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Quality of Life

Longitudinal effects of high-dose chemotherapy and autologous stem cell transplantation on quality of life in the treatment of metastatic breast cancer

Bone Marrow Transplantation volume 27, pages 989–998 (2001)Cite this article

Abstract

This study determined the effects of high-dose chemotherapy (HDCT) with autologous blood stem cell transplantation (ASCT) on quality of life (QL) in women with metastatic breast cancer prior to, and during treatment, and up to 1-year post-ASCT. Thirty-three women diagnosed with metastatic breast cancer participated in a phase 1 clinical trial of a new combination of cyclophosphamide (CTX) and mitoxantrone (MXT), with dose escalation of paclitaxel. Longitudinal QL data were collected using the functional living index-cancer (FLIC) and symptom scales at seven time periods: pre-induction chemotherapy (CT), post-induction CT, post-high dose CT (HDCT), and at 3, 6, 9 and 12 months post-ASCT. FLIC scores indicated that the worst problems for patients were feelings of hardship on themselves and their families, followed by psychological functioning and physical functioning problems. The time around diagnosis of the metastatic disease and following HDCT were the worst times for all levels of quality of life, but anxiety and depression symptoms continued to increase in severity across the entire follow-up period. The symptoms that were most problematic were worry about the future, loss of sexual interest, anxiety about the treatment, general worrying, and joint pain. These data highlight the problems that women with metastatic breast cancer encounter at different stages of the disease and treatment process, and can be used to tailor psychosocial interventions appropriate for treating the relevant issues at different points in time. Bone Marrow Transplantation (2001) 27, 989–998.

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References

  1. Northouse LL . A longitudinal study of the adjustment of patients and husbands to breast cancer Oncol Nurs Forum 1990 17: 39–43

    Google Scholar 

  2. Buccheri G . Depressive reactions to lung cancer are common and often followed by a poor outcome Eur Resp J 1998 11: 173–178

    Article  CAS  Google Scholar 

  3. Coates A, Porzsolt F, Osoba D . Quality of life in oncology practice: prognostic value of EORTC QLQ-C30 scores in patients with advance malignancy Eur J Cancer 1997 33: 1025–1030

    Article  CAS  Google Scholar 

  4. Herndon JE, Fleishman SB, Kornblith AB et al. Is quality of life predictive of the survival of patients with advanced nonsmall cell lung carcinoma? Cancer 1999 85: 333–340

    Article  Google Scholar 

  5. Feld R . Endpoints in cancer clinical trials: is there a need for measuring quality of life? Supp Care Cancer 1995 3: 23–27

    Article  CAS  Google Scholar 

  6. Kiebert GM, Curran D, Aaronson NK . Quality of life as an endpoint in EORTC clinical trials Stat Med 1998 17: 561–569

    Article  CAS  Google Scholar 

  7. Schwarz R, Bernhard J, Flechtner H et al. Guidelines for the assessment of quality of life in oncology – implementing adequate methods and their content J Cancer Res Clin Oncol 1994 120: 691–692

    Article  CAS  Google Scholar 

  8. Spilker B . Quality of Life Assessment in Clinical Trials Raven Press: New York 1990

    Google Scholar 

  9. Taylor K, Macdonald K, Bezjak A et al. Physicians’ perspective on quality of life: an exploratory study of oncologists Qual Life Res 1996 5: 5–14

    Article  CAS  Google Scholar 

  10. Morris J, Perez D, McNoe B . The use of quality of live data in clinical practice Qual Life Res 1998 7: 85–91

    Article  CAS  Google Scholar 

  11. Gough I, Dalgleish L . What value is given to quality of life assessment by health professionals considering response to palliative chemotherapy for advanced cancer? Cancer 1991 68: 220–225

    Article  CAS  Google Scholar 

  12. Bezjak A, Ng P, Taylor KM et al. A preliminary survey of oncologists perceptions of quality of life information Psycho-oncology 1997 6: 107–113

    Article  CAS  Google Scholar 

  13. Ganz PA . Impact of quality of life outcomes on clinical practice Oncology 1995 9: 61–65

    CAS  PubMed  Google Scholar 

  14. Finlay IG, Dunlop R . Quality of life assessment in palliative care Ann Oncol 1994 5: 13–18

    Article  CAS  Google Scholar 

  15. Gluck S, Germond C, Lopez P et al. A phase I trial of high-dose paclitaxel, cyclophosphamide and mitroxantrone with autologous blood stem cell support for the treatment of metastatic breast cancer Eur J Cancer 1998 34: 1008–1014

