Breast cancer patients on adjuvant chemotherapy report a wide range of problems not identified by health-care staff
Adjuvant chemotherapy for primary breast cancer is associated with significant side effects. The aims of this study were (1) to compare health-related quality of life (HRQL) in patients undergoing adjuvant chemotherapy to patients not on chemotherapy and (2) to compare these results against a survey investigating health-care professionals’ knowledge of HRQL.
Patients on adjuvant cyclophosphamide, methotrexate, fluoracil chemotherapy were compared to ‘low-risk’ patients not on chemotherapy (‘control group’). A questionnaire including the EORTC QLQ-C30, the Hospital Anxiety and Depression Scale (HADS), and the DBCG 89 Questionnaire was administered six times during a 2-year period. Forty-six experienced health-care professionals were asked which quality-of-life issues they thought were affected by adjuvant chemotherapy.
After 2 years, 159 of 242 patients on chemotherapy and 148 of 199 patients in the control group were alive and recurrence-free and had completed all questionnaires. Worse HRQL during chemotherapy was seen, as had been previously suggested, for 23 of 30 variables. A number of the health-care professionals had not indicated patients to have these side effects. Several side effects persisted after the chemotherapy.
This study provides the most comprehensive description of HRQL in adjuvant therapy to date. The discrepancy between patients and doctors/nurses suggests that patients have been insufficiently informed about the impact of chemotherapy on quality of life. The results of this study provide a basis for information that can be given to patients, and indicate that the care offered to patients in chemotherapy should seek to prevent, identify, and alleviate a very broad range of problems.
KeywordsBreast neoplasms Adjuvant therapy Chemotherapy Outcomes Quality of life
Supported by the Danish Cancer Society (91-505 and 94 15001).
- 3.van Dam FSAM, Linssen ACG, Engelsman E, van Benthem J, Hanewald GJFP (1980) Life with cytostatic drugs. In: Mouridsen HT, Palshof T (eds) Breast cancer—experimental and clinical aspects. Pergamon, Oxford, pp 229–233Google Scholar
- 7.Hurny C, Bernhard J, Coates AS, Castiglione-Gertsch M, Peterson HF, Gelber RD, Forbes JF, Rudenstam CM, Simoncini E, Crivellari D, Goldhirsch A, Senn HJ (1996) Impact of adjuvant therapy on quality of life in women with node-positive operable breast cancer. International Breast Cancer Study Group. Lancet 347:1279–1284PubMedGoogle Scholar
- 12.Levine MN, Bramwell VH, Pritchard KI, Norris BD, Shepherd LE, Abu-Zahra H, Findlay B, Warr D, Bowman D, Myles J, Arnold A, Vandenberg T, Mackenzie R, Robert J, Ottaway J, Burnell M, Williams CK, Tu D (1998) Randomized trial of intensive cyclophosphamide, epirubicin, and fluorouracil chemotherapy compared with cyclophosphamide, methotrexate, and fluorouracil in premenopausal women with node-positive breast cancer. National Cancer Institute of Canada Clinical Trials Group. J Clin Oncol 16:2651–2658PubMedGoogle Scholar
- 13.Land SR, Kopec JA, Yothers G, Anderson S, Day R, Tang G, Ganz PA, Fisher B, Wolmark N (2004) Health-related quality of life in axillary node-negative, estrogen receptor-negative breast cancer patients undergoing AC versus CMF chemotherapy: findings from the National Surgical Adjuvant Breast and Bowel Project B-23. Breast Cancer Res Treat 86:153–164PubMedCrossRefGoogle Scholar
- 15.Gelber RD, Bonetti M, Cole BF, Gelber S, Goldhirsch A, for the International Breast Cancer Study Group (1998) Quality of life assessment in the adjuvant setting: is it relevant? Recent Results Cancer Res 152:373–389Google Scholar
- 16.Danish Breast Cancer Cooperative Group (1989) DBCG-89. Program for treatment and follow-up of patients with primary, operable breast cancer [in Danish]. DBCG Secretariat, CopenhagenGoogle Scholar
- 17.Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishmann SB, de Haes JCJM, Kaasa S, Klee M, Osoba D, Razavi D, Rofe PB, Schraub S, Sneeuw K, Sullivan M, Takeda F (1993) The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 85:365–376PubMedCrossRefGoogle Scholar
- 25.Fayers PM, Aaronson N, Bjordal K, Groenvold M, Curran D, Bottomley A, on behalf of the EORTC Quality of Life Group (2001) The EORTC QLQ-C30 scoring manual, 3rd edn. European Organization for Research and Treatment of Cancer, BrusselsGoogle Scholar
- 29.Ahles TA, Saykin AJ, Furstenberg CT, Cole B, Mott LA, Skalla K, Whedon MB, Bivens S, Mitchell T, Greenberg ER, Silberfarb PM (2002) Neuropsychologic impact of standard-dose systemic chemotherapy in long-term survivors of breast cancer and lymphoma. J Clin Oncol 20:485–493PubMedCrossRefGoogle Scholar
- 31.Jonat W, Kaufmann M, Sauerbrei W, Blamey R, Cuzick J, Namer M, Fogelman I, de Haes JC, de Matteis A, Stewart A, Eiermann W, Szakolczai I, Palmer M, Schumacher M, Geberth M, Lisboa B (2002) Goserelin versus cyclophosphamide, methotrexate, and fluorouracil as adjuvant therapy in premenopausal patients with node-positive breast cancer: The Zoladex Early Breast Cancer Research Association Study. J Clin Oncol 20:4628–4635PubMedCrossRefGoogle Scholar
- 32.Bernhard J, Zahrieh D, Coates AS, Gelber RD, Castiglione-Gertsch M, Murray E, Forbes JF, Perey L, Collins J, Snyder R, Rudenstam CM, Crivellari D, Veronesi A, Thurlimann B, Fey MF, Price KN, Goldhirsch A, Hurny C (2004) Quantifying trade-offs: quality of life and quality-adjusted survival in a randomised trial of chemotherapy in postmenopausal patients with lymph node-negative breast cancer. Br J Cancer 91:1893–1901PubMedCrossRefGoogle Scholar
- 33.Macquart-Moulin G, Viens P, Bouscary ML, Genre D, Resbeut M, Gravis G, Camerlo J, Maraninchi D, Moatti JP (1997) Discordance between physicians’ estimations and breast cancer patients’ self-assessment of side-effects of chemotherapy: an issue for quality of care. Br J Cancer 76:1640–1645PubMedGoogle Scholar