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C. Vrieling, L. Collette, A. Fourquet, W. Hoogenraad, J. Horiot, J. Jager, M. Piérart, P. Poortmans, H. Struikmans, B. Maat, E. Limbergen, H. Bartelink (2000)
The influence of patient, tumor and treatment factors on the cosmetic results after breast-conserving therapy in the EORTC 'boost vs. no boost' trial. EORTC Radiotherapy and Breast Cancer Cooperative Groups.Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 55 3
T. Leivo, T. Salminen, H. Sintonen, R. Tuominen, K. Auerma, K. Partanen, Urpo Saari, M. Hakama, O. Heinonen (1999)
Incremental cost‐effectiveness of double‐reading mammogramsBreast Cancer Research and Treatment, 54
M. Andersen, N. Urban (1999)
Involvement in decision-making and breast cancer survivor quality of lifeAnnals of Behavioral Medicine, 21
C. Holcombe, N. West, R. Mansel, K. Horgan (1995)
The satisfaction and savings of early discharge with drain in situ following axillary lymphadenectomy in the treatment of breast cancer.European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 21 6
J. Nabholtz, H. Senn, W. Bezwoda, D. Melnychuk, L. Deschênes, J. Douma, T. Vandenberg, B. Rapoport, R. Rosso, V. Trillet‐Lenoir, J. Drbal, A. Molino, J. Nortier, D. Richel, T. Nagykálnai, P. Siedlecki, N. Wilking, J. Genot, P. Hupperets, F. Pannuti, D. Skarlos, E. Tomiak, M. Murawsky, M. Alakl, M. Aapro (1999)
Prospective randomized trial of docetaxel versus mitomycin plus vinblastine in patients with metastatic breast cancer progressing despite previous anthracycline-containing chemotherapy. 304 Study Group.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 17 5
W. Fakhoury (1998)
Satisfaction with palliative care: what should we be aware of?International journal of nursing studies, 35 3
V. Velanovich, V. Velanovich (1995)
Immediate biopsy versus observation for abnormal findings on mammograms: an analysis of potential outcomes and costs.American journal of surgery, 170 4
K. Heimdal, L. Mæhle, P. Møller (2002)
Costs and Benefits of Diagnosing Familial Breast CancerDisease Markers, 15
J. Carpenter, M. Andrykowski, Matthew Cordova, L. Cunningham, J. Studts, P. Mcgrath, D. Kenady, David Sloan, R. Munn (1998)
Hot flashes in postmenopausal women treated for breast carcinomaCancer, 82
A. Liberati (1995)
The GIVIO trial on the impact of follow-up care on survival and quality of life in breast cancer patients. Interdisciplinary Group for Cancer Care Evaluation.Annals of oncology : official journal of the European Society for Medical Oncology, 6 Suppl 2
C. Braden (1990)
Learned self-help response to chronic illness experience: a test of three alternative learning theories.Scholarly inquiry for nursing practice, 4 1
L. Wenzel, D. Fairclough, M. Brady, D. Cella, K. Garrett, Brenda Kluhsman, Lori Crane, A. Marcus (1999)
Age‐related differences in the quality of life of breast carcinoma patients after treatmentCancer, 86
E. Coleman, S. Coon, P. Thompson, S. Lemon, R. Depuy (1995)
Impact of silicone implants on the lives of women with breast cancer.Oncology nursing forum, 22 10
B. Ferrell, M. Grant, B. Funk, N. Garcia, S. Otis-Green, M. Schaffner (1996)
Quality of life in breast cancer.Cancer practice, 4 6
C. Lerman, B. Trock, B. Rimer, A. Boyce, Chris Jepson, P. Engstrom (1991)
Psychological and behavioral implications of abnormal mammograms.Annals of internal medicine, 114 8
B. Hillner, Thomas Smith (2005)
Should women with node-negative breast cancer receive adjuvant chemotherapy? — Insights from a decision analysis modelBreast Cancer Research and Treatment, 23
J. Bower, P. Ganz, K. Desmond, J. Rowland, B. Meyerowitz, T. Belin (2000)
