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Study: Chemo's Benefits Trump Burdens

Worth the physical cost for breast cancer patients

FRIDAY, July 27, 2001 (HealthDayNews) -- Breast cancer patients teetering about whether to abandon chemotherapy should know this: While the drugs may be harsh, they bring more good than harm.

A new review of dozens of earlier studies shows that so-called adjuvant breast cancer drugs after tumor surgery prolong life and improve the quality of those extra months, particularly for younger women. However, the analysis says, while the benefits are significant for older women, too, they're somewhat more variable and, for some patients, might be cause for deliberation.

"The chemotherapy is a lot easier to take than dying of cancer is," says Dr. Herman Kattlove, a medical editor at the American Cancer Society who is familiar with the latest research.

Studies have shown conclusively that chemotherapy prevents relapse and prolongs life. Less clear, however, is at what cost.

"Just knowing that chemotherapy reduces some risk might not by itself be enough," says Bernard Cole, a community and family health researcher at Dartmouth Medical School in Lebanon, N.H. He is lead author of the review, which appears in the July 28 issue of The Lancet.

Cole and his colleagues analyzed 47 trials of breast cancer chemotherapy, involving 18,000 women, to learn how effectively the treatment cuts the risk of relapse and death, and whether the intense toxicity of the drugs outweighed those gains.

The researchers used a model called Q-TWiST, short for Quality-adjusted Time Without Symptoms of Disease or Toxicity of Treatment, to balance the benefits of long-term chemotherapy with its side effects, such as nausea, vomiting, hair loss, early menopause, blood cell problems and other common reactions.

For patients under age 50, multiple drug therapy was clearly better than no treatment. Women in this group survived an average of about 10 months longer without relapsing than those who didn't receive the drugs, and they gained about five months of overall survival across a 10-year period, the researchers say.

Women between 50 and 69 also seemed to benefit from chemotherapy, but had somewhat shorter disease-free and overall survival periods than the younger patients.

"Our findings mainly confirmed the rationale for using chemotherapy. In most cases the benefits of chemotherapy are significant and large enough to outweigh its burdens in terms of side effects," Cole says.

Younger women in almost every case will do better on the drugs than without them, though for older women the choice could be somewhat muddier, Cole says. In both cases, he says the matter should be decided only through conversations between patients and doctors, who now have a highly specialized tool to aid their decision.

Dr. Clifford Hudis, who participated in the analysis, says the report "is a way of quantifying something that we all can feel and know. ... A lot of rational people would say, 'What's the tradeoff there?' This puts into real terms that you suffer a little bit for your treatment, but in the end you benefit from it."

What To Do

About 180,000 American women will develop breast cancer this year, and some 43,000 will die from the disease. Women can reduce their risk of breast cancer through lifestyle changes like regular exercise and eating a healthy diet.

To learn more about breast cancer and its treatment options, visit the Barbara Ann Karmanos Cancer Institute or the National Cancer Institute.

To learn more about breast cancer screening, visit the American Cancer Society.

SOURCES: Interviews with Bernard Cole, Ph.D., associate professor of community and family medicine, Dartmouth Medical School, Lebanon, N.H.; Herman Kattlove, M.D., medical editor, American Cancer Society, and Clifford Hudis, M.D., chief, breast cancer medicine service, Memorial Sloan-Kettering Cancer Center, New York City; July 28, 2001, The Lancet
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