Buijs Ciska, Rodenhuis Sjoerd, Seynaeve Caroline M, van Hoesel Quirinus G C M, van der Wall Elsken, Smit Wim J M, Nooij Marianne A, Voest Emile, Hupperets Pierre, TenVergert Els M, van Tinteren Harm, Willemse Pax H B, Mourits Marian J E, Aaronson Neil K, Post Wendy J, de Vries Elisabeth G E
University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.
J Clin Oncol. 2007 Dec 1;25(34):5403-9. doi: 10.1200/JCO.2007.11.2813.
To evaluate and compare health-related quality of life (HRQOL) after conventional- and high-dose adjuvant chemotherapy in patients with high-risk breast cancer.
Patients were randomly assigned to either a conventional or high-dose chemotherapy regimen; both regimens were followed by radiotherapy and tamoxifen. HRQOL was evaluated until disease progression using the Short Form-36 (SF-36), Visual Analog Scale, and Rotterdam Symptom Checklist and assessed every 6 months for 5 years after random assignment. For the SF-36, data from healthy Dutch women with the same age distribution served as reference values.
Eight hundred four patients (conventional-dose chemotherapy, n = 405; high-dose chemotherapy, n = 399) were included. Median follow-up time was 57 months. Directly after high-dose chemotherapy, HRQOL decreased more compared with conventional chemotherapy for all SF-36 subscales. After 1 year, the reference value of healthy women was reached in both groups. Small differences were observed between the two groups in the role-physical and role-emotional subscales, but 1 year after treatment, these differences were minor and not clinically relevant. During follow-up, patients with a lower educational level and many complaints before chemotherapy experienced a worse HRQOL.
Shortly after high-dose chemotherapy, HRQOL was more affected than after conventional-dose chemotherapy. One year after random assignment, differences were negligible. Identifying patients who have a higher chance of persistent impaired quality of life after treatment (which, in the present study, included patients with a lower educational level and many complaints before chemotherapy) is important and may open the way for better patient-tailored prevention strategies.
评估和比较高危乳腺癌患者接受传统剂量和高剂量辅助化疗后的健康相关生活质量（HRQOL）。
患者被随机分配至传统化疗方案或高剂量化疗方案；两种方案均后续接受放疗和他莫昔芬治疗。使用简短健康调查问卷（SF-36）、视觉模拟量表和鹿特丹症状清单对HRQOL进行评估，直至疾病进展，并在随机分组后每6个月评估1次，共评估5年。对于SF-36，来自年龄分布相同的健康荷兰女性的数据用作参考值。
纳入804例患者（传统剂量化疗组，n = 405；高剂量化疗组，n = 399）。中位随访时间为57个月。高剂量化疗后即刻，所有SF-36子量表的HRQOL较传统化疗下降得更多。1年后，两组均达到健康女性的参考值。两组在身体功能和情感职能子量表上观察到微小差异，但治疗1年后，这些差异较小且无临床意义。在随访期间，教育水平较低且化疗前有许多症状的患者HRQOL较差。
高剂量化疗后不久，HRQOL较传统剂量化疗受到的影响更大。随机分组1年后，差异可忽略不计。识别治疗后生活质量持续受损可能性较高的患者（在本研究中，包括教育水平较低且化疗前有许多症状的患者）很重要，这可能为更好的个体化患者预防策略开辟道路。
