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British Journal of Cancer logoLink to British Journal of Cancer
. 1998 Sep;78(5):686–693. doi: 10.1038/bjc.1998.561

Factors affecting baseline quality of life in two international adjuvant breast cancer trials. International Breast Cancer Study Group (IBCSG).

J Bernhard, C Hürny, A S Coates, H F Peterson, M Castiglione-Gertsch, R D Gelber, E Galligioni, G Marini, B Thürlimann, J F Forbes, A Goldhirsch, H J Senn, C M Rudenstam
PMCID: PMC2063054  PMID: 9744512

Abstract

Quality of life (QL) is used to assess treatments in clinical trials but may be influenced by other factors. We analysed the impact of biomedical, sociodemographic and cultural factors on baseline QL indicators in two International Breast Cancer Study Group trials. Patients with stage II breast cancer were randomized within 6 weeks of primary surgery to various adjuvant treatments. They were asked to assess five indicators of QL at baseline. QL forms were available for 1231 (83%) of the 1475 premenopausal and 989 (82%) of the 1212 post-menopausal patients, who were from nine countries and spoke seven languages. Culture (defined as language/country groups) had a statistically significant impact on baseline QL measures. Premenopausal patients with poor prognostic factors showed a tendency to report worse QL, with oestrogen receptor status as an independent predictor for mood (P = 0.0005). Older post-menopausal patients reported better emotional wellbeing (P = 0.002), mood (P = 0.002), and less effort to cope (P = 0.0009) compared with younger post-menopausal patients. Co-morbidity, type of surgery, treatment assignment and sociodemographic factors showed a statistically significant impact in post-menopausal patients only. Cultural and biomedical factors influenced baseline QL and should be considered when evaluating the impact of treatment on QL in international breast cancer clinical trials.

