Metastatic breast cancer
Do current treatments improve quality of life? A prospective study
Keywords:
Breast neoplasms, Neoplasm metastasis, Quality of life, Depression, Karnofsky performance statusAbstract
CONTEXT AND OBJECTIVE: In metastatic breast cancer cases, the currently available therapeutic approaches provide minimal improvement in sur- vival. As such, quality of life (QOL) becomes one of the main objectives of treatment. It is not known whether current treatments derived from trials improve QOL. The aim was to evaluate changes in QOL among metastatic breast cancer patients receiving treatment derived from trials. DESIGN AND SETTING: Prospective observational QOL survey in a tertiary cancer center. METHODS: To evaluate the influence of current treatments on patients’ QOL, the Medical Out- comes Study Short Form-36 (SF-36) and the Beck Depression Inventory (BDI) were applied on three occasions: before starting treatment and at the 6th and 12th weeks, to consecutive metastatic breast cancer patients over a one-year period. RESULTS: We found an improvement in QOL in the sample evaluated (n = 40), expressed by changes in the overall SF-36 score (p = 0.002) and the BDI (p = 0.004). Taken individually, the SF-36 components Pain, Social Functioning and Mental Health also improved significantly. Patients with worse initial performance status and secondary symptoms displayed greater improve- ment than those with better initial performance status and asymptomatic disease (p < 0.001). Patients who received more than one type of therapy showed larger gains than those given only one type (p = 0.038). CONCLUSIONS: In our environment, current metastatic breast cancer treatments can improve QOL, especially among symptomatic patients and those with low performance status.
Downloads
References
McPherson K, Steel CM, Dixon JM. ABC of breast diseases. Breast cancer-epidemiology, risk factors, and genetics. BMJ. 2000;321(7261):624-8.
Feuer EJ, Wun LM, Boring CC, Flanders WD, Timmel MJ, Tong T. The lifetime risk of developing breast cancer. J Natl Cancer Inst. 1993;85(11):892-7.
Carlson RW. Quality of life issues in the treatment of metastatic breast cancer. Oncology (Williston Park). 1998;12(3 suppl 4):27-31.
Cardoso F, Di LA, Lohrisch C, Bernard C, Ferreira F, Piccart MJ. Second and subsequent lines of chemotherapy for metastatic breast cancer: what did we learn in the last two decades? Ann Oncol. 2002;13(2):197-207.
Fossati R, Confalonieri C, Torri V, et al. Cytotoxic and hormonal treatment for metastatic breast cancer: a systematic review of published randomized trials involving 31,510 women. J Clin Oncol. 1998;16(10):3439-60.
Ghersi D, Wilcken N, Simes J, Donoghue E. Taxane containing regimens for metastatic breast cancer. Cochrane Database Syst Rev. 2005;(2):CD003366.
Brady MJ, Cella DF, Mo F, et al. Reliability and validity of the Functional Assessment of Cancer Therapy-Breast quality-of-life instrument. J Clin Oncol. 1997;15(3):974-86.
Outcomes of cancer treatment for technology assessment and cancer treatment guidelines. American Society of Clinical Oncology. J Clin Oncol. 1996;14(2):671-9.
Day R, Ganz PA, Costantino JP, Cronin WM, Wickerham DL, Fisher B. Health-related quality of life and tamoxifen in breast cancer prevention: a report from the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Clin Oncol. 1999;17(9):2659-69.
Ganz PA, Rowland JH, Meyerowitz BE, Desmond KA. Impact of different adjuvant therapy strategies on quality of life in breast cancer survivors. Recent Results Cancer Res. 1998;152:396-411.
Geels P, Eisenhauer E, Bezjak A, Zee B, Day A. Palliative effect of chemotherapy: objective tumor response is associated with symptom improvement in patients with metastatic breast cancer. J Clin Oncol. 2000;18(12):2395-405.
Norris B, Pritchard KI, James K, et al. Phase III comparative study of vinorelbine combined with doxorubicin versus doxoru- bicin alone in disseminated metastatic/recurrent breast cancer: National Cancer Institute of Canada Clinical Trials Group Study MA8. J Clin Oncol. 2000;18(12):2385-94.
Fallowfield L. Quality of life: a new perspective for cancer patients. Nat Rev Cancer. 2002;2(11):873-9.
Langenhoff BS, Krabbe PF, Wobbes T, Ruers TJ. Quality of life as an outcome measure in surgical oncology. Br J Surg. 2001;88(5):643-52.
