Self-reported health-related quality of life is an independent predictor of chemotherapy treatment benefit and toxicity in women with advanced breast cancer.
BACKGROUND
Baseline health-related quality of life (QL) is associated with survival in advanced breast cancer. We sought to identify patients who were less likely to respond to chemotherapy and at greater risk of toxicity on the basis of their QL.


METHODS
We used data from three advanced breast cancer trials in which patients (n=378) were treated with cyclophosphamide, methotrexate and 5-fluouracil. Patients self-rated their QL using LASA scales for physical well-being (PWB), mood, pain, nausea/vomiting, appetite and overall QL. Multivariable regression models were constructed to compare overall survival (OS), objective tumour response (OTR), adverse events (AEs) and weight loss according to grouped QL scores.


RESULTS
Physical well-being, mood, appetite and overall QL were significant univariable predictors of OS. Physical well-being and appetite remained significant after adjustment for baseline biomedical factors. Poor PWB was associated with lower OTR (odds ratio (OR)=0.21, 95% confidence interval (CI) 0.09-0.51), higher risk of non-haematological AEs (OR=3.26, 95% CI 1.49-7.15) and greater risk of weight loss (OR 2.37, 95% CI 1.12-5.01) compared with good PWB.


CONCLUSIONS
In women with advanced breast cancer, PWB and appetite are predictors of chemotherapy response and toxicity as well as survival. Quality of life should be a routine clinical assessment to guide patient selection for chemotherapy and for stratification of patients in clinical trials.
Lee
C K
CK
NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, NSW, Australia. chee.lee@ctc.usyd.edu.au
Stockler
M R
MR
Coates
A S
AS
Gebski
V
V
Lord
S J
SJ
Simes
R J
RJ
D000339:Affect; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D001066:Appetite; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology* / Q000523:psychology; D018572:Disease-Free Survival; D005260:Female; D006304:Health Status; D006801:Humans; D008875:Middle Aged; D009325:Nausea / Q000453:epidemiology; D009362:Neoplasm Metastasis / Q000188:drug therapy; D017698:Postmenopause; D011788:Quality of Life; D011960:Receptors, Estrogen / Q000032:analysis; D011980:Receptors, Progesterone / Q000032:analysis; D012044:Regression Analysis; D012649:Self Concept; D016019:Survival Analysis; D017741:Survivors; D014839:Vomiting / Q000453:epidemiology; D015431:Weight Loss
D011960:Receptors, Estrogen; D011980:Receptors, Progesterone
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