Breast cancer survivors have high quality of life after lumpectomy, radiation
BOSTON—Women with breast cancer, who are treated with lumpectomy and radiation, report a high level of overall quality of life several years after treatment that is comparable to a general sampling of the adult women U.S. population, according to a survey presented Sunday at the 50th annual meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO).

“Treatments for breast cancer may decrease quality of life temporarily, but this is evidence that survivors on average will return to a normal quality of life,” said Gary Freedman, MD, an attending physician in the department of radiation oncology at Fox Chase Cancer Center in Philadelphia, who led the survey.

The study included women with early-stage breast cancer treated with breast-conserving surgery and radiation with or without chemotherapy and hormone therapy, according to the researchers. During routine follow-up visits with their oncologist, the women were asked to complete a brief questionnaire.

Of the 1,050 women surveyed, Freedman and colleagues found that 32 percent submitted one survey, 29 percent submitted two, 21 percent submitted three and 18 percent submitted four or more surveys. The women were at various points in their follow-up—from three months to 15 years after treatment. The mean follow-up time between treatment and the survey (midway between the two extremes) was three years.

The survey tool used, EQ-5D, a standardized and validated instrument for measuring health outcomes. There were five general questions about health including questions about mobility, self-care, anxiety/depression, pain/discomfort and the ability to perform usual activities. The survey allows for three possible levels of response (one = no problems, two = some problems, or three = extreme problems).

According to the investigators, the answers were combined to determine a health state for each woman at the time of the survey. Considering the five questions and three possible answers for each, there were 243 possible health states. An index number between zero and one was assigned to each health state. The authors said they compared the index scores gathered in the survey to a survey of the general U.S. adult population (Med Care 2005; 43:1078-86).

Freedman and colleagues said that there were no significant differences in health states between patients by age. The mean index score 5 years after treatment was 0.95 for women ages 18, 0.90 for women ages 45, and 0.88 for women older than 64. The mean index score 10 years after treatment was 0.96 for women ages 18, 0.93 for women ages 45, and 0.76 for women older than 64.

By comparison, the authors noted a reported mean index scores for the general U.S. female population by age is 0.91 for ages 18-44, 0.84 for ages 45-64, and 0.81 for women over 64.

“These data appear to show breast cancer survivors have a very high quality of life when compared to the general population,” Freedman said.

He added that in four of the five questions, a statistically significant trend was observed with the women moving between none or some problems over the years following treatment. For the question regarding self care, the patients trend up, moving from "no problems" to "some problems.”

For three of the questions—anxiety, pain and ability to do usual activities—patients reported improved health states from ‘some problems’ to ‘no problems,’ Freedman said. He added that there were very few women (less than 5 percent) reporting extreme problems with pain, usual activity or self care.

“The brevity of this survey with its five questions and three possible responses for each, allows us to conduct it quickly in the clinical setting with more patients,” Freedman concluded. “However, the survey is a general measure of quality of life and does not include information on all possible side effects, such as lymphedema or if the women are happy with their breast appearance.”