Quantifying trade-offs: Quality of life and quality-adjusted survival in a randomised trial of chemotherapy in postmenopausal patients with lymph node-negative breast cancer

J. Bernhard, D. Zahrieh, A. S. Coates, R. D. Gelber, M. Castiglione-Gertsch, E. Murray, J. F. Forbes, L. Perey, J. Collins, R. Snyder, C. M. Rudenstam, D. Crivellari, A. Veronesi, B. Thürlimann, M. F. Fey, K. N. Price, A. Goldhirsch, C. Hürny

Research output: Contribution to journalArticle

21 Scopus citations

Abstract

We evaluated quality of life (QL) and quality-adjusted survival in International Breast Cancer Study Group Trial IX, a randomised trial including 1669 eligible patients receiving tamoxifen for 5 years or three prior cycles of cyclophosphamide, methotrexate and 5-fluorouracil (CMF) followed by 57 months tamoxifen. During the time with CMF toxicity (Tox), without symptoms and toxicity (TWiST), and following relapse (Rel), patients scored their QL indicators and a utility indicator for subjective health estimation between 'perfect' and 'worst' health. Scores were averaged within Tox, TWiST and Rel and transformed to utilities. Mean durations for the three transition times were weighted with utilities to obtain mean quality-adjusted TWiST (Q-TWiST). Patients receiving CMF reported significantly worse scores for most QL domains at month 3, but less hot flushes. After completing chemotherapy, there were no differences by treatment groups. Benefits evaluated by Q-TWiST favoured the additional chemotherapy. CMF provided 3 more months of Q-TWiST for patients with ER-negative tumours, but CMF provided no benefit in Q-TWiST for patients with ER-positive tumours. Q-TWiST analysis based on patient ratings is feasible in large-scale cross-cultural clinical trials.

Original languageEnglish (US)
Pages (from-to)1893-1901
Number of pages9
JournalBritish journal of cancer
Volume91
Issue number11
DOIs
StatePublished - Nov 29 2004

Keywords

  • Adjuvant therapy
  • Breast cancer
  • Q-TWiST
  • Quality of life
  • Quality-adjusted survival
  • Utility

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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