Quality of Life of Older Patients With Early-Stage Breast Cancer Receiving Adjuvant Chemotherapy: A Companion Study to Cancer and Leukemia Group B 49907

Cornell University, Итак, New York, United States
Journal of Clinical Oncology (Impact Factor: 18.43). 02/2011; 29(8):1022-8. DOI: 10.1200/JCO.2010.29.9859
Source: PubMed


A phase III trial (Cancer and Leukemia Group B CALGB-49907) was conducted to test whether older patients with early-stage breast cancer would have equivalent relapse-free and overall survival with capecitabine compared with standard chemotherapy. The quality of life (QoL) substudy tested whether capecitabine treatment would be associated with a better QoL than standard chemotherapy.
QoL was assessed in 350 patients randomly assigned to either standard chemotherapy (cyclophosphamide, methotrexate, and fluorouracil [CMF] or doxorubicin and cyclophosphamide [AC]; n = 182) or capecitabine (n = 168). Patients were interviewed by telephone before treatment (baseline), midtreatment, within 1 month post-treatment, and at 12, 18, and 24 months postbaseline by using questionnaires from the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30), a breast systemic adverse effects scale (EORTC BR23), and the Hospital Anxiety and Depression Scale (HADS).
Compared with patients who were treated with standard chemotherapy, patients who were treated with capecitabine had significantly better QoL, role function, and social function, fewer systemic adverse effects, less psychological distress, and less fatigue during and at the completion of treatment (P ≤ .005). Capecitabine treatment was associated with less nausea, vomiting, and constipation and with better appetite than standard treatment (P ≤ .004), but worse hand-foot syndrome and diarrhea (P < .005). These differences all resolved by 12 months.
Standard chemotherapy was superior to capecitabine in improving relapse-free and overall survival for older women with early-stage breast cancer. Although capecitabine was associated with better QoL during treatment, QoL was similar for both groups at 1 year. The brief period of poorer QoL with standard treatment is a modest price to pay for a chance at improved survival.

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Available from: Gretchen Kimmick, Oct 23, 2014
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    • "In breast cancer patients with nodal metastases following radical surgery, anthracycline-based chemotherapies are efficacious,1,2 and widely used, but are well known to have adverse effects, including hematotoxicity, nausea and vomiting, and hair loss,3,4 which are potentially associated with an impaired quality of life (QOL).5,6 Furthermore, host immune function of breast cancer patients receiving anticancer chemotherapy has been reported to influence the relapse rate,7 and anthracycline-based chemotherapies can negatively affect immune function.8 "
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    ABSTRACT: Anthracycline-based chemotherapies for breast cancer are well known to have adverse effects and can also negatively affect host immune function. There is therefore a necessity for an adjuvant that maintains the quality of life (QOL) and immune function of cancer patients receiving anthracycline-based chemotherapies. The present study investigated the effectiveness of the concomitant use of Lentinula edodes mycelia extract (LEM), an oral immunomodulator, with FEC75 (5-fluorouracil + epirubicin + cyclophosphamide) therapy on host QOL and immune function in breast cancer patients with nodal metastases. Ten breast cancer patients with nodal metastases receiving surgery were enrolled in this study. Treatment with 5-fluorouracil (500 mg/m(2)), epirubicin (75 mg/m(2)), and cyclophosphamide (500 mg/m(2)) was performed every 21 days for two courses, and LEM (1800 mg/day by mouth) was administered during the second course. In the first course, hematological toxicity was observed and host QOL and immune function were exacerbated. In the second course, however, the number of white blood cells and lymphocytes did not decrease and host QOL was maintained. Furthermore, the cytotoxic activities of natural killer (NK) and lymphokine-activated killer cells and the proportion of activated NK and NK T-cells in lymphocytes were maintained in the second course. It has been suggested that the concomitant use of LEM with FEC75 therapy can maintain host QOL and immune function, and offer important implications for an application of LEM as a useful oral adjuvant to anthracycline-based chemotherapies.
    OncoTargets and Therapy 07/2013; 6:853-9. DOI:10.2147/OTT.S44169 · 2.31 Impact Factor
    • "While, Aghabarari et al., showed that there was an indirect (negative) correlation between QoL of patients and the number of chemotherapy sessions.[30] or the study of Kornblith that showed QoL of cancer patients had no significant difference before, during and after chemotherapy.[37] "
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    ABSTRACT: This study was performed to examine quality of life's dimensions and its relationship with some clinical and demographic characteristics on women with breast cancer under chemotherapy referred to the oncology hospital, Isfahan University of medical sciences, Iran. This Cross sectional study was conducted among 330 a descriptive-analytic one breast cancer patients with simple sampling methodology. Data collection instrument included a questionnaire contains 2 parts (clinical and demographic characteristics information and version 2.0 of the SF-36 questionnaire (the international version). The data were analyzed with 99% confidence by carried out using SPSS(18) with using descriptive and analytic statistics. The majority of subjects' quality of life was moderate (53.93%). there was a statistically significant relationship between quality of life among breast cancer patients with chemotherapy sessions (P < 0.05, df =4, χ(2) = 16.37). One way Analysis Of Variance (ANOVA) suggested the absence of any significant relationship between quality of life with marital status (f = 0.21; P = 0.92) and employment status (f = 0.26; P = 0.77). Also, Spearman test showed the absence of any significant relationship between quality of life with age (P = 0.60), and the elapsed duration from diagnosis (P = 0.68), however Spearman test showed significant relationship between quality of life and education status (P = 0.002, r = -0.84). This study showed a direct correlation with regard to results of this study, there was a direct correlation between the number of chemotherapy sessions and patients quality of life. The attitude of the population toward chemotherapy is usually inhibiting and negative, so patients, students and nurses should be trained about chemotherapy efficacy to improve their attitude about chemotherapy, which in turn would lead to improvement of the patients' quality of life.
    International journal of preventive medicine 12/2012; 3(12):853-9. DOI:10.4103/2008-7802.104856
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    • "However, older patients may have an increased toxicity risk when treated with chemotherapy [Pallis et al. 2010], which may impede quality of life. In the abovementioned trial by Muss and colleagues, quality of life after 1-year follow up was similar for both treatments [Kornblith et al. 2011]. A predictive score for chemotherapy toxicity may help to assess the individual risk of severe toxicity from chemotherapy [Extermann et al. 2011]. "
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    ABSTRACT: Breast cancer is the most frequent malignant tumor in women worldwide and as breast cancer incidence increases with increasing age, over 40% of new cases are diagnosed in women older than 65 years of age. However, older patients are not treated to the same extent as younger patients and increasing age at diagnosis predicts deviation from guidelines for all treatment modalities. Evidence-based medicine in older patients is lacking as they are usually excluded from clinical trials often because of existing comorbidities and limited life expectancy. Accordingly, there is a higher competing risk of death from other causes than breast cancer compared with younger patients and this may have led to the false interpretation that prognosis of breast cancer in older patients is relatively good. However, every treatment modality should be evaluated during treatment decision making. Multimodal therapy should not be routinely withheld as data show that disease-specific mortality increases with age, probably due to undertreatment. Prognostic markers, fitness and comorbidities rather than chronological age should determine optimal, individualized therapy. It is recommended that treatment decisions should be discussed in a multidisciplinary setting, ideally in combination with any form of geriatric assessment, to improve breast cancer outcome in the older population.
    rapeutic Advances in Medical Oncology, The 11/2012; 4(6):321-7. DOI:10.1177/1758834012455684 · 2.83 Impact Factor
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