Adjuvant Therapy in Breast Cancer Could Have Long-Term Physical Effects

Embargoed for Release4 p.m. ET on Jan. 1, 2002

Kim Irwin ([email protected]) (310) 206-2805

LONG-TERM BREAST CANCER SUVIVORS MAINTAIN EXCELLENT QUALITY OF LIFE, STUDY FINDS, BUT TREATMENT WITH CHEMOTHERAPY AND TAMOXIFEN CAN IMPAIR PHYSICAL FUNCTIONING OVER TIME

UCLA Jonsson Cancer Center Study, One of the Largest of its Kind, Could Influence the Way Doctors Treat Breast Cancer Patients with Small Tumors, Researchers Say

Long-term breast cancer survivors report excellent quality of life many years after treatment, but the use of chemotherapy and tamoxifen in addition to surgery may result in decreased physical functioning over time, according to a study published in Tuesday's (Jan. 2) issue of the peer-reviewed Journal of the National Cancer Institute.

The study, one of the largest examining quality of life in long-term breast cancer survivors, could influence the way doctors treat women with very small tumors, said Dr. Patricia Ganz, senior author of the article and director of the Division of Cancer Prevention and Control Research at UCLA's Jonsson Cancer Center.

"The question has been asked: Should every woman, even those with very small tumors, receive chemotherapy or tamoxifen or both after surgery?" Ganz said. "I think, in light of this research, the answer may be no. This study shows there are some subtle costs to be paid with adjuvant therapy. But the only place this would carry any weight would be in women with tumors less than a centimeter in size."

Whether women who have small tumors removed really need additional therapy has sparked debate in recent years. There is a substantial benefit to additional, or adjuvant, treatment with chemotherapy and/or tamoxifen in women with tumors larger than a centimeter, or in patients whose cancer has spread to the local lymph nodes. However, for very small tumors, the risk of recurrent cancer is so low that the potential short- and long-term toxicity of the treatments may play a role in decision-making, Ganz said.

Prior to this study, it was generally accepted that adjuvant treatments did not diminish long-term quality of life and physical functioning, so doctors often were not concerned about late effects when they recommended adjuvant therapy to their patients. But this research indicates that women who receive these treatments may have a significant decline in physical functioning compared to breast cancer survivors who did not receive these treatments. However, emotional and social functioning does not deteriorate over time in any of the survivors, the study showed. Women who received chemotherapy, however, had more sexual discomfort and vaginal dryness.

Previous studies, including a large study by Ganz and her colleagues at UCLA, USC and at Georgetown University Medical School, have shown that breast cancer survivors experience good quality of life and physical functioning in the first few years after treatment. Few studies, however, have examined how women do five to 10 years after treatment, said Ganz, who has been conducting quality of life research since 1980.

In this follow-up study, Ganz and her team of researchers focused on 763 disease-free women in Los Angeles and Washington, D.C., who were an average of 6.3 years out from breast cancer diagnosis. The women, who had participated in Ganz's earlier study, filled out 42-page questionnaires seeking information on such quality of life issues as physical functioning, social functioning, pain, mental health, vitality, sexual desire and function and body image. Standardized measures were used to rate quality of life, mood and well being, Ganz said.

"We wanted to see what the long-term effects of a breast cancer diagnosis really were," said Ganz. "We knew what the effects were for women just a few years out from diagnosis from our previous study, so we had a baseline response for comparison."

Overall, the disease-free breast cancer survivors in the follow-up study reported excellent quality of life, with high levels of health and emotional well being. Energy levels and social functioning were good, as were social support systems, Ganz said. These findings were consistent with findings in the previous study. Women in the follow-up study reported fewer problems with hot flashes, night sweats, vaginal discharge and breast sensitivity, but more vaginal dryness, loss of urinary control and a decline in sexual activity. The latter findings may be attributed to age and are not specifically related to cancer treatments.

The follow-up study also confirmed findings from the previous study that a breast cancer diagnosis is harder psychologically on younger women than it is on older women, and that it can positively affect such behaviors as diet, exercise and spirituality.

A difference emerged, however, in the detailed comparison of women according to past types of adjuvant treatment, where several aspects of physical functioning were worse in women who had received treatment with chemotherapy and/or tamoxifen. "I was surprised by these results," Ganz said. "Earlier studies had indicated that adjuvant chemotherapy and tamoxifen didn't have an impact on quality of life. But we've discovered in this follow-up study that the treatments are associated with some late adverse physical effects. This information may be important for women with very small tumors who are weighing the risks and benefits of adding adjuvant treatment on to surgery and radiation."

The study concludes: "These findings suggest that there may be -- effects from treatment that do not appear until many years later."

This year alone, more than 190,000 women will be diagnosed with breast cancer. And women who survive breast cancer make up about half of all female cancer survivors, according to the National Cancer Institute. There are estimated to be more than 2 million breast cancer survivors alive now in the United States.

-UCLA-

For more information about UCLA's Jonsson Cancer Center, its people and resources, visit our site on the World Wide Web at http://www.cancer.mednet.ucla.edu.