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Prospective Study of Long-Term Impact of Adjuvant High-Dose and Conventional-Dose Chemotherapy on Health-Related Quality of Life

Ciska Buijs, Sjoerd Rodenhuis, Caroline M. Seynaeve, Quirinus G.C.M. van Hoesel, Elsken van der Wall, Wim J.M. Smit, Marianne A. Nooij, Emile Voest, Pierre Hupperets, Els M. TenVergert, Harm van Tinteren, Pax H.B. Willemse, Marian J.E. Mourits, Neil K. Aaronson, Wendy J. Post, Elisabeth G.E. de Vries

From the University Medical Center Groningen and University of Groningen, Groningen; The Netherlands Cancer Institute, Amsterdam; Erasmus Medical Center/Daniel den Hoed Cancer Center, Rotterdam; University Medical Center Nijmegen, Nijmegen; University Medical Center Utrecht, Utrecht; Medical Spectrum Twente, Enschede; Leiden University Medical Center, Leiden; and University Hospital, Maastricht, the Netherlands

Address reprint requests to Elisabeth G.E. de Vries, MD, PhD, Department of Medical Oncology, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands; e-mail: e.g.e.de.vries{at}int.umcg.nl

Purpose: To evaluate and compare health-related quality of life (HRQOL) after conventional- and high-dose adjuvant chemotherapy in patients with high-risk breast cancer.

Patients and 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.

Conclusion: 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.

Supported by a grant from the Dutch Health Insurance Council.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.