Fatigue in breast cancer survivors: occurrence, correlates, and impact on quality of life.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 18 4
R. Day, P. Ganz, J. Costantino, W. Cronin, D. Wickerham, B. Fisher (1999)
Health-related quality of life and tamoxifen in breast cancer prevention: a report from the National Surgical Adjuvant Breast and Bowel Project P-1 Study.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 17 9
R. Boer, H. Koning, G. Oortmarssen, P. Maas (1995)
In search of the best upper age limit for breast cancer screening.European journal of cancer, 31A 12
J. Ridley (2001)
Studies of Interference in Serial Verbal Reactions
E. Maunsell, J. Brisson, L. Deschênes, N. Frasure-smith (1996)
Randomized trial of a psychologic distress screening program after breast cancer: effects on quality of life.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 14 10
L. Breslow (1972)
A quantitative approach to the World Health Organization definition of health: physical, mental and social well-being.International journal of epidemiology, 1 4
J. Kearsley, C. Schonfeld, M. Sheehan (1998)
Quality-of-life assessment during palliative radiotherapy.Australasian radiology, 42 4
J. Mandelblatt, H. Freeman, D. Winczewski, K. Cagney, S. Williams, R. Trowers, J. Tang, Karen Gold, T. Lin, J. Kerner (1997)
The costs and effects of cervical and breast cancer screening in a public hospital emergency room. The Cancer Control Center of Harlem.American journal of public health, 87 7
E. Campora, C. Naso, M. Vitullo, S. Giudici, A. Camoirano, L. Repetto, R. Rosso (1992)
The impact of chemotherapy on the quality of life of breast cancer patients.Journal of chemotherapy, 4 1
I. Sarason, B. Sarason (1982)
Concomitants of social support: attitudes, personality characteristics, and life experiences.Journal of personality, 50 3
M. Weitzner, Christina Meyers, K. Stuebing, Angele Saleeba (1997)
Relationship between quality of life and mood in long-term survivors of breast cancer treated with mastectomySupportive Care in Cancer, 5
J. Kramer, D. Curran, M. Piccart, J. Haes, P. Bruning, Jelle Klijn, M. Bontenbal, C. Pottelsberghe, M. Groenvold, R. Paridaens (2000)
Randomised trial of paclitaxel versus doxorubicin as first-line chemotherapy for advanced breast cancer: quality of life evaluation using the EORTC QLQ-C30 and the Rotterdam symptom checklist.European journal of cancer, 36 12
J. Cockburn, Trudy Luise, S. Hurley, K. Clover (1992)
Development and validation of the PCQ: a questionnaire to measure the psychological consequences of screening mammography.Social science & medicine, 34 10
K. Ashing-Giwa, P. Ganz, L. Petersen (1999)
Quality of life of African‐American and white long term breast carcinoma survivorsCancer, 85
T. Jahkola (1998)
Self-perceptions of women after early breast cancer surgery.European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 24 1
M. Watson, M. Law, Maria Santos, S. Greer, J. Baruch, J. Bliss (1994)
The Mini-MAC: Further Development of the Mental Adjustment to Cancer ScaleJournal of Psychosocial Oncology, 12
(1994)
127) Alpherts WC, Aldenkamp AP. The Iron Fepsy. Heemsted (The Netherlands ): Instituut voor epilepsiebestrijding Heemstede
M. Hamilton (1989)
The Health and Activity Limitation Survey.Health reports, 1 2
R. Caplan, A. Abbey, D. Abramis, F. Andrews, T. Conway, J. French (1984)
Tranquilizer use and well-being: A longitudinal study of social and psychological effects
A. Pusic, Tracey Thompson, C. Kerrigan, R. Sargeant, Sheri Slezak, B. Chang, K. Helzlsouer, P. Manson (1999)
Surgical options for the early-stage breast cancer: factors associated with patient choice and postoperative quality of life.Plastic and reconstructive surgery, 104 5
J. Strain (1990)
The evolution of quality of life evaluations in cancer therapy.Oncology, 4 5
