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Quality-of-Life Scores Predict Outcome in Metastatic but Not Early Breast Cancer

From the Australian Cancer Society and Australian New Zealand Breast Cancer Trials Group, University of Sydney, Sydney, Australia; Bürgerspital, St Gallen; International Breast Cancer Study Group Coordinating Center, Bern, Switzerland; International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute, Boston, MA; and Oncology Institute of Southern Switzerland and European Institute of Oncology, Milan, Italy.

Address reprint requests to Alan Coates, MD, FRACP, Australian Cancer Society, GPO Box 4708, Sydney NSW 2001, Australia; email alancoates{at}cancer.org.au

PURPOSE: We compared the prognostic value of quality-of-life (QL) scores in the adjuvant setting and after relapse in two randomized trials of the International Breast Cancer Study Group.

PATIENTS AND METHODS: More than 2,000 premenopausal and postmenopausal patients with node-positive breast cancer who were participating in randomized trials that compared adjuvant therapies completed QL assessments for physical well-being, mood, appetite, and coping at study entry and at months 3 and 18 if they remained relapse-free and, in case of relapse, at 1 month and at 6 months after relapse. Cox regression models were used to test the relationship between QL scores and disease-free survival (DFS), in the adjuvant setting, or overall survival, in the case of postrelapse QL measurement. All models were stratified by language/country group and included other factors related to QL and/or outcome.

RESULTS: DFS was not significantly predicted by QL scores at baseline or month 18, or by changes in QL score between baseline and months 3 or 18. In contrast, after relapse, QL scores were predictive for subsequent overall survival. One month after relapse, better mood (P = .04) in premenopausal patients and better appetite (P = .005) in postmenopausal patients were associated with longer survival. Six months after relapse, better physical well-being (P = .03) and appetite (P = .03) in premenopausal patients and better physical well-being (P < .0001), mood (P = .002), appetite (P = .0001), and coping (P = .0001) in postmenopausal patients predicted longer survival.

CONCLUSION: Any prognostic significance of QL scores in the adjuvant setting is minimal or obscured by chemotherapy effects, but there is strong prognostic significance of QL scores after disease relapse. The contrast suggests that patient perception of the severity of underlying illness may determine reported QL scores.

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