Delayed emotional recovery after taxane‐based chemotherapy

• Published in: Cancer Vol. 113; no. 3; pp. 638 - 647
• Main Authors: Thornton, Lisa M., Carson, William E., Shapiro, Charles L., Farrar, William B., Andersen, Barbara L.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.08.2008; Wiley-Liss
• Subjects: Adult; adverse effects; Affective Symptoms - chemically induced; Affective Symptoms - epidemiology; Affective Symptoms - rehabilitation; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; breast neoplasms; Breast Neoplasms - drug therapy; Breast Neoplasms - psychology; Breast Neoplasms - rehabilitation; Case-Control Studies; Chemotherapy, Adjuvant - adverse effects; depression; Female; Follow-Up Studies; Gynecology. Andrology. Obstetrics; Humans; Incidence; Longitudinal Studies; Mammary gland diseases; Medical sciences; Middle Aged; paclitaxel; Quality of Life; Randomized Controlled Trials as Topic; Taxoids - administration & dosage; Taxoids - adverse effects; Time Factors; Tumors; Mood disorder; Antineoplastic agent; Breast tumor; breast neoplasms; Depression; Recovery; Quality of life; Mammary gland diseases; Chemotherapy; Treatment; Cancerology; Taxane derivatives; Paclitaxel; Secondary effect; adverse effects; Antimitotic
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.23589

BACKGROUND There are few patient‐reported data regarding quality of life after taxane‐based adjuvant chemotherapy and none regarding mental health outcomes. METHODS This was a naturalistic, longitudinal study that used a case–control design. Data were derived from a randomized clinical trial in patients who had stage II/III breast cancer (N = 227). Paclitaxel (Taxol) was approved for use midway during the accrual period (1994–1999). Patients who received taxanes as part of their adjuvant chemotherapy (the taxane group; n = 55) were matched with patients receiving regimens without taxanes (the no‐taxane group; n = 83) on trial arm, lymph node status, surgery type, menopausal status, and partner status. Mixed‐effects models tested for group differences in nurse evaluations of patients' symptoms and Karnofsky performance status and in patient‐reported quality of life (the 36‐item Medical Outcomes Study Short Form) and emotional distress (Profile of Mood States; Center for Epidemiological Studies Depression scale). RESULTS As expected, patients in the taxane group experienced significantly higher rates of selected toxicities, including arthralgia/myalgia (45% vs 26%) and ataxia (20% vs 5%). Patients in the taxane group also had significantly worse emotional distress and mental quality of life throughout adjuvant treatment. Rates of probable clinical depression also were high. In contrast, these outcomes were improving for patients in the no‐taxane group (all P < .023). Emotional recovery for patients in the taxane group required 2 years on average versus 6 to 12 months for patients in the no‐taxane group. During Years 3 through 5, the groups had similar outcomes. CONCLUSIONS These data suggested that taxane‐based chemotherapies confer risk for significant psychological symptoms. Depression, in particular, should be monitored. Cancer 2008. © 2008 American Cancer Society. In this 5‐year longitudinal study, patients with breast cancer who received taxane‐based adjuvant chemotherapy were compared with patients who received other regimens. The results indicated that receipt of taxanes was associated with delays of 6 to 12 months in patients' emotional recovery, including higher rates of depressive symptoms.