Quality of life and quality-adjusted survival (Q-TWiST) in patients receiving dose-intensive or standard dose chemotherapy for high-risk primary breast cancer

Quality of life ( QL) is an important consideration when comparing adjuvant therapies for early breast cancer, especially if they differ substantially in toxicity. We evaluated QL and Q-TWiST among patients randomised to adjuvant dose-intensive epirubicin and cyclophosphamide administered with filgrastim and progenitor cell support ( DI-EC) or standard-dose anthracycline-based chemotherapy ( SD-CT). We estimated the duration of chemotherapy toxicity ( TOX), time without disease symptoms and toxicity ( TWiST), and time following relapse ( REL). Patients scored QL indicators. Mean durations for the three transition times were weighted with patient reported utilities to obtain mean Q-TWiST. Patients receiving DI-EC reported worse QL during TOX, especially treatment burden ( month 3: P < 0.01), but a faster recovery 3 months following chemotherapy than patients receiving SD-CT, for example, less coping effort ( P < 0.01). Average Q-TWiST was 1.8 months longer for patients receiving DI-EC ( 95% CI, -2.5 to 6.1). Q-TWiST favoured DI-EC for most values of utilities attached to TOX and REL. Despite greater initial toxicity, quality-adjusted survival was similar or better with dose-intensive treatment as compared to standard treatment. Thus, QL considerations should not be prohibitive if future intensive therapies show superior efficacy.