Comparison of Adjuvant Therapies Using Quality-Of-Life Considerations
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Auteurs : Richard D. Gelber [États-Unis] ; A. GoldhirschSource :
- International Journal of Technology Assessment in Health Care [ 0266-4623 ] ; 1989-07.
Abstract
The benefit for patients with operable breast cancer treated with adjuvant systemic therapy is small, if reduction of early mortality within the context of randomized control trials is used for treatment comparison. One might consider that the 75%–85% of patients who die despite treatment are overtreated, as are patients who remain alive even without therapy within a given time frame. Larger treatment benefits in terms of avoided or delayed breast cancer relapse have been demonstrated even at early phases of follow-up in the vast majority of adjuvant trials. Exposure of all patients to adjuvant therapy at a time at which no symptoms of disease are present is detrimental in terms of quality of life. Based on our assumption that the quality of life of the patient is typically altered both by subjective toxic effects of adjuvant treatment and by the appearance of relapse, we developed a method of comparing treatment effects in terms of time without symptoms of disease and toxicity of treatment (TWiST). Because the impact of treatment on relapse rates appears earlier than survival effects in all adjuvant therapy trials, and because the value of time without relapse in terms of the quality of life of the patients is as yet poorly defined, we have generalized our method of comparing treatment attitudes to include individual qualitative judgment values. The experience gained from integrating quality-of-life issues into clinical trials for breast cancer might also be applied to other diseases characterized by a chronic course, toxic treatments, and gains in periods of relative or absolute freedom from toxic effects and progressive disease.
Url:
DOI: 10.1017/S0266462300007467
Affiliations:
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Gelber</name><affiliation wicri:level="3"><country>États-Unis</country><placeName><settlement type="city">Boston</settlement><region type="state">Massachusetts</region></placeName><wicri:orgArea>Harvard medical School and School of Public Health Dana-Farber Cancer Institute</wicri:orgArea></affiliation></author><author><name sortKey="Goldhirsch, A" sort="Goldhirsch, A" uniqKey="Goldhirsch A" first="A." last="Goldhirsch">A. Goldhirsch</name><affiliation><wicri:noCountry code="subField">Mendrisio</wicri:noCountry></affiliation></author></analytic><monogr></monogr><series><title level="j">International Journal of Technology Assessment in Health Care</title><title level="j" type="abbrev">Int J Technol Assess Health Care</title><idno type="ISSN">0266-4623</idno><idno type="eISSN">1471-6348</idno><imprint><publisher>Cambridge University Press</publisher><pubPlace>New York, USA</pubPlace><date type="published" when="1989-07">1989-07</date><biblScope unit="volume">5</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="401">401</biblScope><biblScope unit="page" to="413">413</biblScope></imprint><idno type="ISSN">0266-4623</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0266-4623</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">The benefit for patients with operable breast cancer treated with adjuvant systemic therapy is small, if reduction of early mortality within the context of randomized control trials is used for treatment comparison. One might consider that the 75%–85% of patients who die despite treatment are overtreated, as are patients who remain alive even without therapy within a given time frame. Larger treatment benefits in terms of avoided or delayed breast cancer relapse have been demonstrated even at early phases of follow-up in the vast majority of adjuvant trials. Exposure of all patients to adjuvant therapy at a time at which no symptoms of disease are present is detrimental in terms of quality of life. Based on our assumption that the quality of life of the patient is typically altered both by subjective toxic effects of adjuvant treatment and by the appearance of relapse, we developed a method of comparing treatment effects in terms of time without symptoms of disease and toxicity of treatment (TWiST). Because the impact of treatment on relapse rates appears earlier than survival effects in all adjuvant therapy trials, and because the value of time without relapse in terms of the quality of life of the patients is as yet poorly defined, we have generalized our method of comparing treatment attitudes to include individual qualitative judgment values. The experience gained from integrating quality-of-life issues into clinical trials for breast cancer might also be applied to other diseases characterized by a chronic course, toxic treatments, and gains in periods of relative or absolute freedom from toxic effects and progressive disease.</div></front></TEI><affiliations><list><country><li>États-Unis</li></country><region><li>Massachusetts</li></region><settlement><li>Boston</li></settlement></list><tree><noCountry><name sortKey="Goldhirsch, A" sort="Goldhirsch, A" uniqKey="Goldhirsch A" first="A." last="Goldhirsch">A. Goldhirsch</name></noCountry><country name="États-Unis"><region name="Massachusetts"><name sortKey="Gelber, Richard D" sort="Gelber, Richard D" uniqKey="Gelber R" first="Richard D." last="Gelber">Richard D. Gelber</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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