DO PATIENTS WITH ADVANCED BREAST-CANCER BENEFIT FROM CHEMOTHERAPY

This study aimed to assess the proportion of patients with advanced br east cancer who report benefit from first-line palliative chemotherapy using a simple global measure of wellbeing and to identify factors pr edicting benefit. A consecutive series of women with advanced breast c ancer undergoing first-line palliative chemotherapy was evaluated. The main outcome measure was patient report of overall wellbeing assessed at post-treatment interview. Physical, psychological and functional s tatus were assessed using the Rotterdam Symptom Checklist (RSCL) on th ree occasions (pretreatment, at the start of the third cycle and post treatment). It was planned that treatment would be discontinued after six cycles (i.e. 18-24 weeks). One hundred and sixty patients started treatment, of whom 155 were assessable for quality of life. After trea tment, 41 (26%) patients reported they felt better. 29 (19%) felt the same and 34 (22%) felt worse than they did before treatment. The other 51 (33%) patients either died or stopped attending the hospital befor e the post-treatment interview and were assigned as treatment 'failure s'. Patients who reported feeling better after treatment had improveme nts in psychological distress (P < 0.0001), pain (P = 0.01), lack of e nergy (P = 0.02) and tiredness (P = 0.02), as well as improvement in f unctional status (P = 0.07). Feeling better was also correlated with d isease response (P = 0.03). Feeling worse after treatment or treatment 'failure' was predicted by the pretreatment presence of a dry mouth ( P = 0.003) and high levels of psychological distress (P = 0.03). Pretr eatment lack of energy (P = 0.01), dry mouth (P = 0.02), presence of l iver metastases (P = 0.03) and breathlessness (P = 0.03) predicted tre atment 'failures'. The results of this study suggest that first-line p alliative chemotherapy for advanced breast cancer confers benefit on a substantial proportion of patients, with about one-quarter feeling be tter after treatment and nearly a half feeling better or the same some 4-6 months after the start of treatment. Factors identified in this s tudy may assist clinicians in deciding which patients should not be of fered treatment, because of high risk of feeling worse or treatment 'f ailure'. This work now needs to be validated on a further cohort of wo men receiving chemotherapy for advanced breast cancer.