    Article  CAS  Google Scholar 

  16. Whedon M, Ferrell BR . Quality of life in adult bone marrow transplant patients: beyond the first year Semin Oncol Nurs 1994 10: 42–57

    Article  CAS  Google Scholar 

  17. Winer EP, Sutton LM . Quality of life after bone marrow transplantation Oncology 1994 8: 19–27

    CAS  PubMed  Google Scholar 

  18. Peters WP . Autologous bone marrow transplantation for breast cancer Curr Opin Oncol 1992 4: 278–282

    Google Scholar 

  19. Peters WP, Ross M, Vredenburgh JJ et al. High dose chemotherapy and autologous bone marrow support as consolidation after standard-dose adjuvant therapy for high-risk primary breast cancer J Clin Oncol 1993 11: 1132–1143

    Article  CAS  Google Scholar 

  20. Winer EP, Hardee M, Brunatti C et al. Quality of life (QL) assessment in patients with breast cancer surviving 12 months or more following high dose chemotherapy with autologous bone marrow transplant Proc Am Soc Clin Oncol 1992 11: 383

    Google Scholar 

  21. Whedon M, Stearns D, Mills LE . Quality of life of long-term adult survivors of autologous bone marrow transplantation Oncol Nurs Forum 1995 22: 1527–1535

    CAS  PubMed  Google Scholar 

  22. Winer EP, Lindley C, Hardee M et al. Quality of life in patients surviving at least 12 months following high dose chemotherapy with autologous bone marrow support Psycho-Oncology 1999 8: 167–176

    Article  CAS  Google Scholar 

  23. Mytko JJ, Knight SJ, Chastain D et al. Coping strategies and psychological distress in cancer patients before autologous bone marrow transplant J Clin Psych Med Sett 1997 3: 355–366

    Article  Google Scholar 

  24. McQuellon RP, Craven B, Russell GB et al. Quality of life in breast cancer patients before and after autologous bone marrow transplantation Bone Marrow Transplant 1996 18: 579–584

    CAS  PubMed  Google Scholar 

  25. Larsen J, Gardulf A, Nordstrom G et al. Health-related quality of life in women with breast cancer undergoing autologous stem-cell transplantation Cancer Nurs 1996 19: 368–375

    Article  CAS  Google Scholar 

  26. Vose JM, Kennedy BC, Bierman PJ et al. Long-term sequelae of autologous bone marrow or peripheral stem cell transplantation for lymphoid malignancies Cancer 1992 69: 784–789

    Article  CAS  Google Scholar 

  27. Chao NJ, Tierney DK, Bloom JR et al. Dynamic assessment of quality of life after autologous bone marrow transplantation Blood 1992 80: 825–830

    CAS  PubMed  Google Scholar 

  28. Amato JJ, Williams M, Greenberg C et al. Psychological support to an autologous bone marrow transplant unit in a community hospital: a pilot experience Psycho-Oncol 1998 7: 121–125

    Article  CAS  Google Scholar 

  29. Hjermstad MJ, Evenson SA, Kvaloy SO et al. Health-related quality of life 1 year after allogeneic or autologous stem-cell transplantation: a prospective study J Clin Oncol 1999 17: 706–718

    Article  CAS  Google Scholar 

  30. Watson M, Wheatley K, Harrison GA et al. Severe adverse impact on sexual functioning and fertility of bone marrow transplantation, either allogeneic or autologous, compared with consolidation chemotherapy alone Cancer 1999 86: 1231–1239

    Article  CAS  Google Scholar 

  31. Hann DM, Garovoy N, Finkelstein B et al. Fatigue and quality of life in breast cancer patients undergoing autologous stem cell transplantation: a longitudinal comparative study J Pain Sympt Management 1999 17: 311–319

    Article  CAS  Google Scholar 

  32. Schipper H, Clinch J, McMurray A, Levitt M . Measuring the quality of life of cancer patients: the functional living index-cancer: development and validation J Clin Oncol 1984 2: 472–483

    Article  CAS  Google Scholar 

  33. Lindley CM, Hirsch JD, O'Neill CV . Quality of life consequences of chemotherapy-induced emesis Qual Life Res 1992 1: 331–340

    Article  CAS  Google Scholar 

  34. Hjermstad MJ, Holte H, Evensen SA et al. Do patients who are treated with stem cell transplantation have a health-related quality of life comparable to the general population after 1 year? Bone Marrow Transplant 1999 24: 911–918

