The purpose of this study is to use the EQ-5D instrument to evaluate the health states of women with early stage breast cancer after treatment with breast-conserving surgery and radiation.
Materials/Methods
The study population consists of 1,050 women with early stage breast cancer treated with breast-conserving surgery and radiation with or without systemic therapy. During routine follow-up visits, patients were asked to complete the EQ-5D questionnaire. The number of entries per patient was 1 in 32%, 2 in 29%, 3 in 21%, and 4 or more in 18%. The mean length of follow-up between treatment and time of report was 3 years. There were 171 data points at 5 years, 64 at 10 years, and 21 at 15 years. The EQ-5D is a standardized and validated instrument for measuring health outcomes. There are 5 descriptive dimensions of health with three possible levels of response (1. no problems, 2. some problems, or 3. extreme problems). There are 243 (35) possible unique health states described by the combination of these 5 dimensions. Scores were compared to a survey of the general U.S. adult population (Luo et al Med Care 2005;43:1078-86).
Results
The mean index score was 0.89 at 5 years, 0.9 at 10 years, and 0.9 at 15 years. There were no significant differences in health states between patients by age. The mean by age at 5 and 10 years was 0.95 and 0.96 (ages 18-44), 0.9 and 0.93 (ages 45-64), and 0.88 and 0.76 (age >64), respectively. For comparison, the reported mean index scores for the general U.S. female population is 0.86, and by age 0.91 (ages 18-44), 0.84 (ages 45-64), and 0.81 (age >64). There were no differences by use of systemic therapy, or by use of intensity modulated radiation therapy (IMRT) versus conventional radiation, although very few patients treated with IMRT had follow-up greater than 3 years. Four of the 5 descriptive health dimensions showed a statistically significant trend of moving between levels 1 and 2 over 15 years—1 scale trended up from 1 to 2, and 3 scales trended down from 2 to 1. More patients reported some problems with self care, although most patients >95% continued to report no problems. Over the same time period, fewer patients reported some problems with anxiety/depression, pain/discomfort, and usual activities at 15 years compared to immediately after treatment. Two of the 5 subscales, pain/discomfort and usual activity, had a significant trend in increasing reported level 3 but the absolute number of patients reporting this level of problems was approximately ≤5%.
Conclusions
This study of EQ-5D is unique in demonstrating very high levels of overall quality of life in patients treated with breast-conserving surgery and radiation even up to 15 years after treatment. These mean health states are comparable to those reported for the general adult U.S. population.
Fox Chase Cancer Center, Philadelphia, PA
Author Disclosure: G.M. Freedman, None; P.R. Anderson, None; T. Li, None; N. Nicolaou, None; A. Konski, None.
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