Prospective exploratory analysis of the association between tumor response, quality of life, and expenditures among patients receiving paclitaxel monotherapy for refractory metastatic breast cancer Journal Article


Authors: Modi, S.; Panageas, K. S.; Duck, E. T.; Bach, A.; Weinstock, N.; Dougherty, J.; Cramer, L.; Hudis, C.; Norton, L.; Seidman, A.
Article Title: Prospective exploratory analysis of the association between tumor response, quality of life, and expenditures among patients receiving paclitaxel monotherapy for refractory metastatic breast cancer
Abstract: Purpose: To prospectively evaluate the association between tumor response, change in quality of life (QoL), and hospital expenditures in patients with metastatic breast cancer (MBC) receiving single-agent paclitaxel. Patients and Methods: Eligible patients had bidimensionally measurable MBC and any number of previous therapies, excluding taxane chemotherapy. Paclitaxel was administered by various different infusion schedules. QoL measures were evaluated for each patient at baseline and serially using the Memorial Symptom Assessment Scale (MSAS)-Global Distress Index (GDI) and Functional Assessment of Cancer Therapy-Breast (FACT-B) instruments. Patients were assessed for early (first 6 weeks) and ever changes in QoL parameters. Charges were monitored through the hospital's centralized computer billing system and converted to cost ratios for the analysis. Correlations between response and improvement in QoL were assessed by Fisher's exact test statistic. Associations between improvements in QoL with cost ratios were assessed by logistic regression and likewise between response and cost ratios. Results: Of the 59 patients treated, 50 had sufficient data for comparative analyses. The overall response rate was 24% (all partial responses). Minor responses were observed in 17% of patients, 25% had stable disease, and 29% had progression. Responding patients had significant improvement in QoL as assessed by MSAS-GDI (P = .004) and FACT-B (P = .028). The mean total cost/month ratios for patients experiencing improved GDI QoL scores was 1.31 versus 1.56 for those without QoL benefit (P = .52) and 1.05 versus 1.76 for responders versus nonresponders, respectively (P = .07). Conclusion: Patients with evidence of tumor response on paclitaxel had a QoL benefit not observed in nonresponders, and this response was associated with a trend for lower overall costs. © 2002 by American Society of Clinical Oncology.
Keywords: adult; cancer chemotherapy; controlled study; treatment outcome; aged; aged, 80 and over; middle aged; major clinical study; doxorubicin; fluorouracil; cancer growth; monotherapy; paclitaxel; comparative study; prospective study; prospective studies; disease association; metastasis; quality of life; breast cancer; logistic models; antineoplastic agents, phytogenic; breast neoplasms; docetaxel; cost control; drug response; neoplasm metastasis; drug infusion; new york city; rating scale; taxane derivative; navelbine; health care costs; cost-benefit analysis; hospital cost; cost benefit analysis; hospital billing; humans; human; female; priority journal; article
Journal Title: Journal of Clinical Oncology
Volume: 20
Issue: 17
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2002-09-01
Start Page: 3665
End Page: 3673
Language: English
DOI: 10.1200/jco.2002.08.057
PUBMED: 12202668
PROVIDER: scopus
DOI/URL:
Notes: Export Date: 14 November 2014 -- Source: Scopus
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Citation Impact
MSK Authors
  1. Andrew D Seidman
    282 Seidman
  2. Clifford Hudis
    892 Hudis
  3. Larry Norton
    671 Norton
  4. Ariadne Bach
    58 Bach
  5. Laura Cramer
    17 Cramer
  6. Shanu Modi
    171 Modi
  7. Katherine S Panageas
    373 Panageas
  8. Elaine Duck
    13 Duck