Long-Term Physical Decline After Breast Cancer Therapy

By: Maurie Markman, MD

From: medscape.com

Clearly, it is well recognized, well established, and not controversial that chemotherapy and hormone therapy improve survival in breast cancer. Whether you’re looking at this in the metastatic setting in advanced disease or in the adjuvant setting, studies over multiple decades have clearly demonstrated improved survival when, of course, the therapy is given based upon data from well-designed, randomized phase 3 trials.

However, it is also recognized that these agents can have a negative impact on quality of life and physical health during therapy. Again, there’s not a question about that either. What has been appropriately questioned is the longer-term effects of such therapy.

We’re obviously talking about patients who are living much longer now with advanced disease, and certainly patients with adjuvant therapy who hopefully will live a normal lifespan measured in multiple decades. What are the longer-term effects on physical health associated with chemotherapy or hormonal therapies?

Now, obviously, there are many studies that are looking at this and have been looking at this, but I think this particular study is an important milestone providing some information to be provided to current and future patients who will be receiving such therapy.

This analysis looked at the Cancer Prevention Study-3, which was a prospective United States cohort study, which enrolled participants from 35 different states, the District of Columbia, and Puerto Rico. Individuals were treated from 2006 to 2013. Importantly, the focus here was on patient-reported outcomes, and that was a measurement that was prospectively used.

In this analysis, they included 2566 individuals with breast cancer, and they were age matched to 12,826 women who did not have breast cancer during this period of time. There were individuals with breast cancer, 48% of whom received endocrine therapy, 11% received chemotherapy, and 25% received both endocrine therapy and chemotherapy, and they were matched in terms of patient-reported outcomes with this group of individuals who did not have cancer.

Bottom line: Compared to the women who did not have breast cancer, both endocrine therapy and chemotherapy were associated with greater health declines within 2 years of their initial diagnosis. It should be noted, and again not surprisingly, that the women who received chemotherapy had a greater decline in their health compared to the women who received hormonal therapy.

Importantly, the decline with endocrine therapy was restricted to, at least in the statistical sense, women who received aromatase inhibitors. It was the aromatase inhibitors that had the impact from an endocrine perspective on decline in health, patient-reported outcomes, in the first 2 years, and that was less than overall seen with chemotherapy.

However, an important point of the paper and this analysis was that if you looked beyond 2 years, compared to the population of women who did not have cancer, there was no reduction in overall health in the women who had been prescribed endocrine therapy. Again, not surprisingly, because the drugs caused neuropathy, etc., women who received chemotherapy did have a reduction in health as measured in this patient-reported outcome beyond 2 years with chemotherapy, but not with endocrine therapy.

This is clearly important information. We need more data and other analyses. We can now share with patients with breast cancer who are scheduled, asked, suggested, or recommended to receive chemotherapy and endocrine therapy, what the long-term effects are, as reported by patients, in terms of health.