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Abstract
Background: The concept of quality of life (QOL) increasingly has been used to assess health-related
outcomes associated with a specific disease or its treatment, especially in patients
with incurable tumors, such as metastatic breast cancer (MBC). Hormonal therapy (HT)
is often used to treat hormone receptor—positive MBC, with the primary treatment goal
of reducing both disease burden and patients suffering.
Objective: This article reviews the instruments used to assess QOL in patients with breast
cancer, the adverse effects of HTs, and the clinical trials that assess QOL in patients
with MBC receiving various HTs.
Methods: Articles were identified for inclusion in this manuscript through the following
searches, limited to English-language publications: MEDLINE (mid 1960s to January
2002), American Society of Oncology abstracts (1997–2001), and San Antonio Breast
Cancer Symposium abstracts (2001 and 2002). The following search terms were used:
quality of life, breast cancer, hormonal therapies, tamoxifen, toremifene, letrozole,
anastrozole, exemestane, and megestrol acetate.
Conclusions: QOL assessment following MBC treatment has become an important indicator of treatment
effectiveness, and numerous clinical trials have studied the impact of HT on QOL.
In general, the older HTs, such as the progestins and selective estrogen receptor
modulators (SERMs), produce more adverse effects than do the newer HTs, such as the
aromatase inhibitors (AIs) and estrogen receptor (ER) antagonists. QOL data regarding
tamoxifen, a SERM associated with a high incidence of vasomotor symptoms and vaginal
discharge, are limited, although tamoxifen has not been associated with significant
psychological distress when administered as a chemopreventive or adjuvant MBC therapy
in clinical trials. QOL studies comparing the third-generation AIs with tamoxifen
or megestrol acetate show that the AIs produce a more favorable QOL, probably because
these agents target the aromatase enzyme, which results in a lower incidence of thromboembolism
and vaginal bleeding. Although QOL studies of the ER antagonist fulvestrant have not
been conducted, several attributes of this new HT may contribute to the retention
of a good QOL in patients with MBC. A variety of QOL-assessment tools to measure the
impact of HTs on patients with MBC are available. Clinical trial data regarding QOL
in patients with MBC receiving HT will be useful for both clinicians and patients
in evaluating treatment options and developing treatment strategies.
Keywords
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Article info
Publication history
Accepted:
April 2,
2002
Identification
Copyright
© 2002 Published by Elsevier Inc.