    Article  CAS  Google Scholar 

  35. Pasacreta JV, Pickett M . Psychosocial aspects of palliative care Semin Oncol Nurs 1998 14: 110–120

    Article  CAS  Google Scholar 

  36. Zabora JR, Blanchard CG, Smith ED et al. Prevalence of psychological distress among cancer patients across the disease continuum J Psych Oncol 1997 15: 73–86

    Article  Google Scholar 

  37. Winer EP, Gold D . Quality of life (QOL) following high dose chemotherapy with autologous bone marrow support (HDC) in patients with metastatic breast cancer Proc Am Soc Clin Oncol 1991 10: 62

    Google Scholar 

  38. Aisner JC, Cirrincione M, Perloff M . Combination chemotherapy for metastatic or recurrent carcinoma of the breast – a randomized phase III trial comparing CAF versus VATH versus VATH alternating with CMFVP: Cancer and Leukemia Group B Study J Clin Oncol 1995 13: 1443–1452

    Article  CAS  Google Scholar 

  39. Gluck S, Crump M, Bociek G, Stewart D . High dose chemotherapy with autologous blood stem cell transplantation: increasing evidence for efficacy in patients with metastatic breast cancer. Autologous Blood and Marrow Transplantation, Proc 9th Int Symp, Arlington, Texas 1999 pp 290–302

  40. Lotz JP, Cure H, Morvan MJV et al. High dose chemotherapy with hematopoietic stem cell transplantation for metastatic breast cancer: Results of the French Protocol PEGASE 04 Proc Am Soc Clin Oncol 1999 18: 161a

    Google Scholar 

  41. Stadtmauer EA, O'Neill A, Goldstein LJ et al. Conventional-dose chemotherapy compared with high-dose chemotherapy plus autologous hematopoietic stem-cell transplantation for metastatic breast cancer. Philadelphia Bone Marrow Transplant Group New Engl J Med 2000 342: 1069–1076

    Article  CAS  Google Scholar 

  42. Gluck S, Crump M . A randomized trial of high-dose chemotherapy and autologous stem cell therapy versus standard therapy in women with metastatic breast cancer who have responded to anthracycline or taxane-based induction chemotherapy National Cancer Institute of Canada Clinical Trials Group NCIC CTG Protocol Number MA 16 1997

  43. Spiegel D, Bloom JR, Draemer HC, Gottheil E . Effect of psychosocial treatment on survival of patients with breast cancer Lancet 1989 ii: 888–891

    Article  Google Scholar 

  44. Spiegel D . Essentials of psychotherapeutic intervention for cancer patients Supp Care Cancer 1995 3: 252–256

    CAS  Google Scholar 

  45. Spiegel D, Bloom JR, Yalom I . Group support for patients with metastatic cancer: a randomized prospective outcome study Arch Gen Psych 1981 38: 527–533

    Article  CAS  Google Scholar 

  46. Bottomley A . Group cognitive behavioural therapy interventions with cancer patients: a review of the literature Eur J Cancer Care 1996 5: 143–146

    Article  CAS  Google Scholar 

  47. Speca M, Carlson LE, Goodey E, Angen M . A randomized wait-list controlled clinical trial: the effect of a mindfulness meditation-based stress reduction program on mood and symptoms of stress in cancer outpatients Psychosom Med 2000 62: 613–622

    Article  CAS  Google Scholar 

  48. Iacovino V, Reesor K . Literature on interventions to address cancer patients' psychosocial needs: what does it tell us? J Psych Oncol 1997 15: 47–71

    Article  Google Scholar 

  49. Fobair P . Cancer support groups and group therapies: Part I. Historical and theoretical background and research on effectiveness J Psych Oncol 1997 15: 63–81

    Article  Google Scholar 

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Acknowledgements

Dr Linda Carlson is a Research Fellow of the National Cancer Institute of Canada, supported with funds provided by the Canadian Cancer Society. We would like to acknowledge the assistance of Suzanne Cecchetto, Corolynn Sheehan, Sue Gerrard and Merle Heise for data management, and the contribution and dedication of the clinical staff at the Northeastern Ontario Regional Cancer Centre to the patient-related work.

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  1. Tom Baker Cancer Centre, Calgary, Alberta, Canada

    LE Carlson & S Glück

  2. Northeastern Ontario Regional Cancer Centre, Sudbury, Ontario, Canada

    T Koski

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Carlson, L., Koski, T. & Glück, S. Longitudinal effects of high-dose chemotherapy and autologous stem cell transplantation on quality of life in the treatment of metastatic breast cancer. Bone Marrow Transplant 27, 989–998 (2001). https://doi.org/10.1038/sj.bmt.1703002

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