Health - related quality of life of Kuwaiti women with breast cancer: a comparative study using the EORTC Quality of Life Questionnaire.

BACKGROUND: The Kuwaiti perspective on quality of life (QOL) in breast cancer is important because it adds the contribution from a country where the disease affects women at a relatively younger age and seems to be more aggressive. We used the EORTC QLQ - C30 and its breast-specific module (BR-23) to highlight the health-related QOL of Kuwaiti women with breast cancer, in comparison with the international data, and assessed the socio-demographic and clinical variables that predict the five functional scales and global QOL (GQOL) scale of the QLQ - C30. METHODS: Participants were consecutive clinic attendees for chemotherapy, in stable condition, at the Kuwait Cancer Control Center. RESULTS: The 348 participants were aged 20-81 years (mean 48.3, SD 10.3); 58.7% had stages III and IV disease. Although the mean scores for QLQ - C30 (GQOL, 45.3; and five functional scales, 52.6%-61.2%) indicated that the patients had poor to average functioning, only 5.8% to 11.2% had scores that met the < or = 33% criterion for problematic functioning, while 12.0% to 40.0% met the >66% criterion for more severe symptoms. Most (47.8%-70.1%) met the >66% criterion for "good functioning" on the BR-23 functional scales. The mean scores of the QLQ - C30 indicated that, despite institutional supports, Kuwaiti women had clinically significantly poorer global QOL and functional scale scores, and more intense symptom experience, in comparison with the international data (i.e., < or = 10% difference between groups). For the BR-23, Kuwaiti women seemed to have clinically significantly better functional scale scores, but more severe symptoms, especially systemic side effects and breast symptoms. Younger women had poorer HRQOL scores. In regression analysis, social functioning accounted for the highest proportion of variance for GQOL. CONCLUSION: The relatively high number that met the criterion for good functioning on the functional scales is an evidence base to boost national health education about psychosocial prognosis in cancer. In view of the poor performance on the symptom scales, clinicians treating Kuwaiti women with breast cancer should prepare them for the acute toxicities of treatment and address fatigue. The findings call for the institution of a psycho-oncology service to address psycho-social issues.

Neoadjuvant docetaxel and epirubicin in large and locally advanced breast cancer: kuwait cancer control centre experience.

PURPOSE: To evaluate the efficacy of neoadjuvant (NA) docetaxel (DOC) and Epirubicin (EPI) as a part of multimodality treatment of large and locally advanced breast cancer. PATIENTS AND METHODS: Patients with large or locally advanced breast cancer received four cycles of DOC 75mg/m2 and Epirubicine (EPI) 90mg/m2 (DE). Clinical tumor response was assessed. Patients with operable disease were subjected to modified radical mastectomy (MRM) or breast conserving surgery (BCT) and axillary lymph node dissection (ALND). All patients received four cycles of DOC 100mg/m2 as post operative chemotherapy and local radiotherapy. Tamoxifen was given to patients with hormone receptor positive tumors. RESULTS: A total of 80 patients were enrolled; 75 patients completed at least 3 cycles of NA CT and were evaluable. Out of these 75 patients, 67 (89.3 %) patients completed all 4 cycles of DE, while 8 (10.7 %) patients received 3 cycles of DE. Out of all 75 patients; 25 patients (33.3 %) achieved clinical complete response (cCR), while 41 patients (54.7 %) achieved clinical partial response (cPR), making a total of 66 patients (88.0 %) who achieved a clinical response (cPR or cCR). Five patients (6.7 %) had stable disease (cSD), while two patients (2.7 %) had progression of disease (cPD). A total of 69 patients underwent surgery, out of those, 65 patients (94.2 %) underwent MRM and 4 patients (5.8 %) had BCT and ALND. Out of 69 patients evaluated for pathological response, 7 patients (10.1 %) had pathologic CR (pCR) and 62 (89.9 %) patients had pathological PR (pPR). Axillary lymph node examination revealed no residual tumor in 23 (33.3 %) patients. Grade IV neutropenia occurred in 92 (30.9 %) cycles while febrile neutropenia occurred in 17 (5.7 %) cycles. CONCLUSION: NA DE is an effective regimen with an acceptable toxicity profile. KEY WORDS: Advanced cancer breast - Neoadjuvant chemotherapy.