V. Ventafridda, F. Conno, C. Ripamonti, A. Gamba, M. Tamburini (1990)
Quality-of-life assessment during a palliative care programme.Annals of oncology : official journal of the European Society for Medical Oncology, 1 6
M. Rosenberg (1966)
Society and the adolescent self-image
M. Bergner, R. Bobbitt, W. Carter, B. Gilson (1981)
The Sickness Impact Profile: Development and Final Revision of a Health Status MeasureMedical Care, 19
C. Harper-wynne, J. English, L. Meyer, M. Bower, C. Archer, H. Sinnett, C. Lowdell, R. Coombes (1999)
Randomized trial to compare the efficacy and toxicity of cyclophosphamide, methotrexate and 5-fluorouracil (CMF) with methotrexate mitoxantrone (MM) in advanced carcinoma of the breastBritish Journal of Cancer, 81
C. Moinpour, K. Hayden, I. Thompson, P. Feigl, B. Metch (1990)
Quality of life assessment in Southwest Oncology Group trials.Oncology, 4 5
Diane Fairclough, David Cella (1996)
Eastern Cooperative Oncology Group (ECOG).Journal of the National Cancer Institute. Monographs, 20
Susan Wilson, M. Andersen, H. Meischke (2000)
Meeting the needs of rural breast cancer survivors: what still needs to be done?Journal of women's health & gender-based medicine, 9 6
R. Reitan (1958)
Validity of the Trail Making Test as an Indicator of Organic Brain DamagePerceptual and Motor Skills, 8
P. Ganz, C.Anne Schagi, Huei-Ling Cheng (1990)
Assessing the quality of life--a study in newly-diagnosed breast cancer patients.Journal of clinical epidemiology, 43 1
F. Gilbert, C. Cordiner, I. Affleck, D. Hood, Derek Mathieson, L. Walker (1998)
Breast screening: the psychological sequelae of false-positive recall in women with and without a family history of breast cancer.European journal of cancer, 34 13
Aaronson Nk (1988)
Quality of life: what is it? How should it be measured?Oncology, 2
D. Karnofsky, W. Abelmann, L. Craver, J. Burchenal (1948)
The use of the nitrogen mustards in the palliative treatment of carcinoma. With particular reference to bronchogenic carcinomaCancer, 1
T. Tasmuth, K. Smitten, P. Hietanen, M. Kataja, E. Kalso (1995)
Pain and other symptoms after different treatment modalities of breast cancer.Annals of oncology : official journal of the European Society for Medical Oncology, 6 5
A. Stewart, J. Ware, C. Sherbourne, K. Wells (1992)
Psychological Distress/Well-Being and Cognitive Functioning Measures
L. Schover, R. Yetman, L. Tuason, E. Meisler, C. Esselstyn, R. Hermann, S. Grundfest-Broniatowski, R. Dowden (1995)
Partial mastectomy and breast reconstruction. A comparison of their effects on psychosocial adjustment, body image, and sexualityCancer, 75
B. Norris, K. Pritchard, K. James, J. Myles, K. Bennett, Susan Marlin, J. Skillings, B. Findlay, T. Vandenberg, Paul Goss, J. Latreille, L. Rudinskas, Wycliffe Lofters, Maureen Trudeau, David Osoba, A. Rodgers (2000)
Phase III comparative study of vinorelbine combined with doxorubicin versus doxorubicin alone in disseminated metastatic/recurrent breast cancer: National Cancer Institute of Canada Clinical Trials Group Study MA8.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 18 12
James Hayman, Diane Fairclough, Jay Harris, Jane Weeks (1997)
Patient preferences concerning the trade-off between the risks and benefits of routine radiation therapy after conservative surgery for early-stage breast cancer.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 15 3
R. Love, L. Cameron, Brad Connell, H. Leventhal (1991)
Symptoms associated with tamoxifen treatment in postmenopausal women.Archives of internal medicine, 151 9
F. Cox, J. Hirsch (1993)
Ondansetron: a cost-effective advance in anti-emetic therapy.Oncology, 50 3
