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Ongoing Adjuvant Tamoxifen in Breast Cancer Offers Better Quality of Life Than a Switch to Anastrozole: Presented at SABCS

By Bruce Sylvester

SAN ANTONIO, Tex -- December 13, 2008 -- Postmenopausal, postsurgical breast cancer patients who continue tamoxifen after 1 to 4 years of adjuvant tamoxifen therapy achieve higher quality-of-life scores than do patients who switch to anastrozole, researchers reported at the 31st Annual San Antonio Breast Cancer Symposium (SABCS).

"Previously reported data from the same study showed that recurrence-free survival was slightly higher among those subjects who switched to anatrozole," said lead investigator Shozo Ohsumi, MD, PhD, NHO Shikoku Cancer Center, Matsuyama, Japan, speaking here on December 12. Dr. Ohsumi pointed out that these new findings on quality of life suggest that if a switch to anastrozole causes unacceptable side effects, a patient can switch back to tamoxifen without a significant risk of impairing recurrence-free survival.

The subjects were part of the National Surgical Adjuvant Study of Breast Cancer 03 (N-SAS BC 03). All subjects had undergone definitive surgery for hormone receptor (HR)-positive breast cancer, followed by tamoxifen treatment for 1 to 4 years. All subjects then were randomised either to continue tamoxifen or switch to anastrozole.

The total time on adjuvant therapy, including initial tamoxifen, was 5 years.

Subjects completed multiple quality-of-life and psychological well-being questionnaires at the time of randomization (98.6% response rate) and at month 3 (97.2%), year 1 (90.9%) and year 2 (78.5%) after randomisation. At baseline, 694 patients answered the questionnaires -- 346 in the tamoxifen group and 348 in the anastrozole group.

The total postrandomisation scores of both the Functional Assessment of Cancer Therapy - General Quality of Life (FACT-G) scale and Endocrine Symptom scale (FACT-ES) and the scores of the FACT-G Physical Well-Being (PWB) subscale were statistically significantly higher in the tamoxifen group than in the anatrozole group (P = .042, P = .038, and P = .005, respectively). The Functional Assessment of Cancer Therapy - Breast (FACT-B) scores in the tamoxifen cohort were also nonsignificantly better than those in anastrozole cohort (P = .066).

The investigators found no statistically significant differences between the two treatment groups, however, for scores on the Center for Epidemiologic Studies - Depression (CES-D) scale and subscales other than physical well-being subscales of FACT-G, FACT-B, and FACT-ES.

"Further tamoxifen treatment after adjuvant tamoxifen for 1 to 4 years may provide postmenopausal breast cancer patients with slightly better health-related quality of life compared with switching to anastroxole," the investigators concluded.

[Presentation title: Health-Related Quality-of-Life and Psychological Distress of Postmenopausal Breast Cancer Patients After Surgery During the Randomized Trial, N-SAS BC 03, Comparing Further Tamoxifen With Switching to Anastrozole After Adjuvant Tamoxifen for 1 to 4 Years: The Final Results. Abstract 1136]

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