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Chemotherapy versus ovarian ablation as adjuvant therapy for breast cancer: impact on health-related quality of life in a randomized trial

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Summary

Background

Ovarian ablation is an effective adjuvant therapy for primary breast cancer but little is known about its quality of life impact relative to the more widely used adjuvant chemotherapy. This randomized study compared quality of life outcomes of adjuvant ovarian ablation versus cyclophosphamide, methotrexate, fluoracil (CMF) chemotherapy.

Methods

The Danish Breast Cancer Cooperative Group (DBCG) trial 89-b randomized premenopausal patients with receptor-positive, primary breast cancer between nine cycles of CMF chemotherapy given every 3 weeks and ovarian ablation by oophorectomy. In total, 317 randomized patients were invited to take part in a longitudinal quality of life study with assessments at 1, 3, 5, 9, 15, and 24 months after randomization. The questionnaire included the EORTC QLQ-C30, the Hospital Anxiety and Depression Scale, and additional items assessing potential symptoms not included in the standard instruments.

Results

After 2 years, 260 women were alive and recurrence-free, and 196 of these (75%) had completed all six questionnaires. Overall, patients in the chemotherapy group had more symptomatology at the first three assessments (i.e., during the 6 months treatment period), except for hot flushes/sweats. There were few differences between groups at later assessments. In chemotherapy patients, the likelihood of preserving ovarian function decreased steeply with increasing age. CMF chemotherapy and ovarian ablation have similar impact on recurrence and survival.

Conclusion

Chemotherapy had more negative impact on health-related quality of life but preserved ovarian function in some younger patients.

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References

  1. Early Breast Cancer Trialists’ Collaborative Group Polychemotherapy for early breast cancer: an overview of the randomised trials Lancet 352: 930–942 1998

    Article  Google Scholar 

  2. Early Breast Cancer Trialists’ Collaborative Group Ovarian ablation in early breast cancer: overview of the randomised trials Lancet 348: 1189–1196, 1996

    Article  Google Scholar 

  3. Scottish Cancer Trials Breast Group Adjuvant ovarian ablation versus CMF chemotherapy in premenopausal women with pathological stage II breast carcinoma: the Scottish trial Lancet 341: 1293–1298, 1993

    Google Scholar 

  4. Ejlertsen B, Dombernowsky P, Mouridsen HT, Kamby C, Kjaer M, Rose C, Andersen KW, Jensen M-B, Bengtsson NO, Bergh J, Comparable effect of ovarian ablation and CMF chemotherapy in premenopausal hormone receptor positive breast cancer patients Proc Am Soc Clin Oncol 18: 66a, 1999

    Google Scholar 

  5. Boccardo F, Rubagotti A, Amoroso D, Mesiti M, Romeo D, Sismondi P, Giai M, Genta F, Pacini P, Distante V, Bolognesi A, Aldrighetti D, Farris A, Cyclophosphamide, methotrexate, and fluorouracil versus tamoxifen plus ovarian suppression as adjuvant treatment of estrogen receptor-positive pre-/perimenopausal breast cancer patients: results of the Italian Breast Cancer Adjuvant Study Group 02 randomized trial J Clin Oncol 18: 2718–2727, 2000

    PubMed  CAS  Google Scholar 

  6. Jonat W, Kaufmann M, Sauerbrei W, Blamey R, Cuzick J, Namer M, Fogelman I, de Haes JC, de Matteis A, Stewart A, Eiermann W, Szakolczai I, Palmer M, Schumacher M, Geberth M, Lisboa B Goserelin versus cyclophosphamide, methotrexate, and fluorouracil as adjuvant therapy in premenopausal patients with node-positive breast cancer: the Zoladex Early Breast Cancer Research Association Study J Clin Oncol 20: 4628–4635, 2002

    Article  PubMed  CAS  Google Scholar 

  7. Jakesz R, Hausmaninger H, Kubista E, Gnant M, Menzel C, Bauernhofer T, Seifert M, Haider K, Mlineritsch B, Steindorfer P, Kwasny W, Fridrik M, Steger G, Wette V, Samonigg H Randomized adjuvant trial of tamoxifen and goserelin versus cyclophosphamide, methotrexate, and fluorouracil: evidence for the superiority of treatment with endocrine blockade in premenopausal patients with hormone-responsive breast cancer – Austrian Breast and Colorectal Cancer Study Group Trial 5 J Clin Oncol 20: 4621–4627, 2002

    Article  PubMed  CAS  Google Scholar 

  8. Castiglione-Gertsch M, O’Neill A, Price KN, Goldhirsch A, Coates AS, Colleoni M, Nasi ML, Bonetti M, Gelber RD Adjuvant chemotherapy followed by goserelin versus either modality alone for premenopausal lymph node-negative breast cancer: a randomized trial J Natl Cancer Inst 95: 1833–1846, 2003

