This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Coates, A. S. Articles by Goldhirsch, A. Search for Related Content PubMed PubMed Citation Articles by Coates, A. S. Articles by Goldhirsch, A. Social Bookmarking                            What's this?

Quality-of-Life Scores Predict Outcome in Metastatic but Not Early Breast Cancer

From the Australian Cancer Society and Australian New Zealand Breast Cancer Trials Group, University of Sydney, Sydney, Australia; Bürgerspital, St Gallen; International Breast Cancer Study Group Coordinating Center, Bern, Switzerland; International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute, Boston, MA; and Oncology Institute of Southern Switzerland and European Institute of Oncology, Milan, Italy.

Address reprint requests to Alan Coates, MD, FRACP, Australian Cancer Society, GPO Box 4708, Sydney NSW 2001, Australia; email alancoates{at}cancer.org.au

PURPOSE: We compared the prognostic value of quality-of-life (QL) scores in the adjuvant setting and after relapse in two randomized trials of the International Breast Cancer Study Group.

PATIENTS AND METHODS: More than 2,000 premenopausal and postmenopausal patients with node-positive breast cancer who were participating in randomized trials that compared adjuvant therapies completed QL assessments for physical well-being, mood, appetite, and coping at study entry and at months 3 and 18 if they remained relapse-free and, in case of relapse, at 1 month and at 6 months after relapse. Cox regression models were used to test the relationship between QL scores and disease-free survival (DFS), in the adjuvant setting, or overall survival, in the case of postrelapse QL measurement. All models were stratified by language/country group and included other factors related to QL and/or outcome.

RESULTS: DFS was not significantly predicted by QL scores at baseline or month 18, or by changes in QL score between baseline and months 3 or 18. In contrast, after relapse, QL scores were predictive for subsequent overall survival. One month after relapse, better mood (P = .04) in premenopausal patients and better appetite (P = .005) in postmenopausal patients were associated with longer survival. Six months after relapse, better physical well-being (P = .03) and appetite (P = .03) in premenopausal patients and better physical well-being (P < .0001), mood (P = .002), appetite (P = .0001), and coping (P = .0001) in postmenopausal patients predicted longer survival.

CONCLUSION: Any prognostic significance of QL scores in the adjuvant setting is minimal or obscured by chemotherapy effects, but there is strong prognostic significance of QL scores after disease relapse. The contrast suggests that patient perception of the severity of underlying illness may determine reported QL scores.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				F. Meyer, A. Fortin, M. Gelinas, A. Nabid, F. Brochet, B. Tetu, and I. Bairati Health-Related Quality of Life As a Survival Predictor for Patients With Localized Head and Neck Cancer Treated With Radiation Therapy J. Clin. Oncol., June 20, 2009; 27(18): 2970 - 2976. [Abstract] [Full Text] [PDF]

				K.-A. Phillips, R. H. Osborne, G. G. Giles, G. S. Dite, C. Apicella, J. L. Hopper, and R. L. Milne Psychosocial Factors and Survival of Young Women With Breast Cancer: A Population-Based Prospective Cohort Study J. Clin. Oncol., October 1, 2008; 26(28): 4666 - 4671. [Abstract] [Full Text] [PDF]

				F. Efficace, P. F. Innominato, G. Bjarnason, C. Coens, Y. Humblet, S. Tumolo, D. Genet, M. Tampellini, A. Bottomley, C. Garufi, et al. Validation of Patient's Self-Reported Social Functioning As an Independent Prognostic Factor for Survival in Metastatic Colorectal Cancer Patients: Results of an International Study by the Chronotherapy Group of the European Organisation for Research and Treatment of Cancer J. Clin. Oncol., April 20, 2008; 26(12): 2020 - 2026. [Abstract] [Full Text] [PDF]

				C. C. Gotay, C. T. Kawamoto, A. Bottomley, and F. Efficace The Prognostic Significance of Patient-Reported Outcomes in Cancer Clinical Trials J. Clin. Oncol., March 10, 2008; 26(8): 1355 - 1363. [Abstract] [Full Text] [PDF]

				A. Bottomley, C. Coens, F. Efficace, R. Gaafar, C. Manegold, S. Burgers, M. Vincent, C. Legrand, and J. P. van Meerbeeck Symptoms and Patient-Reported Well-Being: Do They Predict Survival in Malignant Pleural Mesothelioma? A Prognostic Factor Analysis of EORTC-NCIC 08983: Randomized Phase III Study of Cisplatin With or Without Raltitrexed in Patients With Malignant Pleural Mesothelioma J. Clin. Oncol., December 20, 2007; 25(36): 5770 - 5776. [Abstract] [Full Text] [PDF]

				H. McCarter, W. Furlong, A. C. Whitton, D. Feeny, S. DePauw, A. R. Willan, and R. D. Barr Health Status Measurements at Diagnosis As Predictors of Survival Among Adults With Brain Tumors J. Clin. Oncol., August 1, 2006; 24(22): 3636 - 3643. [Abstract] [Full Text] [PDF]

