While breast cancer patients are the largest group of female cancer survivors, researchers know little about their quality of life after treatment. Therefore, Dr. Patricia A. Ganz and her colleagues from the University of California, Los Angeles studied over 800 Stage I and II breast cancer patients to determine whether adjuvant therapy (treatment in addition to breast cancer surgery, such as chemotherapy or the drug tamoxifen) affects a breast cancer patient’s quality of life after treatment. The results showed that while breast cancer patients tend to enjoy high qualities of life after treatment, adjuvant therapy can cause sexual problems, urinary incontinence, and vaginal dryness. The researchers suggest that physicians inform women about possible long-term effects of adjuvant therapy to help patients make informed treatment choices.

Adjuvant, or additional, therapies have become common for women diagnosed with breast cancer. Chemotherapy, radiation, or drug therapy (such as tamoxifen) can help reduce the chances that breast cancer will return after treatment and in some cases, increase the chances of disease-free survival. While the side effects of these therapies are usually temporary, Dr. Ganz and her colleagues found that some effects can be long lasting and may affect a woman’s quality of life after treatment.

To conduct their study, the researchers analyzed survey results from 817 breast cancer survivors who had been previously diagnosed with Stage I or Stage II breast cancer. Some of the women received adjuvant therapy after breast cancer surgery while others did not. Overall, Dr. Ganz’s team found that the women were in excellent physical and emotional condition after treatment. In fact, hot flashes, night sweats, vaginal discharge, and breast sensitivity were less frequent since treatment.

However, the researchers found that the women who received adjuvant therapy (chemotherapy, tamoxifen) were less likely to engage in sexual activity than women who did not receive additional treatment. Symptoms of vaginal dryness and urinary incontinence were also higher among the women treated with chemotherapy, tamoxifen, or both therapies (women treated with chemotherapy reported worse results than those treated with tamoxifen, particularly in regards to pain during sexual intercourse).

Dr. Ganz and her colleagues conclude that while long-term, disease-free breast cancer survivors report high levels of functioning and qualities of life, patients who received adjuvant therapy had poorer functioning than those who did not receive adjuvant therapy. The researchers find the results significant, particularly for women with early-stage breast cancer who are likely to survive after treatment and not benefit greatly from additional chemotherapy or tamoxifen.

However, adjuvant therapy has been shown to significantly reduce the chances of breast cancer recurrence in some cases. In fact, because of previous study results, a panel of national and international cancer experts at the National Institutes of Health Consensus Development Conference on Adjuvant Therapy for Breast Cancer in November 2000 recommended that most women with localized breast cancer be offered chemotherapy.

Based on the results of Dr. Ganz’s study and previous research that has shown benefits for breast cancer patients treated with adjuvant therapies, women should discuss the advantages and disadvantages of all treatments with their physicians and decide on an individualized treatment plan based on the personal medical situation. Furthermore, problems reported in Dr. Ganz’s study, such as urinary incontinence, vaginal dryness, and pain during sexual intercourse, can usually be treated as they occur.

• The study, "Quality of Life in Long-Term, Disease-Free Survivors of Breast Cancer: a Follow-up Study," is published in the January 2, 2002 issue of the Journal of the National Cancer Institute, http://jncicancerspectrum.oupjournals.org/
• To learn more about chemotherapy, please visit http://www.imaginis.com/breasthealth/chemo.asp
• To learn more about tamoxifen, please visit
  http://www.imaginis.com/breasthealth/tamoxifen.asp