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The preference to receive chemotherapy and cancer-related outcomes in older adults with breast cancer CALGB 49907 (Alliance)
Authors:Ajeet Gajra  Linda McCall  Hyman B. Muss  Harvey J. Cohen  Aminah Jatoi  Karla V. Ballman  Ann H. Partridge  Linda Sutton  Barbara A. Parker  Gustav Magrinat  Heidi D. Klepin  Jacqueline M. Lafky  Arti Hurria
Affiliation:1. SUNY Upstate Medical University, Syracuse, NY, United States;2. Alliance Statistics and Data Center, Duke University Medical Center, Durham, NC, United States;3. UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC, United States;4. Duke University Medical Center, Durham, NC, United States;5. Mayo Clinic, Rochester, MN, United States;6. Dana-Farber/Partners CancerCare, Boston, MA, United States;7. UC San Diego Moores Cancer Center, La Jolla, CA, United States;8. Cone Health Cancer Center, Greensboro, NC, United States;9. Wake Forest University Health Sciences, Winston-Salem, NC, United States;10. City of Hope Comprehensive Cancer Center, Duarte, CA, United States;11. Weill Medical College of Cornell University, New York, NY, United States
Abstract:

Objective

Chemotherapy preference refers to a patient's interest in receiving chemotherapy. This study examined whether chemotherapy preference was associated with toxicity, efficacy, quality of life (QoL), and functional outcomes during and after completion of adjuvant chemotherapy in older women with breast cancer.

Materials and Methods

This study is a secondary analysis of CALGB 49907, a randomized trial that compared standard adjuvant chemotherapy versus capecitabine in patients age 65?years or older with breast cancer. A subset of 145 patients completed a questionnaire to describe chemotherapy preference pre-treatment. The association of this pre-treatment preference with the patient's perception of self-health, predicted and actual QoL, patient- and professional-reported toxicity, mental health, self-rated function, and survival was studied during and after treatment.

Results

The median age of patients was 71?years and 47% had a high preference for chemotherapy. On baseline demographics, the low preference group had a higher proportion of white patients (95% vs. 78%, p?=?0.004). Before treatment, low chemotherapy preference was associated with greater nausea/vomiting (p?=?0.008). Mid-treatment, low preference was associated with lower QoL, worse social, emotional and physical function (all p?≤?0.02) and worse nausea/vomiting, cancer symptoms and financial worries (all p?p?=?0.02) but was not associated with survival.

Conclusions

Low chemotherapy preference prior to treatment initiation was associated with lower QoL, worse physical symptoms and self-rated function and more adverse events mid-treatment. There is no association of chemotherapy preference with survival.
Keywords:Adjuvant chemotherapy  Breast cancer  Decision-making  Elderly
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