Prospective study of long-term impact of adjuvant high-dose and conventional-dose chemotherapy on health-related quality of life.
OBJECTIVE
To evaluate and compare health-related quality of life (HRQOL) after conventional- and high-dose adjuvant chemotherapy in patients with high-risk breast cancer.


METHODS
Patients were randomly assigned to either a conventional or high-dose chemotherapy regimen; both regimens were followed by radiotherapy and tamoxifen. HRQOL was evaluated until disease progression using the Short Form-36 (SF-36), Visual Analog Scale, and Rotterdam Symptom Checklist and assessed every 6 months for 5 years after random assignment. For the SF-36, data from healthy Dutch women with the same age distribution served as reference values.


RESULTS
Eight hundred four patients (conventional-dose chemotherapy, n = 405; high-dose chemotherapy, n = 399) were included. Median follow-up time was 57 months. Directly after high-dose chemotherapy, HRQOL decreased more compared with conventional chemotherapy for all SF-36 subscales. After 1 year, the reference value of healthy women was reached in both groups. Small differences were observed between the two groups in the role-physical and role-emotional subscales, but 1 year after treatment, these differences were minor and not clinically relevant. During follow-up, patients with a lower educational level and many complaints before chemotherapy experienced a worse HRQOL.


CONCLUSIONS
Shortly after high-dose chemotherapy, HRQOL was more affected than after conventional-dose chemotherapy. One year after random assignment, differences were negligible. Identifying patients who have a higher chance of persistent impaired quality of life after treatment (which, in the present study, included patients with a lower educational level and many complaints before chemotherapy) is important and may open the way for better patient-tailored prevention strategies.
Buijs
Ciska
C
University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.
Rodenhuis
Sjoerd
S
Seynaeve
Caroline M
CM
van Hoesel
Quirinus G C M
QG
van der Wall
Elsken
E
Smit
Wim J M
WJ
Nooij
Marianne A
MA
Voest
Emile
E
Hupperets
Pierre
P
TenVergert
Els M
EM
van Tinteren
Harm
H
Willemse
Pax H B
PH
Mourits
Marian J E
MJ
Aaronson
Neil K
NK
Post
Wendy J
WJ
de Vries
Elisabeth G E
EG
D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000523:psychology; D016190:Carboplatin / Q000008:administration & dosage; D017024:Chemotherapy, Adjuvant; D003520:Cyclophosphamide / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D015251:Epirubicin / Q000008:administration & dosage; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D008137:Longitudinal Studies; D008593:Menopause; D008875:Middle Aged; D009367:Neoplasm Staging; D036102:Peripheral Blood Stem Cell Transplantation; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D013629:Tamoxifen / Q000008:administration & dosage; D013852:Thiotepa / Q000008:administration & dosage; D014182:Transplantation, Autologous
D013629:Tamoxifen; D015251:Epirubicin; D003520:Cyclophosphamide; D013852:Thiotepa; D016190:Carboplatin; D005472:Fluorouracil