.4), and a trend toward shorter survival (relative risk, 1.3; confidence interval, 0.99 to 1.6). The quality of life was expressed as linear-analogue self-assessment scores for physical well-being, mood, pain, and appetite and as a quality-of-life index. It improved significantly during the first three cycles, when all patients received treatment. Thereafter, intermittent therapy was associated with worse scores for physical well-being (by 23 percent of scale; 95 percent confidence interval, 11 to 35 percent), mood (25 percent; 13 to 37 percent), and appetite (12 percent; 0 to 24 percent) and for the quality-of-life index as indicated by the patient (14 percent; 5 to 23 percent) and the physician (16 percent; 7 to 26 percent). Changes in the quality of life were independent prognostic factors in proportional-hazards models of subsequent survival. We conclude that, as tested, continuous chemotherapy is better than intermittent chemotherapy for advanced breast cancer.

Screening for psychiatric morbidity in patients with advanced breast cancer: validation of two self-report questionnaires

“…The RSCL was superior to the HADS in this respect. (Bell et al, 1985;Coates et al, 1987;Padilla et al, 1981;Priestman & Baum, 1976;Selby et al, 1984) but these have not been validated against a psychiatric interview. This makes their scores difficult to interpret.…”

“…Clinicians treating women with advanced breast cancer have become increasingly concerned about their quality of life (Baum et al, 1980;Bell et al, 1985;Brinkely, 1985;Coates et al, 1987;Gough et al, 1983;Tannock et al, 1988), yet, the recognition of psychological distress is handicapped by patients' unwillingness to disclose any emotional problems and doctors' and nurses' reluctance to enquire (Maguire et al, 1980). Ways of improving the identification of psychological morbidity need to be found and a self-assessment approach warrants evaluation.…”

Discordance between physicians' estimations and breast cancer patients' self-assessment of side-effects of chemotherapy: an issue for quality of care

“…In recent years, there have been more systematic attempts to measure the impact of side-effects on patients' well-being and quality of life during chemotherapy treatments by taking into account patients' subjective point of view (Coates et al, 1983(Coates et al, , 1987Knobf, 1986; Byrne, 1992;Payne, 1992;Griffin et al, 1996;Swain et al, 1996). However, it is obvious that such approaches have not yet been fully integrated in day-to-day clinical practice in oncology (Waitzkin, 1984;Sutherland et al, 1989).…”

Maintenance treatment with Pegylated liposomal doxorubicin versus observation following induction chemotherapy for metastatic breast cancer: GEICAM 2001-01 study

“…Several trials over the past two decades have demonstrated consistent prolongation of progression-free survival (PFS); however, a survival benefit or quality of life (QoL) advantage has been infrequently documented. These studies have supported the use of more protracted chemotherapy regimens [2,[4][5][6][7]9]. Results of a meta-analysis demonstrated a modest, but statistically significant survival advantage for patients randomized to longer versus shorter treatments [11].…”

“…Although the role of maintenance therapy in MBC is still undefined, its goal is to prolong the primary therapy benefit and improve disease control, while maintaining an acceptable quality of life. To date, eight out of nine randomized trials of standard versus extended duration chemotherapy in MBC patients have consistently demonstrated a progression-free survival (PFS) advantage favoring extended duration therapies [2][3][4][5][6][7][8][9][10]. Unfortunately, these trials have failed to demonstrate a consistent benefit in overall survival (OS), and the additional cycles of chemotherapy were often associated with a significant increase in toxicity.…”