Effect of peri-operative chemotherapy on the quality of life of patients with early breast cancer

doi:10.1016/0277-5379(90)90046-V

European Journal of Cancer and Clinical Oncology

Volume 26, Issue 10, 1990, Pages 1038-1042

European Journal of ...

https://doi.org/10.1016/0277-5379(90)90046-V Get rights and content

Abstract

Since chemotherapy is assumed to have a negative impact on quality of life, the impact of peri-operative chemotherapy on physical, psychological and social well-being and on the activity level of patients with early stage breast cancer was investigated. 24 women received peri-operative chemotherapy and 29 did not. They were interviewed 2 months and at a mean of 12 months post-surgery. Although the treated group reported more fatigue and considered hair loss a severe side-effect, no differences were found in overall physical and psychological well-being, perceived social interaction and activity level at 2 months. 1 year after surgery no differences were found between the two groups. Although no substantial effects of peri-operative chemotherapy on quality of life were demonstrated, patients almost unanimously considered peri-operative chemotherapy the most burdensome aspect of the treatment because of alopecia.

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Cited by (40)

Scalp cooling for reducing alopecia in gynecology oncology patients treated with dose-dense chemotherapy: A pilot project
2021, Gynecologic Oncology Reports
Citation Excerpt :
The psychological effects of hair loss include negative effects on body image, sexuality, self-esteem, and quality of life (Boehmke and Dickerson, 2005; Luoma and Hakamies-Blomqvist, 2004; Richer and Ezer, 2002). Alopecia has been described as one of the most distressing side effects of chemotherapy (Carelle et al., 2002; Kiebert et al., 1990; McGarvey et al., 2001), with effects persisting after patient’s hair returned (Koszalinski and Williams, 2012; Rosman, 2004). Scalp hypothermia is becoming increasingly popular in preventing chemotherapy-induced alopecia, with newer systems such as DigniCap™ using helmets with a continuously supplied coolant to maintain a constant temperature.
Determine the efficacy of scalp cooling for the prevention of chemotherapy-induced alopecia in gynecology oncology patients.
This prospective pilot study included patients diagnosed with a gynecological malignancy that received DigniCap™ scalp cooling. Patients were divided into two groups based on chemotherapy regimen: Carboplatin with area under the curve (AUC) 5–6 every three weeks and (1) conventional Paclitaxel 175 mg/m² every three weeks or (2) Paclitaxel 80 mg/m² weekly. A 1–10 visual analogue scale (1 no hair loss, 10 – complete hair loss) was used to assess degree of hair loss by patients themselves and by a certified dermatologist using photographs. Changes in quality of life and body image were measured using the European Organization for Research and Treatment of Cancer quality of life questionnaire version 3 (EORTC QLQ-C30) and the Body Image Scale (BIS) for cancer patients.
Hair preservation occurred with use of a scalp cooling device for patients receiving weekly Paclitaxel (n = 20), but not conventional every three weeks Paclitaxel (n = 8). Ten of 15 patients (66.7%) in the dose-dense group lost less than 50% of their hair based on self-assessment and 14 of 16 (87.5%) based on dermatologist assessment. No patient in this group acquired a cranial prosthesis (wig). There was no difference between groups in terms of quality of life (QoL) and BIS scores.
Scalp cooling may allow for hair preservation in gynecology oncology patients receiving Carboplatin AUC 5–6 and weekly Paclitaxel 80 mg/m² combination chemotherapy.
Management of chemotherapy-induced alopecia (CIA): A comprehensive review and future directions
2020, Critical Reviews in Oncology/Hematology
Citation Excerpt :
In one study, the decline in self-esteem was not restored after hair regrowth happened (Münstedt et al., 1997). Conversely, some studies reported that patients were not distressed by alopecia; and in one study, some patients reported that the negative effects of CIA were not significant enough to change their QoL (Kiebert et al., 1990). A limited number of effective prevention strategies for CIA were found, and the only US-FDA approved strategy currently available for patients was found to be scalp-cooling (Nangia et al., 2017).
To review and summarize the available literature on the management of chemotherapy-induced alopecia (CIA) including complementary and alternative medicine (CAM), and to present CIA’s effect on quality of life (QoL).