Essink-Bot ML, Krabbe PF, Bonsel GJ, Aaronson NK. An empirical comparison of four generic health status measures. The Nottingham Health Profile, the Medical Outcomes Study 36-item Short-Form Health Survey, the COOP/ WONCA charts, and the EuroQol instrument. Med Care. 1997;35(5):522-37.
Cooley ME, McCorkle R, Knafl GJ, et al. Comparison of health- related quality of life questionnaires in ambulatory oncology. Qual Life Res. 2005;14(5):1239-49.
Okamoto T, Shimozuma K, Katsumata N, et al. Measuring qual- ity of life in patients with breast cancer: a systematic review of reliable and valid instruments available in Japan. Breast Cancer. 2003;10(3):204-13.
Mosconi P, Apolone G, Barni S, Secondino S, Sbanotto A, Filiberti A. Quality of life in breast and colon cancer long-term survivors: an assessment with the EORTC QLQ-C30 and SF-36 questionnaires. Tumori. 2002;88(2):110-6.
Yost KJ, Haan MN, Levine RA, Gold EB. Comparing SF-36 scores across three groups of women with different health profiles. Qual Life Res. 2005;14(5):1251-61.
Ware JE Jr. SF-36 health survey update. Spine. 2000; 25(24):3130-9.
Mosconi P, Colozza M, De Laurentiis M, De Placido S, Maltoni M. Survival, quality of life and breast cancer. Ann Oncol. 2001;12 (Suppl 3):S15-9.
Ciconelli RM, Ferraz MB, Santos W, Meinão I, Quaresma MR. Tradução para a língua portuguesa e validação do questionário genérico de avaliação de qualidade de vida SF-36 (Brasil SF- 36). [Brazilian-Portuguese version of the SF-36. A reliable and valid quality of life outcome measure]. Rev Bras Reumatol. 1999;39(3):143-50.
Gorenstein C, Andrade L. Validation of a Portuguese ver- sion of the Beck Depression Inventory and the State-Trait Anxiety Inventory in Brazilian subjects. Braz J Med Biol Res. 1996;29(4):453-7.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561-71.
Conill C, Verger E, Salamero M. Performance status assessment in cancer patients. Cancer. 1990;65(8):1864-6.
Wang XS, Cleeland CS, Mendoza TR, et al. The effects of pain severity on health-related quality of life: a study of Chinese cancer patients. Cancer. 1999;86(9):1848-55.
Handy JR Jr, Asaph JW, Skokan L, et al. What happens to patients undergoing lung cancer surgery? Outcomes and quality of life before and after surgery. Chest. 2002;122(1):21-30.
Bottomley A. Depression in cancer patients: a literature review. Eur J Cancer Care (Engl). 1998;7(3):181-91.
Osoba D. Lessons learned from measuring health-related quality of life in oncology. J Clin Oncol. 1994;12(3):608-16.
Pivot X, Asmar L, Hortobagyi GN, Theriault R, Pastorini F, Buzdar A. A retrospective study of first indicators of breast cancer recurrence. Oncology. 2000;58(3):185-90.
Rojas MP, Telaro E, Russo A, et al. Follow-up strategies for women treated for early breast cancer. Cochrane Database Syst Rev. 2005;(1):CD001768.
Mollick JA, Carlson RW. Rational surveillance programs for early stage breast cancer patients after primary treatment. Breast Dis. 2004;21:47-54.
Coates A, Gebski V, Signorini D, et al. Prognostic value of quality-of-life scores during chemotherapy for advanced breast cancer. Australian New Zealand Breast Cancer Trials Group. J Clin Oncol. 1992;10(12):1833-8.
Hann DM, Jacobsen PB, Martin SC, Kronish LE, Azzarello LM, Fields KK. Quality of life following bone marrow transplantation for breast cancer: a comparative study. Bone Marrow Transplant. 1997;19(3):257-64.
Murray KJ, Nelson DF, Scott C, et al. Quality-adjusted survival analysis of malignant glioma. Patients treated with twice-daily radiation (RT) and carmustine: a report of Radiation Therapy Oncology Group (RTOG) 83-02. Int J Radiat Oncol Biol Phys. 1995;31(3):453-9.
Sprangers MA, Groenvold M, Arraras JI, et al. The Euro- pean Organization for Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire module: first results from a three-country field study. J Clin Oncol. 1996;14(10):2756-68.
Greimel E, Thiel I, Peintinger F, Cegnar I, Pongratz E. Pro- spective assessment of quality of life of female cancer patients. Gynecol Oncol. 2002;85(1):140-7.
