QOL and Menopause Symptoms
Now this is, I think, an interesting and rather obvious/self-evident study. But it does feel like a AH HA moment that someone actually designed a study to look at the impact of menopausal symptoms on Quality of Life (QOL). We all know that it is tough to be happy and well when tormented by intense hot flashes and coping with scarlet faces and sweaty heads.
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ASCO Breast: QOL Tied to Chemo, Menopausal Symptoms
By Charles Bankhead, Staff Writer, MedPage Today
October 02, 2010
MedPage Today Action Points
Note that this study was published as an abstract and presented at a conference. These data
and conclusions should be considered to be preliminary until published in a peer-reviewed
Explain to interested patients that chemotherapy and menopausal symptoms accounted for
almost 70% of quality-of-life (QOL) changes in breast cancer survivors.
NATIONAL HARBOR, Md. -- Chemotherapy and menopausal symptoms accounted for almost 70% of quality-of-life (QOL) changes in breast cancer survivors, according to a study reported here.
In a multivariate analysis, components of the Menopause Rating Scale were the strongest predictors of QOL.
The findings have implications for clinical management of breast cancer, including the choice of therapy, Mark A. Arredondo, MD, reported at the American Society of Clinical Oncology's Breast Cancer Symposium.
"In America we try to treat each stage of cancer the same way," said Arredondo, of Texas Tech University in Amarillo. "That's our benchmark, how closely we adhere to standard treatment programs with an expected outcome.
"Instead, maybe we need to adapt our treatment depending on what a patient's menopausal symptoms or quality of life is now and how it's going to be perceived after their treatment. So maybe the decision about chemotherapy or antiestrogen therapy should be influenced by the patient's current quality of life."
Improved breast cancer survival has increased the significance of QOL as a long-term clinical issue for patients and physicians. However, follow-up visits tend to focus on recurrence and other cancer- specific factors, said Arredondo.
The emergence of survivorship programs reflects the improved breast cancer survival, and the programs have attracted attention as a means to improve breast cancer survivors' QOL. To have a meaningful impact on quality of life, survivorship programs should address the factors that have the greatest impact on QOL. To date, few studies have focused on identifying and targeting specific influences on QOL.
Arredondo and colleagues attempted to identify predictors of poor QOL that might be addressed in a survivorship program. Breast cancer survivors completed the Functional Assessment of Cancer Therapy-Breast (FACT-B) and the Menopause Rating Scale (MRS). Investigator compared patients' scores on the FACT-B and MRS subscales with clinical factors in an effort to identify the best predictors of poor QOL.
Arredondo reported findings from an analysis of the first 100 patients enrolled in the study.
The patients had a median age of 62.8, and 85.8% had early-stage disease. Treatment included chemotherapy in 40.2% of cases and radiation therapy in 67.4%, and 19.6% of the patients had reconstruction. About 9% of the patients had no insurance or had Medicaid coverage..
Comparing variables with the FACT-B subscales, the investigators found that age, insurance status, disease stage, and chemotherapy all had a significant impact on physical well-being (P<0.05 to P<0.01). Type of surgery (lumpectomy versus mastectomy) affected functional well-being but not any of the other subscales. Radiation therapy affected only the domain of cancer-specific concerns. Chemotherapy significantly affected all of the FACT-B suscales: physical well-being (P<0.01), social well-being (P<0.01), emotional well-being (P<0.0001), functional well-being (P<0.01), cancer-specific concerns (P<0.0001), and overall QOL (P<0.0001).
Other variables either had no influence on the subscales or had modest effects on a few of the subscales.
In a multivariate analysis, all three subscales of the MRS significantly affected quality of life:
psychological P=0.0006; somatic, P<0.0001; urogenital, P<0.0001. Chemotherapy remained as a significant predictor of poorer QOL, but less so compared with the MRS scales (P=0.0362).
Collectively, the MRS and chemotherapy accounted for 69.4% of the effect on QOL.
Arredondo said data collection and analysis will continue as more breast cancer survivors are enrolled in the study. A principal goal of the study is to identify factors that survivorship programs can address to improve or maintain quality of life in breast cancer patients.
Primary source: ASCO Breast Cancer Symposium
Rahman RL, et al "Determinants of quality of life in breast cancer survivors." ASCO Breast 2010;
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