Economics, quality of life and breast cancer outcomes - is a balance possible?

Breast cancer is a leading cause of cancer death and a major source of heal thcare expenditure in most countries in the developed world. Recent therape utic advances have led to widespread use of breast-conserving therapy and t o increased use of systemic adjuvant therapy. New hormonal. chemotherapeuti c and supportive care agents have been introduced in the metastatic setting . Collectively, these advances have led to increased survival and, arguably , enhanced quality of life. However. incremental survival benefits have oft en been small and psychosocial/quality of life improvements difficult to qu antify. In contrast, both incremental and total costs have usually been lar ge and readily apparent. Available resources have often been inadequate to provide what is perceived to be optimal care to all patients. and it has be en necessary to make trade-offs between survival. psychosocial status/quali ty of life and costs. Approaches to incorporation of quality of life into e conomic evaluations are reviewed and limitations discussed. Published econo mic evaluations in breast cancer are summarized. Potential approaches to ba lancing costs and benefits. as they apply to breast cancer. are outlined. ( C) 2001 Harcourt Publishers Ltd.