Quality of life in elderly breast cancer patients with localized disease receiving endocrine treatment: a prospective study
- 33 Downloads
In this paper we study the quality of life (QoL) of elderly breast cancer patients receiving endocrine treatment (ET). More QoL data on elderly patients treated with ET are needed. Our aims are to study QoL in early-stage breast cancer patients throughout the treatment period and compare the QoL of ET groups.
148 patients > 65 years who began ET with either tamoxifen or aromatase inhibitor (AI) completed the EORTC QLQ-C30 and QLQ-BR23 and the Interview for Deterioration in Daily Living Activities in Dementia (IDDD) questionnaires three times over 3 years of ET. Linear mixed-effect models were used to evaluate longitudinal QoL changes. ET group comparisons were conducted after 3 years of treatment via ANCOVA adjusted by basal QoL.
QoL scores were high (> 80/100 points) in most QoL areas, with moderate limitations (> 30) in sexual functioning and enjoyment and in future perspective. After 3 years of ET, four QoL areas improved (< 6 points) compared to baseline and 3-month assessments. Hot flushes worsened (8 points) at the 3-month assessment but by 3 years had recovered. AI patients showed more hot flushes, pain and diarrhea and less sexual enjoyment than tamoxifen patients after 3 years of ET (differences 3–12 points).
Results indicate that elderly early-stage breast cancer patients adapted well to their disease and ET treatment over the 3 years. Few QoL differences were observed between ET groups.
KeywordsQuality of life Elderly Endocrine treatment Breast cancer EORTC
We thank all professionals at the Oncology Departments of the Complejo Hospitalario de Navarra for their support in this study.
This study was supported by grants from the Instituto Carlos III and FEDER (project P115/02114), Fundación Caja Navarra, Fundación Obra Social “La Caixa” and UNED Pamplona for a research assistant who collected the data.
Compliance ethical standards
Conflict of interest
The authors declare they have no conflict of interest.
This study was approved by Regional Ethics Committee for Biomedical Research and followed the recommendations of the Declaration of Helsinki.
Informed consent was obtained from all individual participants included in the study.
- 3.Cao A, Zhang J, Liu X, Wu W, Liu Y, Fan Z, et al. Health-related quality of life of postmenopausal Chinese women with hormone receptor-positive early breast cancer during treatment with adjuvant aromatase inhibitors: a prospective, multicenter, non-interventional study. Health Qual Life Outcomes. 2016;24(14):51.CrossRefGoogle Scholar
- 4.Van Nes JG, Fontein DB, Hille ET, Voskuil DW, van Leeuwen FE, de Haes JC, et al. Quality of life in relation to tamoxifen or exemestane treatment in postmenopausal breast cancer patients: a Tamoxifen Exemestane Adjuvant Multinational (TEAM) Trial side study. Breast Cancer Res Treat. 2012;134(1):267–76.CrossRefGoogle Scholar
- 5.Cella D, Fallowfield L, Barker P, Cuzick J, Locker G, Howell A, ATAC Trialistsa9 Group. Quality of life of postmenopausal women in the ATAC (“Arimidex”, tamoxifen, alone or in combination) trial after completion of 5 years’ adjuvant treatment for early breast cancer. Breast Cancer Res Treat. 2006;100(3):273–84.CrossRefGoogle Scholar
- 8.Egawa C, Hirokaga K, Takao S, Yamagami K, Miyashita M, Baba M, Ichii S, et al. Risk factors for joint symptoms in postmenopausal Japanese breast cancer patients treated with anastrozole: a prospective multicenter cohort study of patient-reported outcomes. Int J Clin Oncol. 2016;21(2):262–9.CrossRefGoogle Scholar