    PubMed  Google Scholar 

  9. Pritchard KI Adjuvant therapy for premenopausal women with breast cancer: is it time for another paradigm shift? J Clin Oncol 20: 4611–4614, 2002

    PubMed  Google Scholar 

  10. Krop IE, Winer EP Ovarian suppression for breast cancer: an effective treatment in search of a home J Clin Oncol 23: 5869–5872 2005

    Article  PubMed  Google Scholar 

  11. van Dam FSAM, Linssen ACG, Engelsman E, van Benthem J, Hanewald GJFP 1980 Life with cytostatic drugs In: Mouridsen HT, Palshof T (eds) Breast Cancer – Experimental and Clinical Aspects Pergamon Press Oxford pp. 229–233

    Google Scholar 

  12. Meyerowitz BE, Watkins IK, Sparks FC Quality of life for breast cancer patients receiving adjuvant chemotherapy Am J Nurs 83: 232–234 1983

    Article  PubMed  CAS  Google Scholar 

  13. Knobf MT Physical and psychologic distress associated with adjuvant chemotherapy in women with breast cancer J Clin Oncol 4: 678–684 1986

    PubMed  CAS  Google Scholar 

  14. Levine MN, Guyatt GH, Gent M, Pauw SD, Goodyear MD, Hryniuk WM, Arnold A, Findlay B, Skillings JR, Bramwell VH, Levin L, Bush H, Abu-Zahra H, Kotalik J Quality of life in stage II breast cancer: an instrument for clinical trials J Clin Oncol 6: 1798–1810 1988

    PubMed  CAS  Google Scholar 

  15. Hurny C, Bernhard J, Coates AS, Castiglione-Gertsch M, Peterson HF, Gelber RD, Forbes JF, Rudenstam CM, Simoncini E, Crivellari D, Goldhirsch A, Senn HJ Impact of adjuvant therapy on quality of life in women with node-positive operable breast cancer. International Breast Cancer Study Group Lancet 347: 1279–1284 1996

    PubMed  CAS  Google Scholar 

  16. Groenvold M Quality of life in breast cancer adjuvant therapy: validation and pilot testing of a combination of questionnaires Breast 6: 97–107 1997

    Article  Google Scholar 

  17. Fairclough DL, Fetting JH, Cella D, Wonson W, Moinpour CM Quality of life and quality adjusted survival for breast cancer patients receiving adjuvant therapy. Eastern Cooperative Oncology Group (ECOG) Qual Life Res 8: 723–731 1999

    Article  PubMed  CAS  Google Scholar 

  18. Jacobsen PB, Hann DM, Azzarello LM, Horton J, Balducci L, Lyman GH Fatigue in women receiving adjuvant chemotherapy for breast cancer: characteristics, course, and correlates J Pain Symptom Manage 18: 233–242 1999

    Article  PubMed  CAS  Google Scholar 

  19. Shapiro CL, Recht A Side effects of adjuvant treatment of breast cancer N Engl J Med 344: 1997–2008 2001

    Article  PubMed  CAS  Google Scholar 

  20. de Haes H, Olschewski M, Kaufmann M, Schumacher M, Jonat W, Sauerbrei W Quality of life in goserelin-treated versus cyclophosphamide + methotrexate + fluorouracil-treated premenopausal and perimenopausal patients with node-positive, early breast cancer: the Zoladex Early Breast Cancer Research Association Trialists Group J Clin Oncol 21: 4510–4516 2003

    Article  PubMed  CAS  Google Scholar 

  21. Taylor CW, Green S, Dalton WS, Martino S, Rector D, Ingle JN, Robert NJ, Budd GT, Paradelo JC, Natale RB, Bearden JD, Mailliard JA, Osborne CK Multicenter randomized clinical trial of goserelin versus surgical ovariectomy in premenopausal patients with receptor-positive metastatic breast cancer: an intergroup study J Clin Oncol 16: 994–999 1998

    PubMed  CAS  Google Scholar 

  22. Danish Breast Cancer Cooperative Group: DBCG-89. Program for Treatment and Follow-Up of Patients With Primary, Operable Breast Cancer (In Danish). DBCG-Sekretariatet, Copenhagen, 1989

  23. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishmann SB, de Haes JCJM, Kaasa S, Klee M, Osoba D, Razavi D, Rofe PB, Schraub S, Sneeuw K, Sullivan M, Takeda F The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology J Natl Cancer Inst 85: 365–376 1993

    Article  PubMed  CAS  Google Scholar 

  24. Groenvold M, Bjorner JB, Klee MC, Kreiner S Test for item bias in a quality of life questionnaire J Clin Epidemiol 48: 805–816, 1995

    Article  PubMed  CAS  Google Scholar 

  25. Groenvold M, Klee MC, Sprangers MAG, Aaronson NK Validation of the EORTC QLQ-C30 quality of life questionnaire through combined qualitative and quantitative assessment of patient-observer agreement J Clin Epidemiol 50: 441–450, 1997

