Quality of life and quality-adjusted survival (Q-TWiST) in patients receiving dose-intensive or standard dose chemotherapy for high-risk primary breast cancer

Bernhard, J; Zahrieh, D; Zhang, J J; Martinelli, G; Basser, R; Hürny, C; Forbes, J F; Aebi, S; Yeo, W; Thürlimann, B; Green, M D; Colleoni, M; Gelber, R D; Castiglione-Gertsch, M; Price, K N; Goldhirsch, A; Coates, A S (2008). Quality of life and quality-adjusted survival (Q-TWiST) in patients receiving dose-intensive or standard dose chemotherapy for high-risk primary breast cancer. British journal of cancer, 98(1), pp. 25-33. Basingstoke: Nature Publishing Group 10.1038/sj.bjc.6604092

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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.

Item Type:	Journal Article (Original Article)
Division/Institute:	04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Medical Oncology
UniBE Contributor:	Bernhard, Jürg Theodor, Aebi, Stefan
ISSN:	0007-0920
ISBN:	18043579
Publisher:	Nature Publishing Group
Language:	English
Submitter:	Factscience Import
Date Deposited:	04 Oct 2013 15:02
Last Modified:	02 Mar 2023 23:22
Publisher DOI:	10.1038/sj.bjc.6604092
PubMed ID:	18043579
Web of Science ID:	000252247300007
URI:	https://boris.unibe.ch/id/eprint/27088 (FactScience: 102191)