Quality of Life Results Can Be Put to Practical Use in the Oncology Clinic

LONG BEACH, Calif--A breast cancer patient who is a good candidatefor breast conservation says to her physician, "I want amastectomy. I don't want to have radiation."

By referring to a 1992 study that compared quality of life outcomesamong women who had mastectomy and those who chose breast conservation,the physician can tell his patient with confidence that womenreport little difference between the two treatments in their impacton quality of life.

The only significant differences reported in this study were interms of body image and clothing fit, which were significantlybetter among the lumpectomy patients.

Patricia Ganz, MD, used this example of a practical applicationof a quality of life study in her presentation at the 1995 Qualityof Life symposium, sponsored by St. Mary Medical Center.

Dr. Ganz, of the Jonsson Comprehensive Cancer Center, Los Angeles,also cited one of the first studies to look at quality of lifein addition to survival, published in 1987.

The main thrust of this randomized study of women with advancedmetastatic breast cancer, Dr. Ganz said, was to compare continuouschemotherapy with intermittent therapy (3 months of treatmentwith resumption of therapy only when symptoms recur).

The researchers hypothesized that the continuous chemotherapywould have more adverse effects on quality of life, but in fact,the study showed that quality of life was better in patients receivingcontinuous therapy. They also found that baseline quality of lifepredicted long-term survival.

The clinical implication is that the toxicity of therapy was outweighedby the improvement in disease status, Dr. Ganz said. Althoughnausea was more common in the patients who had continuous therapy,in the patients' own estimation, quality of life was better becausethe disease was under control for a longer time.

"In my clinical practice, in patients with advanced disease,I can refer to this particular study as a reason why we wouldnot stop therapy shortly after getting the symptoms under control,"she said.