Long term health-related quality of life among women with high-risk breast cancer receiving adjuvant high-dose chemotherapy : a comparison with the normal population

Abstract

The aims of the thesis were 1) to provide reference values for the EORTC QLQ-C30 in the general Swedish population, 2) to investigate effects of adjuvant high-dose treatment on health-related quality of life (HRQoL) among high-risk breast cancer patients during and after treatment and 3) to investigate differences in HRQoL between the patients and women of corresponding age in the general population.

The EORTC QLQ-C30 questionnaire was mailed to a sample of 4008 randomly selected individuals in the Swedish population. A total of 3069 individuals returned completed questionnaires. The respondents provided information, in addition to gender and age, about marital status, income, employment status, and reported presence of one or several chronic health problems.

A total of 408 women in the Nordic multicenter adjuvant breast cancer trial (SBG-9401) were included in the HRQoL-study. They were randomised to receive treatment with either tailored FEC or stem cell/marrow-supported high-dose chemotherapy (CTCb). The patients completed the EORTC QLQ-C30ffl) questionnaire at the time for randomisation, at seven points during the first year and also one and two years after randomisation. The patients also completed the breast cancer-specific questionnaire, EORTC QLQ-BR23, at five points of assessment. At the 2-year assessment point 358 patients remained assessable.

Results: HRQoL in the reference sample decreased with increasing age with the exception of emotional functioning. Low income and unemployment were associated with poorer HRQoL. Respondents without any health problems rated highest HRQoL. An increasing number of health problems was associated with decreasing HRQoL irrespective of age. HRQoL decreased more for the respondents aged 30-59 years who were unemployed and reported the lowest income, and among disability pensioners.

The patients in SBG-9401 reported lower HRQoL, at the time for randomisation than women in the reference sample from the Swedish population. During ongoing treatment, HRQoL among patients further decreased. The decrease was more pronounced in the CM group, but this group recovered faster with respect to HRQoL than patients in the tailored FEC group, for whom the treatment continued longer. After 42 weeks from randomisation, differences between the two treatment arms in HRQoL were small. After one year, the levels of functioning were higher when compared to those at randomisation with the exception of physical functioning. Emotional functioning and global quality of life were similar to that in the reference sample. Hence, there were no differences in HRQoL between the two treatment arms.

After two years, physical functioning remained lower in comparison with randomisation. The levels of symptoms gradually declined and were after two years comparable to those in the reference sample, as were emotional functioning and global quality of life. The patients rated slightly, but consistently lower on role, cognitive and social functioning over time than did the reference sample. Arm problems remained similar to levels found at randomisation. Decreased sexual enjoyment and increased hot flashes were reported after two years. Financial difficulties were reported by the patients across the study period.

Conclusion: HRQoL among women with high risk breast cancer two years after randomisation to high-dose adjuvant treatment was higher than at randomisation, assuming HRQoL similar to HRQoL of women in the reference sample. However, arm problems, problems with sexuality and financial difficulties persisted in the long term perspective.