V. Grann, Jacobson Js, William Whang, D. Hershman, Daniel Heitjan, Karen Antman, A. Neugut (2000)
Prevention with tamoxifen or other hormones versus prophylactic surgery in BRCA1/2-positive women: a decision analysis.The cancer journal from Scientific American, 6 1
C. Lindley, Shamul Vasa, W. Sawyer, E. Winer (1998)
Quality of life and preferences for treatment following systemic adjuvant therapy for early-stage breast cancer.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 16 4
R. McQuellon, H. Muss, S. Hoffman, G. Russell, B. Craven, S. Yellen (1995)
Patient preferences for treatment of metastatic breast cancer: a study of women with early-stage breast cancer.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 13 4
P. Ganz, J.Jack Lee, M. Sim, M. Polinsky, C. SCHAG (1992)
Exploring the influence of multiple variables on the relationship of age to quality of life in women with breast cancer.Journal of clinical epidemiology, 45 5
M. Levine, G. Guyatt, M. Gent, S. Pauw, M. Goodyear, W. Hryniuk, A. Arnold, B. Findlay, J. Skillings, V. Bramwell (1988)
Quality of life in stage II breast cancer: an instrument for clinical trials.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 6 12
Thomas Smith, B. Hillner (2000)
Tamoxifen should be cost-effective in reducing breast cancer risk in high-risk women.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 18 2
(1995)
J Clin Oncol
D. Fairclough, J. Fetting, D. Cella, W. Wonson, C. Moinpour (1999)
Quality of life and quality adjusted survival for breast cancer patients receiving adjuvant therapyQuality of Life Research, 8
L. Fogarty, B. Curbow, J. Wingard, K. McDonnell, M. Somerfield (1999)
Can 40 seconds of compassion reduce patient anxiety?Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 17 1
R. Launois, J. Reboul-Marty, B. Henry, J. Bonneterre (1996)
A cost-utility analysis of second-line chemotherapy in metastatic breast cancer. Docetaxel versus paclitaxel versus vinorelbine.PharmacoEconomics, 10 5
G. Fischer (1979)
UTILITY MODELS FOR MULTIPLE OBJECTIVE DECISIONS: DO THEY ACCURATELY REPRESENT HUMAN PREFERENCES?*Decision Sciences, 10
J. Haes, F. Knippenberg (1985)
The quality of life of cancer patients: a review of the literatureSocial Science & Medicine, 20
P. Salzmann, K. Kerlikowske, K. Phillips (1997)
Cost-Effectiveness of Extending Screening Mammography Guidelines To Include Women 40 to 49 Years of AgeAnnals of Internal Medicine, 127
M. Vaile, M. Calnan, Derek Rutter, Barbara Wall (1993)
Breast cancer screening services in three areas: uptake and satisfaction.Journal of public health medicine, 15 1
B. Piper, A. Lindsey, M. Dodd, S. Ferketich, S. Paul, S. Weller (1989)
The Development of an Instrument to Measure the Subjective Dimension of Fatigue
P. Mosconi, B. Meyerowitz, Li Mc, A. Liberati, Givio (1991)
Original article: Disclosure of breast cancer diagnosis: Patient and physician reportsAnnals of Oncology, 2
P. Ganz, K. Desmond, T. Belin, B. Meyerowitz, J. Rowland (1999)
Predictors of sexual health in women after a breast cancer diagnosis.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 17 8
P Nutting, B Calonge, D Iverson, L Green (1994)
The danger of applying uniform clinical policies across populations: the case of breast cancer in American Indians.American journal of public health, 84 10
W. Satariano, Gerald DeLorenze (1996)
The likelihood of returning to work after breast cancer.Public health reports, 111 3
(1997)
Popularity of less frequent follow up for breast cancer in randomised study: initial findings from the hotline study
L. Layfield, E. Chrischilles, Michael Cohen, K. Bottles (1993)
The palpable breast nodule. A cost‐effectiveness analysis of alternate diagnostic approachesCancer, 72
