CHICAGO, IL—Early intervention to reduce symptom burden should be offered to young women with breast cancer on ovarian function suppression and tamoxifen, who experience poorer quality of life (QOL) in the early survivorship period compared with those on tamoxifen alone, according to a study presented at the 2015 American Society of Clinical Oncology (ASCO) Annual Meeting.
Such intervention has the potential to “improve QOL, enhance adherence, and optimize survival,” noted Shoshana M. Rosenberg, ScD, of Dana-Farber Cancer Institute in Boston, MA, and colleagues. Compared with tamoxifen alone, women on tamoxifen and ovarian function suppression experience more vasomotor systems and, in those who receive chemotherapy, greater cognition issues, and poorer QOL.
Recently, data have shown that when added to tamoxifen or aromatase inhibitors (AIs), ovarian function suppression can improve breast cancer-free survival in younger women with hormone receptor-positive (HR+) breast cancer. This prospective study evaluated the impact of suppression on QOL in young women, a known population at risk for worse QOL outcomes and survival.
As part of a cohort study enrolling women age 40 years or younger newly diagnosed with breast cancer, the investigators collected patient-reported symptom and QOL data 1 year after diagnosis.
Using the Breast Cancer Prevention Trial checklist, symptom severity was compared between women on ovarian function suppression plus tamoxifen and tamoxifen alone. For QOL, differences in mean scores between the two groups were compared using the Cancer Rehabilitation Evaluation System (CARES) physical, psychosocial, sexual subscales. All study participants were stratified by chemotherapy receipt and, because of small numbers, women receiving AIs were excluded.
A total of 106 women, or 24%, of the 444 women with stage 0-III, HR+ disease on tamoxifen reported ovarian function suppression use. Among the 333 who had chemotherapy, those on ovarian function suppression had higher mean CARES scores, representing worse QOL, on all 3 subscales, (all P≤0.05). In contrast, mean scores for the 111 women who did not receive chemotherapy did not differ significantly between groups.
In the chemotherapy group, women on ovarian suppression plus tamoxifen reported significantly more “at least moderately bothersome” menopausal symptoms than those on tamoxifen alone. These included hot flashes (59% vs. 39%; P=0.002), night sweats (47% vs. 33%; P=0.03), vaginal dryness, (36% vs. 28%; P=0.20), difficulty concentrating (42% vs. 27%; P=0.02), easily distracted (39% vs. 26%; P=0.03), weight gain (21% vs. 11%; P=0.04), and unhappy with appearance (49% vs. 34%; P=0.02). Among women who did not receive chemotherapy, only hot flashes (77% vs. 30%; P<0.0001), night sweats (63% vs. 35%; P=0.009), and vaginal dryness (33% vs. 16%; P=0.06) were reported by a greater percentage on ovarian function suppression and tamoxifen compared with tamoxifen alone.
1. Rosenberg SM, Ruddy KJ, Tamimi RM, et al. Ovarian function suppression, symptom burden, and quality of life in young women with breast cancer: A prospective study. J Clin Oncol. 2015:33;(suppl; abstr 515).