The Role of Health-Related Quality of Life in Early Discontinuation of Chemotherapy for Breast Cancer

  1. Lisa C. Richardson MD, MPH1,
  2. Wei Wang PhD2,
  3. Abraham G. Hartzema Pharm D, MSPH, PhD3,
  4. Samuel Wagner PhD4

Article first published online: 4 OCT 2007

DOI: 10.1111/j.1524-4741.2007.00512.x

Issue

The Breast Journal

The Breast Journal

Volume 13, Issue 6, pages 581–587, November/December 2007

Additional Information

How to Cite

Richardson, L. C., Wang, W., Hartzema, A. G. and Wagner, S. (2007), The Role of Health-Related Quality of Life in Early Discontinuation of Chemotherapy for Breast Cancer. The Breast Journal, 13: 581–587. doi: 10.1111/j.1524-4741.2007.00512.x

Author Information

  1. 1

    Centers for Disease Control and Prevention, Atlanta, Georgia

  2. 2

    Department of Biostatistics, Harvard University, Cambridge, Massachusetts

  3. 3

    College of Pharmacy, University of Florida, Gainesville, Florida

  4. 4

    Pfizer Pharmaceuticals, New York, New York

*Address correspondence and reprint requests to: Lisa C. Richardson, MD, MPH, Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, 4770 Buford Highway, NE, Atlanta, GA 30341, USA, or e-mail: lfr8@cdc.gov.

  1. This study was presented in part at the San Antonio Breast Cancer Symposium (December 2004) and at the Annual Meeting of the Robert Wood Johnson Clinical Scholars Program in Tucson, AZ (November 2004).

Publication History

  1. Issue published online: 18 OCT 2007
  2. Article first published online: 4 OCT 2007

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Keywords:

  • breast cancer;
  • quality of life;
  • treatment adherence

Abstract:  To examine the role of health-related quality of life (HRQOL) in early treatment discontinuation among women enrolled in a breast cancer clinical trial. A total of 464 women were enrolled in the Eastern Cooperative Oncology Group randomized controlled trial of adjuvant regimens comparing six cycles of cytoxan, adriamycin and 5-flurouricil (5-FU) with a 16-week regimen (weekly therapy with cytoxan, adriamycin, vincristine, methotrexate, and 5-FU) among women with lymph node positive breast cancer. One hundred sixty-four women participated in the HrQL substudy using the Breast Chemotherapy Questionnaire, which was designed to measure HRQOL in women receiving chemotherapy. Changes in global HRQOL score were examined over time as a predictor of early treatment discontinuation using generalized estimation equations (GEE) modeling and Cox proportional hazards regression. We considered early treatment discontinuation as a longitudinal binary variable determined at each time point HRQOL was measured. The results of multivariate GEE model fitting indicated that declines in HRQOL (p = 0.04), older age (p = 0.02), higher degree of nausea (p = 0.02), higher degree of neurosensory toxicity (0.03) and lower degrees of hair loss (p = 0.004) were correlated with early treatment discontinuation. We then fitted a proportional hazard regression model for time to early discontinuation with HRQOL score as a time-dependent covariate. The results were identical. Declines in HRQOL during therapy predicted early treatment discontinuation even after accounting for age and chemotherapy-related side effects. In the age of ever more aggressive treatments for breast cancer, women’s perception of the impact of these treatments on their lives will become more important.

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