[Chemotherapy for patients with recurrent breast cancer and quality of life]

Chemotherapy plays a major indispensable role in treating patients with recurrent breast cancer. Although standard regimens such as CAF, FAC or CMF yield approximately a 50% response rate, the response usually lasts only for 6 months or so on average. For those who have an unfavorable response to chemotherapy, significant portions of their remaining time are to be consequently lost with only identifying damaging effects of treatment, depressed quality of life. Because of this dismal outcome, many of the patients are deeply discouraged about the future, and there is a desperate need for better treatment. Autologous stem cell support, originally practiced in the form of autologous bone marrow transplantation, has been found instrumental in treating breast cancer, and our pilot study started some fifteen years ago showed a higher response rate and survival rate compared to conventional chemotherapy. Moreover, there have been some long-term disease-free survivors with probable cures among complete responders. This is because quality of life is not a mere rating of health status, and is something perceived by each patient individually, reflecting the way in which individual patients feel about their health status. Although high-dose chemotherapy with autologous stem cell support will cause quite a lower quality of life for a significant period of time, it has been fairly well accepted and tolerated by many patients who would be able to maintain some degree of hope. The need to incorporate patients' values, preferences and hopes is what distinguishes quality of life from all other health measures, and physicians' values ought to play no major role in the decision making process when the outcome is often palliation and treatments may be unpleasant.