M. Koopmanschap, B. Ineveld, T. Miltenburg (1992)
Costs of home care for advanced breast and cervical cancer in relation to cost-effectiveness of screening.Social science & medicine, 35 8
V. Grann, J. Jacobson, Sundararajan, Steven Albert, Andrea Troxel, A. Neugut (1999)
The quality of life associated with prophylactic treatments for women with BRCA1/2 mutations.The cancer journal from Scientific American, 5 5
J. Kramer, D. Curran, M. Piccart, J. Haes, P. Bruning, J. Klijn, I. Hoorebeeck, R. Paridaens (2000)
Identification and interpretation of clinical and quality of life prognostic factors for survival and response to treatment in first-line chemotherapy in advanced breast cancer.European journal of cancer, 36 12
C. Peruselli, P. Giulio, F. Toscani, M. Gallucci, C. Brunelli, M. Costantini, M. Tamburini, E. Paci, G. Miccinesi, J. Addington-hall, I. Higginson (1999)
Home palliative care for terminal cancer patients: a survey on the final week of lifePalliative Medicine, 13
M. Clavel, M. Soukop, Y. Greenstreet (1993)
Improved control of emesis and quality of life with ondansetron in breast cancer.Oncology, 50 3
S. Katz (1963)
Studies of illness in the agedJAMA
G. Devins (1994)
Illness intrusiveness and the psychosocial impact of lifestyle disruptions in chronic life-threatening disease.Advances in renal replacement therapy, 1 3
M. Roworth, G. McIlwaine, A. Wallace (1993)
Women's views of the Scottish Breast Screening Programme: a national consumer opinion survey.Public health, 107 3
J. Fetting, R. Gray, D. Fairclough, T. Smith, K. Margolin, M. Citron, M. Grove-Conrad, D. Cella, K. Pandya, N. Robert, I. Henderson, C. Osborne, M. Abeloff (1998)
Sixteen-week multidrug regimen versus cyclophosphamide, doxorubicin, and fluorouracil as adjuvant therapy for node-positive, receptor-negative breast cancer: an Intergroup study.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 16 7
G. Spanier (1976)
Measuring Dyadic Adjustment: new scales for assessing the quality of marriage and similar dyadsJournal of Marriage and Family, 38
Sian Cotton, E. Levine, C. Fitzpatrick, Kristin Dold, E. Targ (1999)
Exploring the relationships among spiritual well‐being, quality of life, and psychological adjustment in women with breast cancerPsycho‐Oncology, 8
M. Horowitz, N. Wilner, W. Alvarez (1979)
Impact of Event Scale: A Measure of Subjective StressPsychosomatic Medicine, 41
R. Miller, T. Walsh (1991)
Psychosocial aspects of palliative care in advanced cancer.Journal of pain and symptom management, 6 1
M. Zappa, G. Spagnolo, S. Ciatto, D. Giorgi, E. Paci, M. Turco (1995)
Measurement of the Costs in Two Mammographic Screening Programmes in the Province of Florence, ItalyJournal of Medical Screening, 2
M. Youngblood, P. Williams, Holly Eyles, J. Waring, Susan Runyon (1994)
A comparison of two methods of assessing cancer therapy‐related symptomsCancer Nursing, 17
W. Schain (1993)
Psychosocial issues in breast cancer clinical trials.Recent results in cancer research. Fortschritte der Krebsforschung. Progres dans les recherches sur le cancer, 127
A. Paradiso, P. Nitti, P. Frezza, N. Scorpiglione (1995)
A survey in Puglia: the attitudes and opinions of specialists, general physicians and patients on follow-up practice. G.S.Bio.Ca.M.Annals of oncology : official journal of the European Society for Medical Oncology, 6 Suppl 2
J. Hollandsworth (1988)
Evaluating the impact of medical treatment on the quality of life: a 5-year update.Social science & medicine, 26 4
P. Enckevort, E. Tenvergert, S. Schrantee, F. Rutten, E. Vries (1999)
Economic evaluations of systemic adjuvant breast cancer treatments: methodological issues and a critical review.Critical reviews in oncology/hematology, 32 2
