Nineteen RCTs (n=5,732) were included.
The HRQOL data were used to support recommendations for future treatment in 85% of the trials. However, 63% of the studies reported no significant differences between the treatment groups in HRQOL.
Chemotherapy treatment: 7 studies found no significant difference in QOL between the treatment groups and one study was inconclusive. There were possible QOL benefits of epirubicin plus mitomycin in comparison with CEF (less nausea, stomach pain, diarrhoea, hair loss, swelling and itching), while doxorubicin resulted in poorer QOL than paclitaxel. There was no significant difference in CEF versus CEF with double-dose epirubicin, but less pain and better body image was experienced in the high dosage group than at baseline. There was better physical and sexual functioning, pain, fatigue, insomnia and diarrhoea with CDF, compared with doxorubicin plus paclitaxel, though nausea and vomiting was better with the latter.
Hormonal therapy: 2 studies reported no significant difference in QOL between the treatment groups; compared with megestrol acetate, there was better QOL with anastrozole and exemestane and better psychological well-being with vorozore; and in one study patients with partial or complete response had better QOL.
Biological therapy: the one study in this category reported no significant difference in QOL for trastuzumab plus chemotherapy in comparison with trastuzumab alone.