Choice of Treatment and Long-Term Quality of Life

A new report published in the Journal of the National Cancer Institute suggests that disease-free breast cancer survivors maintain an excellent quality of life many years after primary treatment. However, the study-one of the largest prospective studies to date looking at quality of life after breast cancer-also found that the use of adjuvant treatments, such as chemotherapy, tamoxifen, or a combination of both, was associated with a decrease in physical functioning over time.

This information may help physicians better assist their patients in making decisions about systemic adjuvant therapy, concluded Dr. Patricia A. Ganz of the University of California at Los Angeles Jonsson Comprehensive Cancer Center and colleagues.

Women who survive breast cancer account for nearly half of all female cancer survivors. Previous studies have shown that these women maintain a healthy quality of life during the first several years after their primary treatment has ended, but surprisingly few studies have looked at how these women fare years later.

In the new study, the researchers resurveyed 763 breast cancer-free women who had participated in an earlier study looking at quality of life during the first 5 years after diagnosis. The follow-up re-evaluated these women, focusing on their quality of life between 5 and 9.5 years after diagnosis.

Overall, the women in the follow-up study reported high levels of health, physical functioning, and emotional well-being. Their energy level and social functioning remained the same as in the initial survey. The researchers also found that the social support that the survivors received seemed to predict how they assessed their current quality of life.

In the follow-up study, the women also reported less frequent hot flashes, night sweats, vaginal discharge, and breast sensitivity than they reported in the initial survey. But they experienced more vaginal dryness and loss of urinary control. Women in the follow-up study also reported a decline in sexual activity. The researchers noted that these symptoms and sexual problems increased modestly and that the increases may be related to the normal aging process.

In separate analyses, the authors looked at the late effects of adjuvant systemic therapy (chemotherapy, tamoxifen, or a combination of both) on quality of life and reported a statistically significant decrease in physical functioning associated with adjuvant therapy, even many years after the therapy ended.

"These findings suggest that there may be ... effects from treatment that do not appear until many years later," the authors concluded.

The authors cautioned that the study was limited to women from Washington, D.C. and Los Angeles, Calif., and that the response rate to the follow-up survey was only 61%. But they maintained that their findings should help patients and physicians make more informed decisions about adjuvant therapy, especially for women with very small tumors (no more than 1 cm), who may be at much lower risk for recurrence.

SOURCE:
Journal of the National Cancer Institute, January 2, 2002; 94:39-49

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