Nine databases were searched for CIA-related keywords, including the effect on QoL, and management options. Among 1019 articles found, 54 articles focusing on treatment/prevention or QoL were retrieved. References of selected articles were also checked manually.
CIA was found to negatively affect QoL and body image, regardless of head covering status (i.e., for cultural or religious reasons). Most studies related to treatment/prevention of CIA reported on the use of scalp-cooling. The efficacy of CAM treatments was found to be questionable.
A high incidence rate of CIA exists with certain chemotherapies, and it significantly impairs QoL. Preventive and treatment strategies are incompletely effective. Additional literature is needed to explore potential preventive or therapeutic options for CIA.
Preventive effects of cedrol against alopecia in cyclophosphamide-treated mice
2016, Environmental Toxicology and Pharmacology
Although numerous hypotheses have been proposed to prevent chemotherapy-induced alopecia (CIA), effective pharmaceuticals have yet to be developed. In our study, the back hairs of C57BL/6 mice were factitiously removed. These mice were then treated with cedrol or minoxidil daily. Mice with early-stage anagen VI hair follicles were treated with cyclophosphamide (CYP, 125 mg/kg) to induce alopecia. The CYP-damaged hair follicles were observed and quantified by using a digital photomicrograph. The results demonstrated that the minoxidil-treated mice suffered from complete alopecia similar to the model 6 days after CYP administration. Simultaneously, the cedrol-treated (200 mg/kg) mice manifested mild alopecia with 40% suppression. Histological observation revealed that anagen hair follicles of the cedrol-pretreated mice (82.5%) likely provided from damage compared with the sparse and dystrophic hair follicles of the model mice (37.0%). Therefore, the use of topical cedrol can prevent hair follicle dystrophy and provide local protection against CIA.
Chemotherapy-induced alopecia
2012, Journal of the American Academy of Dermatology
Citation Excerpt :
Across the literature, hair loss consistently ranks among the most troublesome and traumatic aspects of chemotherapy (Fig 2).36,37 Almost 90% of patients with early-stage breast cancer considered perioperative chemotherapy to be the most burdensome aspect of their treatment course because of the alopecia.38 Some women have found hair loss to be more difficult to cope with than the loss of a breast.39,40
Chemotherapy-induced alopecia is a distressing side effect common to certain treatment regimens in oncology. Unfortunately, chemotherapy-induced alopecia is an often overlooked or minor factor among our current research priorities and thus advances in amelioration have been minimal. This review offers a comprehensive examination of the clinically relevant basic science, clinical research, and current management options for chemotherapy-induced alopecia. We emphasize that hair loss secondary to chemotherapy is not as random or nonspecific in patterns or extent of disease, as one would initially perceive. Patient support and education information and templates are provided to facilitate patient treatment.
Influence of clinical and biographical factors on the quality of life of women with breast cancer receiving adjuvant chemotherapy
2011, Revista de Calidad Asistencial
La quimioterapia adyuvante afecta a diferentes aspectos de la calidad de vida de la mujer con cáncer de mama. Se ha estudiado su efecto en la calidad de vida y el impacto de las variables clínicas y biográficas.
Una cohorte de mujeres con cáncer de mama, tratadas con quimioterapia adyuvante, participantes en un ensayo clínico aleatorizado de intervención no farmacológica (ClinicalTrials.gov Identifier: NCT00964522), completó los cuestionarios de calidad de vida EORTC QOL-C30 y QOL-BR23 antes, a mitad y al terminar el tratamiento.
Cincuenta mujeres completaron los cuestionarios. La salud global empeoró con el tiempo (p = 0,01). El funcionamiento físico (p = 0,0001) y la imagen corporal (p = 0,002) fueron las escalas más deterioradas. La astenia (p = 0,004), las náuseas y vómitos (p = 0,05) y anorexia (p = 0,025) fueron los síntomas con mayor efecto temporal de la quimioterapia. Las mujeres desempleadas sufrieron peor funcionamiento físico (p = 0,046) y de rol (p = 0,005). Las mayores presentaron más diarrea (p = 0,013). Las más educadas mostraron peor puntuación en la escala de dificultades financieras (p = 0,034). Los casos con estadios más avanzados sufrieron mayor deterioro en su imagen corporal (p = 0,001) y estuvieron más preocupados por su futuro (p = 0,006). Las tratadas con antraciclinas y taxanos sintieron también peor perspectiva de futuro (p = 0,02).