J. Ellershaw, S. Peat, L. Boys (1995)
Assessing the effectiveness of a hospital palliative care teamPalliative Medicine, 9
V. Velanovich, W. Szymanski (1999)
Quality of life of breast cancer patients with lymphedema.American journal of surgery, 177 3
Les Noe, Russell Becker, W. Gradishar, Mugdha Gore, Jeffrey Trotter (1999)
The cost effectiveness of tamoxifen in the prevention of breast cancer.The American journal of managed care, 5 6 Suppl
D. Watson, L. Clark, A. Tellegen (1988)
Development and validation of brief measures of positive and negative affect: the PANAS scales.Journal of personality and social psychology, 54 6
M. Soukop, B. McQuade, E. Hunter, Adam Stewart, S. Kaye, J. Cassidy, D. Kerr, S. Khanna, J. Smyth, R. Coleman, D. Cunningham, T. Powles, N. Davidson, A. Hutcheon, J. Green, A. Slater, G. Rustin, D. Carney (1992)
Ondansetron compared with metoclopramide in the control of emesis and quality of life during repeated chemotherapy for breast cancer.Oncology, 49 4
M. Gold (2016)
Cost-effectiveness in health and medicine
L. Degner, L. Kristjanson, D. Bowman, J. Sloan, K. Carriere, J. O’Neil, B. Bilodeau, P. Watson, B. Mueller (1997)
Information needs and decisional preferences in women with breast cancer.JAMA, 277 18
C. Spielberger (1983)
Manual for the State-Trait Anxiety Inventory (STAI) (Form Y
P. Ganz, K. Hirji, M. Sim, C. SCHAG, C. Fred, M. Polinsky (1993)
Predicting Psychosocial Risk in Patients With Breast CancerMedical Care, 31
T. Whelan, M. Levine, J. Julian, P. Kirkbride, P. Skingley (2000)
The effects of radiation therapy on quality of life of women with breast carcinomaCancer, 88
C. Lerman, J. Seay, A. Balshem, J. Audrain (1995)
Interest in genetic testing among first-degree relatives of breast cancer patients.American journal of medical genetics, 57 3
C. Ferrans, M. Powers (1985)
Quality of life index: development and psychometric propertiesAdvances in Nursing Science, 8
J. Stroop (1992)
Studies of interference in serial verbal reactions.Journal of Experimental Psychology: General, 18
K. Shimozuma, P. Ganz, L. Petersen, K. Hirji (1999)
Quality of life in the first year after breast cancer surgery: rehabilitation needs and patterns of recoveryBreast Cancer Research and Treatment, 56
K. Brain, J. Gray, P. Norman, E. France, Cathy Anglim, G. Barton, E. Parsons, A. Clarke, H. Sweetland, M. Tischkowitz, J. Myring, K. Stansfield, D. Webster, K. Gower-Thomas, R. Daoud, C. Gateley, I. Monypenny, H. Singhal, L. Branston, J. Sampson, Elizabeth Roberts, R. Newcombe, D. Cohen, C. Rogers, R. Mansel, Peter Harper (2000)
Randomized trial of a specialist genetic assessment service for familial breast cancer.Journal of the National Cancer Institute, 92 16
Dorte Gyrd-Hansen (1999)
The relative economics of screening for colorectal cancer, breast cancer and cervical cancer.Critical reviews in oncology/hematology, 32 2
M. Kurtz, J. Kurtz, M. Stommel, C. Given, B. Given (1999)
The influence of symptoms, age, comorbidity and cancer site on physical functioning and mental health of geriatric women patients.Women & health, 29 3
J. House (1981)
Work stress and social support
L. Berkman (1983)
The Assessment of Social Networks and Social Support in the ElderlyJournal of the American Geriatrics Society, 31
T. Chalder, G. Berelowitz, T. Pawlikowska, L. Watts, S. Wessely, D. Wright, E. Wallace (1993)
Development of a fatigue scale.Journal of psychosomatic research, 37 2
A. Campbell (1982)
the Sense of well-being in America: Recent patterns and trendsPolitical Science Quarterly, 97
R. Melzack (1975)
The McGill Pain Questionnaire: Major properties and scoring methodsPAIN, 1
R. Boer, H. Koning, A. Threlfall, P. Warmerdam, A. Street, E. Friedman, C. Woodman (1998)
