Quality of life scores predict outcome in metastatic but not in early breast cancer

We compared the prognostic value of quality of life (QL) scores in the adju vant setting and after relapse in two randomized trials of the Internationa l Breast Cancer Study Group (IBCSG). More than 2000 premenopausal and postm enopausal patients with node-positive breast cancer participating in random ized trials comparing adjuvant therapies completed QL assessments for physi cal wellbeing (PWB), mood, appetite and coping at study entry, at months 3 and 18 if they remained relapse-free, and at I month and at 6 months after relapse. Cox regression models were used to test the relationship between Q L scores and disease-free survival (DFS) in the adjuvant setting, or overal l survival in the case of post-relapse QL measurement. All models were stra tified by language/country group and included other factors related to QL a nd/or outcome. DFS was not significantly predicted by QL scores at baseline or month 18, or by changes in QL score between baseline and months 3 or 18 . In contrast, after relapse, QL scores were predictive for subsequent over all survival One month after relapse, better mood (P = 0.04) was associated with longer survival in premenopausal patients, and better appetite (P = 0 .005) in postmenopausal patients. Six months after relapse, PWB (P = 0.03) and appetite (P = 0.03) were predictive for survival in premenopausal, and PWB ( P < 0.0001), mood (P = 0.002), appetite (P = 0.0001) and coping (P = 0.0001) in postmenopausal patients. Any prognostic significance of QL scores in the adjuvant setting is minimal or obscured by chemotherapy effects, but there is strong prognostic signif icance after disease relapse. The contrast suggests that patient perception of the severity of underlying illness may determine reported QL scores. (C ) 2001 Harcourt Publishers Ltd.