La quimioterapia adyuvante deteriora la calidad de vida de mujeres con cáncer de mama, sobre todo en su funcionamiento físico e imagen corporal. La astenia y toxicidad digestiva son los efectos secundarios predominantes. Las mujeres necesitan soporte si son mayores, desempleadas, mejor formadas, con estadio III y tratadas con antraciclinas y taxanos.
Adjuvant chemotherapy affects the life of women with breast cancer in different ways. The aim of this work is to study the effect of adjuvant chemotherapy on the quality of their lives and the impact of their clinical and biographical characteristics.
Women with breast cancer, candidates for adjuvant chemotherapy, participating in a randomised trial with non-pharmacological intervention (ClinicalTrials.gov Identifier: NCT00964522), completed the EORTC QOL-C30 and QOL-BR23 quality of life questionnaires before, in the middle, and at the end of the treatment.
Fifty women completed the questionnaires. Overall health got worse over time (p = 0.01). Physical functioning (p = 0.0001) and body image (p = 0.002) were the scales that deteriorated most, and asthenia (p = 0.004), nausea/vomiting (p = 0.05), and anorexia (p = 0.025), were the symptoms with the largest temporary impact of the chemotherapy. Unemployed women had worse physical functioning (p = 0.046) and role functioning (p = 0.005). Older women had more diarrhoea (p = 0.013). The most qualified women had a worse score in financial difficulties scale (p = 0.034). Women with advanced stage (III) underwent more deterioration in the body image (p = 0.001) and were more concerned about the future (p = 0.006). Women treated with anthracycline and taxane also had a worse perspective of the future (p = 0.02).
Adjuvant chemotherapy deteriorates the quality of life of patients with breast cancer, basically in physical functioning and body image areas. Asthenia and gastrointestinal toxicity are the side effects that affect patients most. Women need support if they are older, unemployed, more educated, and have stage III breast cancer treated with anthracycline and taxane based chemotherapy.
Permanent alopecia after cranial irradiation: Dose-response relationship
2004, International Journal of Radiation Oncology Biology Physics
To develop a dose–response relationship for the occurrence of permanent alopecia after cranial irradiation and to analyze potential confounding variables that may contribute to this unwanted and often unavoidable complication of treatment.
Twenty-six patients were enrolled in this study. Three reviewers independently assessed 61 scalp regions and assigned a score for the degree of alopecia in each region using a 4-point scale. Patient and treatment data were collected using a patient questionnaire and outpatient medical chart review. The hair follicle dose was calculated for each scalp region and correlated with the alopecia score for that region. A dose–response relationship was established using the data from these correlations.
Permanent alopecia correlated significantly with the follicle dose only (p < 0.001). A personal history of alopecia and the use of chemotherapy correlated with permanent alopecia with borderline statistical significance (p = 0.059 and p = 0.068, respectively). Patient age, family history of baldness, gender, tobacco use, diabetes, and beam energy did not correlate with alopecia.
We report the first human dose–response relationship describing the effect of the follicle dose on the subsequent development of permanent scalp alopecia after cranial irradiation. This information will assist the radiation oncologist, physicist, and dosimetrist in designing a treatment plan that might minimize the risk of this untoward side effect of cranial irradiation.

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Special interest articleEffect of peri-operative chemotherapy on the quality of life of patients with early breast cancer

Abstract

Soc Sci Med

Eur J Cancer Clin Oncol

Adjuvant therapy for breast cancer

N Engl J Med

A randomised clinical trial evaluating sequential methotrexate and fluorouracil in the treatment of patients with node-negative breast cancer who have estrogen-receptor-negative tumors

N Engl J Med

A randomised clinical trial evaluating tamoxifen in the treatment of patients with node-negative breast cancer who have estrogen-receptor-negative tumors

N Engl J Med

Efficacy of adjuvant chemotherapy in high-risk node-negative breast cancer

N Engl J Med

Adjuvant therapy of node-negative breast cancer

N Engl J Med

Factors contributing to emotional distress during cancer chemotherapy

Cancer

Aspecten van ‘kwaliteit van leven’ en de behandeling van patiënten met borstkanker

Nederlands Tijdschrift Geneeskunde

The meaning of comparative research on the quality of life

Special interest article
Effect of peri-operative chemotherapy on the quality of life of patients with early breast cancer