Cost effectiveness of shortening screening interval or extending age range of NHS breast screening programme: computer simulation studyBMJ, 317
Pauline Leung, I. Tannock, A. Oza, A. Puodziunas, G. Dranitsaris (1999)
Cost-utility analysis of chemotherapy using paclitaxel, docetaxel, or vinorelbine for patients with anthracycline-resistant breast cancer.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 17 10
A. Campbell, P. Converse, W. Rodgers (1976)
The Quality of American Life: Perceptions, Evaluations, and Satisfactions
D. Curran, J. Dongen, N. Aaronson, G. Kiebert, I. Fentiman, F. Mignolet, H. Bartelink (1998)
Quality of life of early-stage breast cancer patients treated with radical mastectomy or breast-conserving procedures: results of EORTC Trial 10801. The European Organization for Research and Treatment of Cancer (EORTC), Breast Cancer Co-operative Group (BCCG).European journal of cancer, 34 3
G. Berglund, C. Bolund, T. Fornander, L. Rutqvist, P. Sjödén (1991)
Late effects of adjuvant chemotherapy and postoperative radiotherapy on quality of life among breast cancer patients.European journal of cancer, 27 9
T. Preston (1999)
Will to live in the terminally illThe Lancet, 354
R. Couzi, K. Helzlsouer, J. Fetting (1995)
Prevalence of menopausal symptoms among women with a history of breast cancer and attitudes toward estrogen replacement therapy.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 13 11
Bakker Da, Lightfoot Ne, S. Steggles, C. Jackson (1998)
The experience and satisfaction of women attending breast cancer screening.Oncology nursing forum, 25 1
A. Maslin, M. Baum, J. Walker, R. A’Hern, A. Prouse (1998)
Using an interactive video disk in breast cancer patient support.Nursing times, 94 44
(1993)
Beck depression inventory manual. San Antonio (TX): The Psychological Corp
P. Fayers, P. Hopwood, A. Harvey, D. Girling, D. Machin, R. Stephens (1997)
Quality of life assessment in clinical trials—guidelines and a checklist for protocol writers: the U.K. Medical Research Council experienceEuropean Journal of Cancer, 33
Eva Tomiak, B. Diverty, Shailendra Verma, William Evans, C. LePetit, P. Will, Jean-Marie Berthelot (1998)
Follow-up practices for patients with early stage breast cancer: a survey of Canadian oncologists.Cancer prevention & control : CPC = Prevention & controle en cancerologie : PCC, 2 2
B. Ferrell, K. Dow, M. Grant (1995)
Measurement of the quality of life in cancer survivorsQuality of Life Research, 4
T. Chalmers, H. Smith, Bradley Blackburn, Bernard Silverman, Biruta Schroeder, D. Reitman, Alex Ambroz (1981)
A method for assessing the quality of a randomized control trial.Controlled clinical trials, 2 1
K. Pandya, R. Raubertas, P. Flynn, H. Hynes, R. Rosenbluth, J. Kirshner, H. Pierce, V. Dragalin, G. Morrow (2000)
Oral Clonidine in Postmenopausal Patients with Breast Cancer Experiencing Tamoxifen-Induced Hot Flashes: A University of Rochester Cancer Center Community Clinical Oncology Program StudyAnnals of Internal Medicine, 132
M. Bates, D. Lieu, M. Zagari, A. Spiers, T. Williamson (1997)
A pharmacoeconomic evaluation of the use of dexrazoxane in preventing anthracycline-induced cardiotoxicity in patients with stage IIIB or IV metastatic breast cancer.Clinical therapeutics, 19 1
K. Heithoff, K. Lohr (1990)
Effectiveness and Outcomes in Health Care
Allen Mw, P. Hendi, J. Schwimmer, Lawrence Bassett, S. Gambhir (2000)
Decision analysis for the cost effectiveness of sestamibi scintimammography in minimizing unnecessary biopsies.The quarterly journal of nuclear medicine : official publication of the Italian Association of Nuclear Medicine (AIMN) [and] the International Association of Radiopharmacology, 44 2