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Selected References

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  1. Butow P., Coates A., Dunn S., Bernhard J., Hürny C. On the receiving end. IV: Validation of quality of life indicators. Ann Oncol. 1991 Sep;2(8):597–603. doi: 10.1093/oxfordjournals.annonc.a058027. [DOI] [PubMed] [Google Scholar]
  2. Carver C. S., Pozo-Kaderman C., Harris S. D., Noriega V., Scheier M. F., Robinson D. S., Ketcham A. S., Moffat F. L., Jr, Clark K. C. Optimism versus pessimism predicts the quality of women's adjustment to early stage breast cancer. Cancer. 1994 Feb 15;73(4):1213–1220. doi: 10.1002/1097-0142(19940215)73:4<1213::aid-cncr2820730415>3.0.co;2-q. [DOI] [PubMed] [Google Scholar]
  3. Coates A., Dillenbeck C. F., McNeil D. R., Kaye S. B., Sims K., Fox R. M., Woods R. L., Milton G. W., Solomon J., Tattersall M. H. On the receiving end--II. Linear analogue self-assessment (LASA) in evaluation of aspects of the quality of life of cancer patients receiving therapy. Eur J Cancer Clin Oncol. 1983 Nov;19(11):1633–1637. doi: 10.1016/0277-5379(83)90096-2. [DOI] [PubMed] [Google Scholar]
  4. Coates A., Gebski V., Bishop J. F., Jeal P. N., Woods R. L., Snyder R., Tattersall M. H., Byrne M., Harvey V., Gill G. Improving the quality of life during chemotherapy for advanced breast cancer. A comparison of intermittent and continuous treatment strategies. N Engl J Med. 1987 Dec 10;317(24):1490–1495. doi: 10.1056/NEJM198712103172402. [DOI] [PubMed] [Google Scholar]
  5. Coates A., Gebski V., Signorini D., Murray P., McNeil D., Byrne M., Forbes J. F. Prognostic value of quality-of-life scores during chemotherapy for advanced breast cancer. Australian New Zealand Breast Cancer Trials Group. J Clin Oncol. 1992 Dec;10(12):1833–1838. doi: 10.1200/JCO.1992.10.12.1833. [DOI] [PubMed] [Google Scholar]
  6. Coates A., Glasziou P., McNeil D. On the receiving end--III. Measurement of quality of life during cancer chemotherapy. Ann Oncol. 1990;1(3):213–217. doi: 10.1093/oxfordjournals.annonc.a057724. [DOI] [PubMed] [Google Scholar]
  7. Fallowfield L. J., Hall A., Maguire G. P., Baum M. Psychological outcomes of different treatment policies in women with early breast cancer outside a clinical trial. BMJ. 1990 Sep 22;301(6752):575–580. doi: 10.1136/bmj.301.6752.575. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Ganz P. A., Hirji K., Sim M. S., Schag C. A., Fred C., Polinsky M. L. Predicting psychosocial risk in patients with breast cancer. Med Care. 1993 May;31(5):419–431. doi: 10.1097/00005650-199305000-00004. [DOI] [PubMed] [Google Scholar]
  9. Ganz P. A., Schag A. C., Lee J. J., Polinsky M. L., Tan S. J. Breast conservation versus mastectomy. Is there a difference in psychological adjustment or quality of life in the year after surgery? Cancer. 1992 Apr 1;69(7):1729–1738. doi: 10.1002/1097-0142(19920401)69:7<1729::aid-cncr2820690714>3.0.co;2-d. [DOI] [PubMed] [Google Scholar]
  10. Ganz P. A., Schag C. A., Cheng H. L. Assessing the quality of life--a study in newly-diagnosed breast cancer patients. J Clin Epidemiol. 1990;43(1):75–86. doi: 10.1016/0895-4356(90)90059-x. [DOI] [PubMed] [Google Scholar]
  11. Hürny C., Bernhard J., Bacchi M., van Wegberg B., Tomamichel M., Spek U., Coates A., Castiglione M., Goldhirsch A., Senn H. J. The Perceived Adjustment to Chronic Illness Scale (PACIS): a global indicator of coping for operable breast cancer patients in clinical trials. Swiss Group for Clinical Cancer Research (SAKK) and the International Breast Cancer Study Group (IBCSG). Support Care Cancer. 1993 Jul;1(4):200–208. doi: 10.1007/BF00366447. [DOI] [PubMed] [Google Scholar]
  12. Hürny C., Bernhard J., Coates A. S., Castiglione-Gertsch M., Peterson H. F., Gelber R. D., Forbes J. F., Rudenstam C. M., Simoncini E., Crivellari D. Impact of adjuvant therapy on quality of life in women with node-positive operable breast cancer. International Breast Cancer Study Group. Lancet. 1996 May 11;347(9011):1279–1284. doi: 10.1016/s0140-6736(96)90936-8. [DOI] [PubMed] [Google Scholar]
  13. Hürny C., Bernhard J., Coates A., Castiglione M., Peterson H. F., Gelber R. D., Rudenstam C. M., Goldhirsch A., Senn H. J. Timing of baseline quality of life assessment in an international adjuvant breast cancer trial: its effect on patient self-estimation. The International Breast Cancer Study Group. Ann Oncol. 1994 Jan;5(1):65–74. doi: 10.1093/oxfordjournals.annonc.a058697. [DOI] [PubMed] [Google Scholar]
