Self-reported health-related quality of life is an independent predictor of chemotherapy treatment benefit and toxicity in women with advanced breast cancer

Abstract

Background: Baseline health-related quality of life (QL) is associated with survival in advanced breast cancer. We sought to identify patients who were less likely to respond to chemotherapy and at greater risk of toxicity on the basis of their QL.

Methods: We used data from three advanced breast cancer trials in which patients (n=378) were treated with cyclophosphamide, methotrexate and 5-fluouracil. Patients self-rated their QL using LASA scales for physical well-being (PWB), mood, pain, nausea/vomiting, appetite and overall QL. Multivariable regression models were constructed to compare overall survival (OS), objective tumour response (OTR), adverse events (AEs) and weight loss according to grouped QL scores.

Results: Physical well-being, mood, appetite and overall QL were significant univariable predictors of OS. Physical well-being and appetite remained significant after adjustment for baseline biomedical factors. Poor PWB was associated with lower OTR (odds ratio (OR)=0.21, 95% confidence interval (CI) 0.09-0.51), higher risk of non-haematological AEs (OR=3.26, 95% CI 1.49-7.15) and greater risk of weight loss (OR 2.37, 95% CI 1.12-5.01) compared with good PWB.

Conclusion: In women with advanced breast cancer, PWB and appetite are predictors of chemotherapy response and toxicity as well as survival. Quality of life should be a routine clinical assessment to guide patient selection for chemotherapy and for stratification of patients in clinical trials.

Figure 1

Overall survival (A) and PFS (B) curves stratified by PWB score, and OS (C) and PFS (D) curves stratified by Appetite score.

Figure 2

(A) Proportion of OTR stratified by PWB and Appetite scores. (B) Proportion with weight loss during chemotherapy stratified by PWB and Appetite scores. (C) Proportion with grade-3/4 non-haematological toxicity stratified by PWB and Appetite scores (^*QL adjusted for performance status, age, liver, and brain metastasis, oestrogen receptor status, neutrophil, serum alkaline phosphatase and trial enrolment).