TY - JOUR
T1 - Quality of life and quality-adjusted survival (Q-TWiST) in patients receiving dose-intensive or standard dose chemotherapy for high-risk primary breast cancer
AU - Bernhard, J.
AU - Zahrieh, D.
AU - Zhang, J. J.
AU - Martinelli, G.
AU - Basser, R.
AU - Hürny, C.
AU - Forbes, J. F.
AU - Aebi, S.
AU - Yeo, W.
AU - Thürlimann, B.
AU - Green, M. D.
AU - Colleoni, M.
AU - Gelber, R. D.
AU - Castiglione-Gertsch, M.
AU - Price, K. N.
AU - Goldhirsch, A.
AU - Coates, A. S.
N1 - Funding Information:
We thank the patients, physicians, nurses, and data managers, the trial coordinators who participated in the International Breast Cancer Study Group trials, and Rita Hinkle, Heidi Gusset, and Gerda Egli for central data management. The International Breast Cancer Study Group is funded in part by: the Swiss Group for Clinical Cancer Research (SAKK), Frontier Science and Technology Research Foundation (FSTRF), The Cancer Council Australia, Australian New Zealand Breast Cancer Trials Group, National Cancer Institute (CA-75362), Swedish Cancer Society, Oncosuisse/ Cancer Research Switzerland, and Foundation for Clinical Cancer Research of Eastern Switzerland (OSKK).
PY - 2008/1/15
Y1 - 2008/1/15
N2 - Quality of life (QL) is an important consideration when comparing adjuvant therapies for early breast cancer, especially if they differ substantially in toxicity. We evaluated QL and Q-TWiST among patients randomised to adjuvant dose-intensive epirubicin and cyclophosphamide administered with filgrastim and progenitor cell support (DI-EC) or standard-dose anthracycline-based chemotherapy (SD-CT). We estimated the duration of chemotherapy toxicity (TOX), time without disease symptoms and toxicity (TWiST), and time following relapse (REL). Patients scored QL indicators. Mean durations for the three transition times were weighted with patient reported utilities to obtain mean Q-TWiST. Patients receiving DI-EC reported worse QL during TOX, especially treatment burden (month 3: P<0.01), but a faster recovery 3 months following chemotherapy than patients receiving SD-CT, for example, less coping effort (P<0.01). Average Q-TWiST was 1.8 months longer for patients receiving DI-EC (95% CI, -2.5 to 6.1). Q-TWiST favoured DI-EC for most values of utilities attached to TOX and REL. Despite greater initial toxicity, quality-adjusted survival was similar or better with dose-intensive treatment as compared to standard treatment. Thus, QL considerations should not be prohibitive if future intensive therapies show superior efficacy.
AB - Quality of life (QL) is an important consideration when comparing adjuvant therapies for early breast cancer, especially if they differ substantially in toxicity. We evaluated QL and Q-TWiST among patients randomised to adjuvant dose-intensive epirubicin and cyclophosphamide administered with filgrastim and progenitor cell support (DI-EC) or standard-dose anthracycline-based chemotherapy (SD-CT). We estimated the duration of chemotherapy toxicity (TOX), time without disease symptoms and toxicity (TWiST), and time following relapse (REL). Patients scored QL indicators. Mean durations for the three transition times were weighted with patient reported utilities to obtain mean Q-TWiST. Patients receiving DI-EC reported worse QL during TOX, especially treatment burden (month 3: P<0.01), but a faster recovery 3 months following chemotherapy than patients receiving SD-CT, for example, less coping effort (P<0.01). Average Q-TWiST was 1.8 months longer for patients receiving DI-EC (95% CI, -2.5 to 6.1). Q-TWiST favoured DI-EC for most values of utilities attached to TOX and REL. Despite greater initial toxicity, quality-adjusted survival was similar or better with dose-intensive treatment as compared to standard treatment. Thus, QL considerations should not be prohibitive if future intensive therapies show superior efficacy.
KW - Adaptation
KW - Adjuvant chemotherapy
KW - Breast cancer
KW - Quality of life
KW - Quality-adjusted survival
UR - http://www.scopus.com/inward/record.url?scp=38049033043&partnerID=8YFLogxK
U2 - 10.1038/sj.bjc.6604092
DO - 10.1038/sj.bjc.6604092
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C2 - 18043579
AN - SCOPUS:38049033043
SN - 0007-0920
VL - 98
SP - 25
EP - 33
JO - British Journal of Cancer
JF - British Journal of Cancer
IS - 1
ER -
