Adding bevacizumab to chemotherapy does not worsen quality of life in breast cancer subset
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The addition of bevacizumab to chemotherapy did not appear to be negatively associated with quality of life at 18 months in lymph node-positive or high-risk lymph node-negative breast cancer, according to a study in JAMA Network Open.
However, researchers reported a substantial proportion of patients experienced issues related to pain or discomfort and anxiety or depression.
“While there were no differences in quality of life across treatment arms at 18 months, in secondary analyses, which evaluated whether there were associations between sociodemographic and clinical factors and quality of life, we found that mastectomy with radiation and nonwhite race was associated with lower quality of life, underscoring the importance of timely referral to supportive care resources for groups that may be at increased risk for experiencing diminished quality of life,” Shoshana Rosenberg, ScD, MPH, assistant professor of population health sciences in the division of epidemiology at Weill Cornell Medicine, told Healio.
Background and methodology
Breast cancer treatment is often lengthy, resulting in a substantial impact on patients’ quality of life. Rosenberg and colleagues sought to identify factors associated with reduced quality of life among breast cancer survivors who had received intensive systemic therapy.
The analysis included data at 18 months from 455 patients (median age at enrollment, 52 years; range, 25-76; 99% women; 86% white) with lymph node-positive or high-risk lymph node-negative breast cancer enrolled in ECOG-ACRIN E5103, a multisite, phase 3 trial from January to June 2010.
Patients had undergone definitive surgery and received adjuvant doxorubicin, cyclophosphamide and paclitaxel with either bevacizumab (Avastin, Genentech) or placebo. Researchers surveyed patients 18 months after enrollment.
Quality of life and health status — assessed with the EuroQol 5-Dimensions 3-Levels, EuroQol-visual analog scale and Functional Assessment of Cancer Therapy Scale-Breast Cancer, with arm subscale — served as the primary outcomes.
Key findings
Results at 18 months showed more than half of patients (258 of 444; 58%) reported at least some pain or discomfort and 170 (38%) reported symptoms of anxiety or depression. Multivariable analyses revealed associations of mastectomy with radiation (vs. breast-conserving surgery) and Asian, Black, or American Indian or Alaska Native race (vs. white race) with lower quality of life (mastectomy with radiation: coefficient = 5.5; 95% CI, 10.1 to 0.9; Asian, Black, or American Indian or Alaska Native race: coefficient: 7.3; 95% CI, 13.2 to 1.4).
Rosenberg and colleagues reported no differences in quality of life or health status across groups treated with chemotherapy plus placebo, plus bevacizumab or plus extended bevacizumab.
“It was reassuring that those who received extended-duration targeted therapy were no more likely to experience worse quality of life at 18 months than patients who did not,” Rosenberg said. “It is concerning that more than half of all patients did report pain and discomfort and greater than a third reported some symptoms of anxiety and depression.”
Implications
Rosenberg and colleagues concluded that routine monitoring of symptoms and functional status in breast cancer survivors is necessary to find and treat symptoms that may adversely affect quality of life.
“Collectively, our findings highlight the continued need for attention to both physical and psychosocial sequelae of a breast cancer diagnosis and treatment following the completion of active treatment and into survivorship,” Rosenberg said.
For more information:
Shoshana M. Rosenberg, ScD, MPH, can be reached at Department of Population Health Sciences, Weill Cornell Medicine, 402 E. 67th St., LA-0005, New York, NY 10065; email: shr4009@med.cornell.edu.
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