- 9.Leinert E, Singer S, Janni W, Harbeck N, Weissenbacher T, Rack B, et al. The impact of age on quality of life in breast cancer patients receiving adjuvant chemotherapy: a comparative analysis from the prospective multicenter randomized ADEBAR trial. Clin Breast Cancer. 2017;17(2):100–6.CrossRefGoogle Scholar
- 11.Muss HB, Tu D, Ingle JN, Martino S, Robert NJ, Pater JL, et al. Efficacy, toxicity, and quality of life in older women with early-stage breast cancer treated with letrozole or placebo after 5 years of tamoxifen: NCIC CTG intergroup trial MA.17. J Clin Oncol. 2008;26(12):1956–64.CrossRefGoogle Scholar
- 14.Sprangers MA, Groenvold M, Arraras JI, Franklin J, te Velde A, Muller M, et al. The European 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.CrossRefGoogle Scholar
- 16.Arraras JI, Tejedor M, Illarramendi JJ, Vera R, Pruja E, Marcos M, et al. El cuestionario de calidad de vida para cáncer de mama de la EORTC, QLQ-BR23. Estudio psicométrico con una muestra española. Psic Conduc. 2001;9(1):81–98.Google Scholar
- 18.Karnofsky DA, Burchenal JH. The evaluation of chemotherapeutic agents in cancer. In: McLeod CM, editor. evaluation of chemotherapeutic agents. New York: University Press; 1949. p. 191–205.Google Scholar
- 19.Cocks K, King MT, Velikova G, de Castro Jr G, Martyn St-James M, Fayers PM, et al. Evidence-based guidelines for interpreting change scores for the European Organisation for the Research and Treatment of Cancer quality of life questionnaire core 30. Eur J Cancer. 2012;48(11):1713–21.CrossRefGoogle Scholar
- 20.Cocks K, King MT, Velikova G, Martyn St-James M, Fayers PM, Brown JM. Evidence-based guidelines for determination of sample size and interpretation of the European Organisation for the Research and Treatment of Cancer quality of life questionnaire core 30. J Clin Oncol. 2011;29(1):89–96.CrossRefGoogle Scholar
- 23.Karlsen RV, Frederiksen K, Larsen MB, von Heymann-Horan AB, Appel CW, Christensen J, et al. The impact of a breast cancer diagnosis on health-related quality of life. A prospective comparison among middle-aged to elderly women with and without breast cancer. Acta Oncol. 2016;55(6):720–7.CrossRefGoogle Scholar
- 24.Scott N, Fayers P, Aaronson N, Bottomley A, de Graeff A, Groenvold M, et al. EORTC QLQ-C30. Reference values. Brussels: EORTC; 2008.Google Scholar
- 25.Whelan TJ, Pritchard KI. Managing patients on endocrine therapy: focus on quality-of-life issues. Clin Cancer Res. 2006;1:12.Google Scholar
- 27.Versmessen H, Vinh-Hung V, Van Parijs H, Miedema G, Voordeckers M, Adriaenssens N, et al. Health-related quality of life in survivors of stage I-II breast cancer: randomized trial of post-operative conventional radiotherapy and hypofractionated tomotherapy. BMC Cancer. 2012;25(12):495.CrossRefGoogle Scholar
- 29.Jones SE, Cantrell J, Vukelja S, Pippen J, O’Shaughnessy J, Blum JL, et al. Comparison of menopausal symptoms during the first year of adjuvant therapy with either exemestane or tamoxifen in early breast cancer: report of a Tamoxifen Exemestane Adjuvant Multicenter trial substudy. J Clin Oncol. 2007;25(30):4765–71.CrossRefGoogle Scholar
- 30.Ohsumi S, Shimozuma K, Ohashi Y, Shinji M, Hozumi Y, Mukai H, et al. Health-related quality of life and psychological distress of breast cancer patients after surgery during a phase III randomized trial comparing continuation of tamoxifen with switching to anastrozole after adjuvant tamoxifen for 1–4 years: N-SAS BC 03. Breast Cancer Res Treat. 2011;127(1):143–52.CrossRefGoogle Scholar