    Article  PubMed  CAS  Google Scholar 

  26. Zigmond AS, Snaith RP The hospital anxiety and depression scale Acta Psychiatr Scand 67: 361–370 1983

    Article  PubMed  CAS  Google Scholar 

  27. Fayers PM, Aaronson N, Bjordal K, Groenvold M, Curran D, Bottomley A, on behalf of the EORTC Quality of Life Group: The EORTC QLQ-C30 Scoring Manual. 3rd ed. European Organization for Research and Treatment of Cancer, Brussels, 2001

  28. Schagen SB, van Dam FS, Muller MJ, Boogerd W, Lindeboom J, Bruning PF Cognitive deficits after postoperative adjuvant chemotherapy for breast carcinoma Cancer 85: 640–650 1999

    Article  PubMed  CAS  Google Scholar 

  29. Brezden CB, Phillips KA, Abdolell M, Bunston T, Tannock IF Cognitive function in breast cancer patients receiving adjuvant chemotherapy J Clin Oncol 18: 2695–2701 2000

    PubMed  CAS  Google Scholar 

  30. Ahles TA, Saykin AJ, Furstenberg CT, Cole B, Mott LA, Skalla K, Whedon MB, Bivens S, Mitchell T, Greenberg ER, Silberfarb PM Neuropsychologic impact of standard-dose systemic chemotherapy in long-term survivors of breast cancer and lymphoma J Clin Oncol 20: 485–493 2002

    Article  PubMed  CAS  Google Scholar 

  31. Berglund G, Nystedt M, Bolund C, Sjoden PO, Rutquist LE Effect of endocrine treatment on sexuality in premenopausal breast cancer patients: a prospective randomized study J Clin Oncol 19: 2788–2796 2001

    PubMed  CAS  Google Scholar 

  32. Bines J, Oleske DM, Cobleigh MA Ovarian function in premenopausal women treated with adjuvant chemotherapy for breast cancer J Clin Oncol 14: 1718–1729 1996

    PubMed  CAS  Google Scholar 

  33. Goodwin PJ, Ennis M, Pritchard KI, Trudeau M, Hood N Risk of menopause during the first year after breast cancer diagnosis J Clin Oncol 17: 2365–2370 1999

    PubMed  CAS  Google Scholar 

  34. Sprangers MAG, Groenvold M, Arraras JI, Franklin J, te Velde A, Muller M, Franzini L, Williams A, de Haes HCJM, Hopwood P, Cull A, Aaronson NK The EORTC Breast Cancer-Specific Quality-of-Life Questionnaire Module (QLQ-BR23): first results from a three-country field study J Clin Oncol 14: 2756–2768 1996

    PubMed  CAS  Google Scholar 

  35. Fallowfield LJ, Leaity SK, Howell A, Benson S, Cella D Assessment of quality of life in women undergoing hormonal therapy for breast cancer: validation of an endocrine symptom subscale for the FACT-B Breast Cancer Res Treat 55: 189–199 1999

    Article  PubMed  CAS  Google Scholar 

  36. Goodwin PJ, Black JT, Bordeleau LJ, Ganz PA Health-related quality-of-life measurement in randomized clinical trials in breast cancer-taking stock J Natl Cancer Inst 95: 263–281 2003

    Article  PubMed  Google Scholar 

  37. Fallowfield L, McGurk R, Dixon M Same gain, less pain: potential patient preferences for adjuvant treatment in premenopausal women with breast cancer Eur J Cancer 40: 2403–2410 2004

    Article  PubMed  Google Scholar 

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Acknowledgement

Supported by the Danish Cancer Society (Grants 91-505 and 94 150 01).

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Authors and Affiliations

  1. The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark

    Mogens Groenvold & Morten Aagaard Petersen

  2. Department of Health Services Research, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark

    Mogens Groenvold

  3. Department of Public Health, University of Aberdeen Medical School, Aberdeen, UK

    Peter M. Fayers

  4. Unit for Applied Clinical Research, Norwegian University of Science and Technology, Trondheim, Norway

    Peter M. Fayers

  5. Department of Oncology ONK, The Finsen Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

    Henning T. Mouridsen

  6. The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Bispebjerg Bakke 23, DK-2400 , Copenhagen, Denmark

    Mogens Groenvold

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  1. Mogens Groenvold
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  4. Henning T. Mouridsen
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Correspondence to Mogens Groenvold.

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Groenvold, M., Fayers, P.M., Petersen, M.A. et al. Chemotherapy versus ovarian ablation as adjuvant therapy for breast cancer: impact on health-related quality of life in a randomized trial. Breast Cancer Res Treat 98, 275–284 (2006). https://doi.org/10.1007/s10549-006-9160-9

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  • DOI: https://doi.org/10.1007/s10549-006-9160-9

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