  14. Hürny C., Bernhard J., Coates A., Peterson H. F., Castiglione-Gertsch M., Gelber R. D., Rudenstam C. M., Collins J., Lindtner J., Goldhirsch A. Responsiveness of a single-item indicator versus a multi-item scale: assessment of emotional well-being in an international adjuvant breast cancer trial. Med Care. 1996 Mar;34(3):234–248. doi: 10.1097/00005650-199603000-00004. [DOI] [PubMed] [Google Scholar]
  15. Hürny C., Bernhard J., Gelber R. D., Coates A., Castiglione M., Isley M., Dreher D., Peterson H., Goldhirsch A., Senn H. J. Quality of life measures for patients receiving adjuvant therapy for breast cancer: an international trial. The International Breast Cancer Study Group. Eur J Cancer. 1992;28(1):118–124. doi: 10.1016/0959-8049(92)90399-m. [DOI] [PubMed] [Google Scholar]
  16. Hürny C. Coping and survival in early breast cancer: an update. Recent Results Cancer Res. 1993;127:211–220. doi: 10.1007/978-3-642-84745-5_29. [DOI] [PubMed] [Google Scholar]
  17. Irvine D., Brown B., Crooks D., Roberts J., Browne G. Psychosocial adjustment in women with breast cancer. Cancer. 1991 Feb 15;67(4):1097–1117. doi: 10.1002/1097-0142(19910215)67:4<1097::aid-cncr2820670438>3.0.co;2-z. [DOI] [PubMed] [Google Scholar]
  18. Karjalainen S., Pukkala E. Social class as a prognostic factor in breast cancer survival. Cancer. 1990 Aug 15;66(4):819–826. doi: 10.1002/1097-0142(19900815)66:4<819::aid-cncr2820660437>3.0.co;2-e. [DOI] [PubMed] [Google Scholar]
  19. Kiebert G. M., de Haes J. C., van de Velde C. J. The impact of breast-conserving treatment and mastectomy on the quality of life of early-stage breast cancer patients: a review. J Clin Oncol. 1991 Jun;9(6):1059–1070. doi: 10.1200/JCO.1991.9.6.1059. [DOI] [PubMed] [Google Scholar]
  20. Maraste R., Brandt L., Olsson H., Ryde-Brandt B. Anxiety and depression in breast cancer patients at start of adjuvant radiotherapy. Relations to age and type of surgery. Acta Oncol. 1992;31(6):641–643. doi: 10.3109/02841869209083846. [DOI] [PubMed] [Google Scholar]
  21. Maunsell E., Brisson J., Deschênes L. Psychological distress after initial treatment of breast cancer. Assessment of potential risk factors. Cancer. 1992 Jul 1;70(1):120–125. doi: 10.1002/1097-0142(19920701)70:1<120::aid-cncr2820700120>3.0.co;2-u. [DOI] [PubMed] [Google Scholar]
  22. Mor V., Malin M., Allen S. Age differences in the psychosocial problems encountered by breast cancer patients. J Natl Cancer Inst Monogr. 1994;(16):191–197. [PubMed] [Google Scholar]
  23. Pozo C., Carver C. S., Noriega V., Harris S. D., Robinson D. S., Ketcham A. S., Legaspi A., Moffat F. L., Jr, Clark K. C. Effects of mastectomy versus lumpectomy on emotional adjustment to breast cancer: a prospective study of the first year postsurgery. J Clin Oncol. 1992 Aug;10(8):1292–1298. doi: 10.1200/JCO.1992.10.8.1292. [DOI] [PubMed] [Google Scholar]
  24. Priestman T. J., Baum M. Evaluation of quality of life in patients receiving treatment for advanced breast cancer. Lancet. 1976 Apr 24;1(7965):899–900. doi: 10.1016/s0140-6736(76)92112-7. [DOI] [PubMed] [Google Scholar]
  25. Razavi D., Farvacques C., Delvaux N., Beffort T., Paesmans M., Leclercq G., Van Houtte P., Paridaens R. Psychosocial correlates of oestrogen and progesterone receptors in breast cancer. Lancet. 1990 Apr 21;335(8695):931–933. doi: 10.1016/0140-6736(90)90996-i. [DOI] [PubMed] [Google Scholar]
  26. Receptor status and psychological adjustment of breast cancer patients. Lancet. 1990 Jul 7;336(8706):47–48. [PubMed] [Google Scholar]
  27. Receptor status and psychological adjustment of breast cancer patients. Lancet. 1990 Jul 7;336(8706):47–48. [PubMed] [Google Scholar]
  28. Roberts C. S., Cox C. E., Reintgen D. S., Baile W. F., Gibertini M. Influence of physician communication on newly diagnosed breast patients' psychologic adjustment and decision-making. Cancer. 1994 Jul 1;74(1 Suppl):336–341. doi: 10.1002/cncr.2820741319. [DOI] [PubMed] [Google Scholar]
  29. Schrijvers C. T., Mackenbach J. P., Lutz J. M., Quinn M. J., Coleman M. P. Deprivation and survival from breast cancer. Br J Cancer. 1995 Sep;72(3):738–743. doi: 10.1038/bjc.1995.403. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Tjemsland L., Søreide J. A., Malt U. F. Psychosocial factors in women with operable breast cancer. An association to estrogen receptor status? J Psychosom Res. 1995 Oct;39(7):875–881. doi: 10.1016/0022-3999(94)00029-2. [DOI] [PubMed] [Google Scholar]
  31. Vinokur A. D., Threatt B. A., Vinokur-Kaplan D., Satariano W. A. The process of recovery from breast cancer for younger and older patients. Changes during the first year. Cancer. 1990 Mar 1;65(5):1242–1254. doi: 10.1002/1097-0142(19900301)65:5<1242::aid-cncr2820650535>3.0.co;2-1. [DOI] [PubMed] [Google Scholar]

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