Quality of life and quality-adjusted survival (Q-TWiST) in patients receiving dose-intensive or standard dose chemotherapy for high-risk primary breast cancer

Abstract

Quality of life (QL) is an important consideration when comparing adjuvant therapies for early breast cancer, especially if they differ substantially in toxicity. We evaluated QL and Q-TWiST among patients randomised to adjuvant dose-intensive epirubicin and cyclophosphamide administered with filgrastim and progenitor cell support (DI-EC) or standard-dose anthracycline-based chemotherapy (SD-CT). We estimated the duration of chemotherapy toxicity (TOX), time without disease symptoms and toxicity (TWiST), and time following relapse (REL). Patients scored QL indicators. Mean durations for the three transition times were weighted with patient reported utilities to obtain mean Q-TWiST. Patients receiving DI-EC reported worse QL during TOX, especially treatment burden (month 3: P <0.01), but a faster recovery 3 months following chemotherapy than patients receiving SD-CT, for example, less coping effort ( P <0.01). Average Q-TWiST was 1.8 months longer for patients receiving DI-EC (95% CI, −2.5 to 6.1). Q-TWiST favoured DI-EC for most values of utilities attached to TOX and REL. Despite greater initial toxicity, quality-adjusted survival was similar or better with dose-intensive treatment as compared to standard treatment. Thus, QL considerations should not be prohibitive if future intensive therapies show superior efficacy.

Women’s perceptions of chemotherapy‐induced cognitive side affects on work ability: a focus group study

“…Studies have examined the effects of cognitive impairments on quality of life (Bernhard et al. 2004, 2008, Bower 2008) but not to the same extent on the quality of working life (Main et al.…”

Quality‐adjusted time without symptoms or toxicity (Q‐TWiST): patient‐reported outcome or mathematical model? A systematic review in cancer

“…Most studies utilized a health index, whereas other studies had a battery of health questionnaires. The EQ‐5D and the subjective health estimation were used to calculate utilities in two studies (18.2%) each . Three (27.3%) studies used utility weights from non‐study participants with similar cancers .…”

“…Adverse events that were considered to affect QoL were defined on a protocol‐by‐protocol basis. Most studies set a threshold of a grade III or grade IV event that was not a laboratory event, which means that the subject could feel the effect of the event, theoretically impacting their QoL . One study set grade II as the threshold .…”

Preliminary Validation of an Optimally Weighted Patient-Based Utility Index by Application to Randomized Trials in Breast Cancer

“…The quality‐adjusted life‐year (QALY) approach is a useful way to compare cancer treatments, because it integrates the beneficial and harmful effects of treatment on health‐related quality of life (HRQL), expressed as a utility, with the effects of treatment on survival [1–3]. Analyses of cancer trials in terms of utilities and QALYs are increasingly used to inform economic decisions about cancer treatments [4–10], but can also be used to inform clinical decisions [11–16].…”