				J. A. Meyerhardt, J. A. Sloan, D. J. Sargent, R. M. Goldberg, M. Pollak, R. F. Morton, R. K. Ramanathan, S. K. Williamson, B. P. Findlay, and C. S. Fuchs Associations between Plasma Insulin-Like Growth Factor Proteins and C-Peptide and Quality of Life in Patients with Metastatic Colorectal Cancer Cancer Epidemiol. Biomarkers Prev., June 1, 2005; 14(6): 1402 - 1410. [Abstract] [Full Text] [PDF]

				C. C. Gotay Assessing Cancer-Related Quality of Life Across a Spectrum of Applications J Natl Cancer Inst Monographs, October 1, 2004; 2004(33): 126 - 133. [Abstract] [Full Text] [PDF]

				M. S. Donaldson Taking Stock of Health-Related Quality-of-Life Measurement in Oncology Practice in the United States J Natl Cancer Inst Monographs, October 1, 2004; 2004(33): 155 - 167. [Abstract] [Full Text] [PDF]

				F. Efficace, P. Therasse, M. J. Piccart, C. Coens, K. Van Steen, M. Welnicka-Jaskiewicz, T. Cufer, J. Dyczka, M. Lichinitser, L. Shepherd, et al. Health-Related Quality of Life Parameters As Prognostic Factors in a Nonmetastatic Breast Cancer Population: An International Multicenter Study J. Clin. Oncol., August 15, 2004; 22(16): 3381 - 3388. [Abstract] [Full Text] [PDF]

				E. P. Winer, D. A. Berry, S. Woolf, D. Duggan, A. Kornblith, L. N. Harris, R. A. Michaelson, J. A. Kirshner, G. F. Fleming, M. C. Perry, et al. Failure of Higher-Dose Paclitaxel to Improve Outcome in Patients With Metastatic Breast Cancer: Cancer and Leukemia Group B Trial 9342 J. Clin. Oncol., June 1, 2004; 22(11): 2061 - 2068. [Abstract] [Full Text] [PDF]

				V. Velanovich Using Quality-of-Life Measurements to Predict Patient Satisfaction Outcomes for Antireflux Surgery Arch Surg, June 1, 2004; 139(6): 621 - 626. [Abstract] [Full Text] [PDF]

				P. J. Goodwin Reversible Ovarian Ablation or Chemotherapy: Are We Ready for Quality of Life to Guide Adjuvant Treatment Decisions in Breast Cancer? J. Clin. Oncol., December 15, 2003; 21(24): 4474 - 4475. [Full Text] [PDF]

				C. T. Chung and R. W. Carlson Goals and Objectives in the Management of Metastatic Breast Cancer Oncologist, December 1, 2003; 8(6): 514 - 520. [Abstract] [Full Text] [PDF]

				M. J. Fisch, M. L. Titzer, J. L. Kristeller, J. Shen, P. J. Loehrer, S.-H. Jung, S. D. Passik, and L. H. Einhorn Assessment of Quality of Life in Outpatients With Advanced Cancer: The Accuracy of Clinician Estimations and the Relevance of Spiritual Well-Being--A Hoosier Oncology Group Study J. Clin. Oncol., July 15, 2003; 21(14): 2754 - 2759. [Abstract] [Full Text] [PDF]

				S. Modi, K. S. Panageas, E. T. Duck, A. Bach, N. Weinstock, J. Dougherty, L. Cramer, C. Hudis, L. Norton, and A. Seidman Prospective Exploratory Analysis of the Association Between Tumor Response, Quality of Life, and Expenditures Among Patients Receiving Paclitaxel Monotherapy for Refractory Metastatic Breast Cancer J. Clin. Oncol., September 1, 2002; 20(17): 3665 - 3673. [Abstract] [Full Text] [PDF]

				D. Osoba, D. J. Slamon, M. Burchmore, and M. Murphy Effects on Quality of Life of Combined Trastuzumab and Chemotherapy in Women With Metastatic Breast Cancer J. Clin. Oncol., July 15, 2002; 20(14): 3106 - 3113. [Abstract] [Full Text] [PDF]

				F. Cardoso, A. Di Leo, C. Lohrisch, C. Bernard, F. Ferreira, and M. J. Piccart Second and subsequent lines of chemotherapy for metastatic breast cancer: what did we learn in the last two decades? Ann. Onc., February 20, 2002; 13(2): 197 - 207. [Abstract] [Full Text] [PDF]

				A. Goldhirsch, J. H. Glick, R. D. Gelber, A. S. Coates, and H.-J. Senn Meeting Highlights: International Consensus Panel on the Treatment of Primary Breast Cancer J. Clin. Oncol., September 15, 2001; 19(18): 3817 - 3827. [Full Text] [PDF]