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Benefits Outweigh Burden Of Chemotherapy After Breast Cancer (P 277)
July 25, 2001The benefits of adjuvant chemotherapy for breast cancer outweigh its side-effects, especially for younger women, conclude authors of a study in this week's issue of THE LANCET.
Previous randomised trials have shown that prolonged chemotherapy for breast cancer substantially reduces the risk of disease relapse and death compared with no chemotherapy. However, toxic side-effects are a concern because they may result in decreased quality of life for patients; it is therefore important to determine whether the benefits of chemotherapy are sufficient to offset its side effects and justify its use, both overall, and within specific subgroups of patients.
Bernard Cole from Dartmouth Medical School, Lebanon, USA, and colleagues did a statistical analysis, using data from 47 randomised trials involving about 18,000 women, to measure the benefits of chemotherapy in terms of survival time adjusted for the quality of life experienced. The investigators used a statistical method called Q-TWiST (Quality-adjusted Time Without Symptoms of disease or Toxicity of treatment) to compare women treated with chemotherapy with women not given chemotherapy. Their analysis considered three major health states experienced by patients: (1) time with chemotherapy, (2) time following chemotherapy and before disease relapse, and (3) time following disease relapse. They weighted the duration of each health state based on a valuation of quality of life, and summed the weighted durations to produce a measure called quality-adjusted survival.
Within 10 years' follow-up the benefit of increased relapse-free and overall survival for younger women (aged younger than 50 years) who received chemotherapy balanced the burdens in terms of acute toxic side-effects, especially among women enrolled in trials that did not include tamoxifen treatment. Overall, chemotherapy-treated younger women gained an average of 10.3 months of relapse-free survival and 5.4 months of overall survival within 10 years compared with the no-chemotherapy group. Chemotherapy provided more quality-adjusted time than control for most quality-of-life valuations assigned to time spent undergoing chemotherapy and time after relapse. The range of the quality-adjusted benefit was 0.6 months to 10.3 months. For older women (50-69 years) overall, chemotherapy also provided substantial benefit compared with no chemotherapy, but the size of the benefit was less than that seen in younger women. Average gains within 10 years for older women treated with chemotherapy were 6.8 months of relapse-free survival and 2.9 months of overall survival. The quality-adjusted benefit ranged from 3.1 to 6.8 months. For older women with oestrogen-receptor-poor tumours who did not receive tamoxifen (9% of the total), the quality-adjusted benefit of chemotherapy was significant and similar to younger women.
Bernard Cole comments: "We conclude that within 10 years' follow-up the benefits of adjuvant chemotherapy outweigh its burdens for younger women for a wide range of quality-of-life values for toxicity and relapse. However, the size of the benefit will depend on these values. Therefore additional studies to evaluate quality of life relative to chemotherapy, endocrine therapies, and their combination are essential. In addition, very few younger women were enrolled in studies designed to evaluate the role of chemotherapy plus endocrine therapy (ovarian ablation or tamoxifen) compared with endocrine therapy alone. Such trials for younger women with tumours that express steroid-hormone receptors should be a high priority."
Lancet
Within 10 years' follow-up the benefit of increased relapse-free and overall survival for younger women (aged younger than 50 years) who received chemotherapy balanced the burdens in terms of acute toxic side-effects, especially among women enrolled in trials that did not include tamoxifen treatment. Overall, chemotherapy-treated younger women gained an average of 10.3 months of relapse-free survival and 5.4 months of overall survival within 10 years compared with the no-chemotherapy group. Chemotherapy provided more quality-adjusted time than control for most quality-of-life valuations assigned to time spent undergoing chemotherapy and time after relapse. The range of the quality-adjusted benefit was 0.6 months to 10.3 months. For older women (50-69 years) overall, chemotherapy also provided substantial benefit compared with no chemotherapy, but the size of the benefit was less than that seen in younger women. Average gains within 10 years for older women treated with chemotherapy were 6.8 months of relapse-free survival and 2.9 months of overall survival. The quality-adjusted benefit ranged from 3.1 to 6.8 months. For older women with oestrogen-receptor-poor tumours who did not receive tamoxifen (9% of the total), the quality-adjusted benefit of chemotherapy was significant and similar to younger women.
Bernard Cole comments: "We conclude that within 10 years' follow-up the benefits of adjuvant chemotherapy outweigh its burdens for younger women for a wide range of quality-of-life values for toxicity and relapse. However, the size of the benefit will depend on these values. Therefore additional studies to evaluate quality of life relative to chemotherapy, endocrine therapies, and their combination are essential. In addition, very few younger women were enrolled in studies designed to evaluate the role of chemotherapy plus endocrine therapy (ovarian ablation or tamoxifen) compared with endocrine therapy alone. Such trials for younger women with tumours that express steroid-hormone receptors should be a high priority."
Lancet
Breast Cancer Current Events and Breast Cancer News RSSResearchers Identify Role of Gene in Tumor Development, Growth and Progression
Virginia Commonwealth University Massey Cancer Center and VCU Institute of Molecular Medicine researchers have identified a gene that may play a pivotal role in two processes that are essential for tumor development, growth and progression to metastasis.
UCLA researchers create 'fly paper' to capture circulating cancer cells
Just as fly paper captures insects, an innovative new device with nano-sized features developed by researchers at UCLA is able to grab cancer cells in the blood that have broken off from a tumor.
Fertility procedures need not delay breast cancer treatment for younger women
A new study published in the November issue of the Journal of the American College of Surgeons shows that breast cancer patients under 40 years old who undergo fertility preservation do not face a significant delay in the treatment of their disease when their care is coordinated in a timely fashion.
Coffee break: Compound brewing new research in colon, breast cancer
A compound in coffee has been found to be estrogenic in studies by Texas AgriLife Research scientists.
Drugs to treat anemia in cancer patients linked to thromboembolism
Medications frequently given to cancer patients to reduce their risk of anemia are associated with an increased risk of deep vein thrombosis or pulmonary embolism, according to new research led by Dawn Hershman, M.D, M.S., co-director of the breast cancer program at the Herbert Irving Comprehensive Cancer Center at NewYork-Presbyterian Hospital/Columbia University Medical Center.
Discovery in worms by Queen's researchers points to more targeted cancer treatment
Researchers at Queen's University have found a link between two genes involved in cancer formation in humans, by examining the genes in worms. The groundbreaking discovery provides a foundation for how tumor-forming genes interact, and may offer a drug target for cancer treatment.
FDA approved leukemia drugs shows promise in ovarian cancer cells
The drug Sprycel, approved for use by the U.S. Food and Drug Administration in patients with chronic myeloid leukemia, significantly inhibited the growth and invasiveness of ovarian cancer cells and also promoted their death, a study by researchers with UCLA's Jonsson Comprehensive Cancer Center found.
Carnegie Mellon researchers link health-care debate to risk of dying in US and Europe
The current health care debate in the United States is complicated. Trade-offs between heath care expenditures, lifestyle choices and life expectancy have been suggested but seldom clearly demonstrated.
Scientists uncover new key to the puzzle of hormone therapy and breast cancer
The use of postmenopausal hormone therapy has decreased over time in the United States, which researchers suggest may play a key role in the declining rate of atypical ductal hyperplasia, a known risk factor for breast cancer.
Breast density associated with increased risk of cancer recurrence
A new study finds that women treated for breast cancer are at higher risk of cancer recurrence if they have dense breasts. Published in the December 15, 2009 issue of Cancer, a peer-reviewed journal of the American Cancer Society, the study's results indicate that breast cancer patients with dense breasts may benefit from additional therapies following surgery, such as radiation.
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