Chemotherapy versus ovarian ablation as adjuvant therapy for breast cancer: impact on health-related quality of life in a randomized trial.
BACKGROUND
Ovarian ablation is an effective adjuvant therapy for primary breast cancer but little is known about its quality of life impact relative to the more widely used adjuvant chemotherapy. This randomized study compared quality of life outcomes of adjuvant ovarian ablation versus cyclophosphamide, methotrexate, fluoracil (CMF) chemotherapy.


METHODS
The Danish Breast Cancer Cooperative Group (DBCG) trial 89-b randomized premenopausal patients with receptor-positive, primary breast cancer between nine cycles of CMF chemotherapy given every 3 weeks and ovarian ablation by oophorectomy. In total, 317 randomized patients were invited to take part in a longitudinal quality of life study with assessments at 1, 3, 5, 9, 15, and 24 months after randomization. The questionnaire included the EORTC QLQ-C30, the Hospital Anxiety and Depression Scale, and additional items assessing potential symptoms not included in the standard instruments.


RESULTS
After 2 years, 260 women were alive and recurrence-free, and 196 of these (75%) had completed all six questionnaires. Overall, patients in the chemotherapy group had more symptomatology at the first three assessments (i.e., during the 6 months treatment period), except for hot flushes/sweats. There were few differences between groups at later assessments. In chemotherapy patients, the likelihood of preserving ovarian function decreased steeply with increasing age. CMF chemotherapy and ovarian ablation have similar impact on recurrence and survival.


CONCLUSIONS
Chemotherapy had more negative impact on health-related quality of life but preserved ovarian function in some younger patients.
Groenvold
Mogens
M
The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark. mg02@bbh.hosp.dk
Fayers
Peter M
PM
Petersen
Morten Aagaard
MA
Mouridsen
Henning T
HT
D000328:Adult; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000494:pharmacology; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000523:psychology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant / Q000379:methods*; D003520:Cyclophosphamide / Q000494:pharmacology; D018572:Disease-Free Survival; D005260:Female; D005472:Fluorouracil / Q000494:pharmacology; D006801:Humans; D008727:Methotrexate / Q000494:pharmacology; D008875:Middle Aged; D010053:Ovary / Q000601:surgery*; D011788:Quality of Life; D012008:Recurrence; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
D000970:Antineoplastic Agents; D003520:Cyclophosphamide; D005472:Fluorouracil; D008727:Methotrexate