Palliative effect of chemotherapy: Objective tumor response is associated with symptom improvement in patients with metastatic breast cancer

Purpose: Because one of the goals of chemotherapy for metastatic breast can cer is to provide symptom palliation, we were interested in identifying the relationship between tumor shrinkage and improvement in disease-related sy mptoms. Patients and Methods: Three hundred patients enrolled onto a randomized tri al of metastatic breast cancer formed the basis of our study. The nine most common baseline symptoms were identified and followed. Changes from baseli ne (improvement, stable, worsening) were defined using patient responses to a quality-of-life (QoL) questionnaire (the European Organization for Resea rch and Treatment of Cancer EORTC QLQ-C30) as well as using graded toxicity data collected on case report forms (CRFs). The association between sympto m improvement and tumor response was assessed using a linear trend test via a logistic regression model. Results: The most commonly reported baseline symptoms were cancer pain in 3 8% (CRF data) and 81% of patients (QoL data) and tiredness in 26% (CRF data ) and 89% (QoL data) of patients. Three symptoms-cancer pain, shortness of breach, and abnormal mood-showed a significant relationship between improve ment and objective response, using bath CRF and QoL assessments, Constipati on, anorexia, and nausea showed a similar trend when QoL data were used but not when CRF information was used. The converse was seen for lethargy. The re wets no correlation between symptom change and response for cough and in somnia. Conclusion: For some symptoms, we found a significant association between s ymptom improvement and objective tumor regression. In these cases, symptom improvement was greatest in those patients who had complete or partial resp onses, followed by those with stable disease and then those with progressiv e disease. Further work in this area will be useful in determining the surr ogate value of objective tumor response in identifying the efficacy of pall iative chemotherapy. J Clin Oncol 18:2395-2405. (C) 2000 by American Societ y of Clinical Oncology.