Chemotherapy, Tamoxifen Treatment Can Impair Physical Function Over Time.

2002 JAN 17 - (NewsRx.com & NewsRx.net) -- Long-term breast cancer survivors report excellent quality of life many years after treatment, but the use of chemotherapy and tamoxifen in addition to surgery may result in decreased physical functioning over time, according to a study.

The study, one of the largest examining quality of life in long-term breast cancer survivors, could influence the way doctors treat women with very small tumors, said Dr. Patricia Ganz, senior author of the article and director of the Division of Cancer Prevention and Control Research at UCLA's Jonsson Cancer Center.

"The question has been asked: should every woman, even those with very small tumors, receive chemotherapy or tamoxifen or both after surgery?" Ganz said. "I think, in light of this research, the answer may be no. This study shows there are some subtle costs to be paid with adjuvant therapy. But the only place this would carry any weight would be in women with tumors less than a centimeter in size."

Whether women who have small tumors removed really need additional therapy has sparked debate in recent years. There is a substantial benefit to additional, or adjuvant, treatment with chemotherapy and/or tamoxifen in women with tumors larger than a centimeter, or in patients whose cancer has spread to the local lymph nodes. However, for very small tumors, the risk of recurrent cancer is so low that the potential short- and long-term toxicity of the treatments may play a role in decision-making, Ganz said.

Prior to this study, it was generally accepted that adjuvant treatments did not diminish long-term quality of life and physical functioning, so doctors often were not concerned about late effects when they recommended adjuvant therapy to their patients. But this research indicates that women who receive these treatments may have a significant decline in physical functioning compared with breast cancer survivors who did not receive these treatments. However, emotional and social functioning does not deteriorate over time in any of the survivors, the study showed. Women who received chemotherapy, however, had more sexual discomfort and vaginal dryness, according to the study published in January 2, 2002, issue of the peer-reviewed Journal of the National Cancer Institute.

Previous studies, including a large study by Ganz and her colleagues at UCLA, USC and at Georgetown University Medical School, have shown that breast cancer survivors experience good quality of life and physical functioning in the first few years after treatment. Few studies, however, have examined how women do five to 10 years after treatment, said Ganz, who has been conducting quality of life research since 1980.

In this follow-up study, Ganz and her team of researchers focused on 763 disease-free women in Los Angeles and Washington, D.C., who ...