A. Holten-Verzantvoort, Jo Hermans, L. Beex, G. Blijham, F. Cleton, B. Eck-Smit, Harm Sleeboom, S. Papapoulos (1996)
Does supportive pamidronate treatment prevent or delay the first manifestation of bone metastases in breast cancer patients?European journal of cancer, 32A 3
L. Verhoef, L. Stalpers, A. Verbeek, T. Wobbes, W. Daal (1991)
Breast-conserving treatment or mastectomy in early breast cancer: a clinical decision analysis with special reference to the risk of local recurrence.European journal of cancer, 27 9
D. Hayes, J Zyl, A. Hacking, L. Goedhals, W Bezwoda, J. Mailliard, S Jones, C. Vogel, R Berris, I. Shemano (1995)
Randomized comparison of tamoxifen and two separate doses of toremifene in postmenopausal patients with metastatic breast cancer.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 13 10
A. Zigmond, R. Snaith (1983)
The Hospital Anxiety and Depression ScaleActa Psychiatrica Scandinavica, 67
P. Warmerdam, H. Koning, R. Boer, P. Beemsterboer, M. Dierks, E. Swart, B. Robra (1997)
Quantitative estimates of the impact of sensitivity and specificity in mammographic screening in Germany.Journal of Epidemiology and Community Health, 51
J. Bloom, L. Kessler (1994)
Emotional support following cancer: a test of the stigma and social activity hypotheses.Journal of health and social behavior, 35 2
S. Shiloh, O. Avdor, R. Goodman (1990)
Satisfaction with genetic counseling: dimensions and measurement.American journal of medical genetics, 37 4
A. Holten-Verzantvoort, A. Zwinderman, Neil Aaronson, Jo Hermans, Beatrix Emmerik, Frits Dam, Birgit Bos, Olav Bijvoet, F. Cleton (1991)
The effect of supportive pamidronate treatment on aspects of quality of life of patients with advanced breast cancer.European journal of cancer, 27 5
(1992)
Breast cancer screening for elderly women with and without comorbid conditions. A decision analysis model
M. Dimatteo, C. Sherbourne, Ron Hays, Lynn Ordway, R. Kravitz, E. McGlynn, S. Kaplan, W. Rogers (1993)
Physicians' characteristics influence patients' adherence to medical treatment: results from the Medical Outcomes Study.Health psychology : official journal of the Division of Health Psychology, American Psychological Association, 12 2
L. Hakamies-blomqvist, M. Luoma, J. Sjöström, A. Płużańska, M. Sjödin, H. Mouridsen, B. Østenstad, I. Mjaaland, S. Ottosson-Lönn, J. Bergh, P. Malmström, C. Blomqvist (2000)
Quality of life in patients with metastatic breast cancer receiving either docetaxel or sequential methotrexate and 5-fluorouracil. A multicentre randomised phase III trial by the Scandinavian breast group.European journal of cancer, 36 11
D. Carr (1977)
The manual for the staging of cancer.Annals of internal medicine, 87 4
A. Ramirez, KE Towlson, Mark Leaning, Marcia Richards, RD Rubens (1998)
Do patients with advanced breast cancer benefit from chemotherapy?British Journal of Cancer, 78
L. Derogatis, N. Melisaratos (1983)
The Brief Symptom Inventory: an introductory reportPsychological Medicine, 13
M. Lawton, E. Brody (1969)
Assessment of older people: self-maintaining and instrumental activities of daily living.The Gerontologist, 9 3
T. Hoerger, Kristen Downs, M. Lakshmanan, R. Lindrooth, L. Plouffe, Brett Wendling, S. West, R. Ohsfeldt (1999)
Healthcare use among U.S. women aged 45 and older: total costs and costs for selected postmenopausal health risks.Journal of women's health & gender-based medicine, 8 8
D. Osoba, M. Burchmore (1999)
Health-related quality of life in women with metastatic breast cancer treated with trastuzumab (Herceptin).Seminars in oncology, 26 4 Suppl 12
P. Ganz, R. Day, J. Ware, C. Redmond, B. Fisher (1995)
Base-line quality-of-life assessment in the National Surgical Adjuvant Breast and Bowel Project Breast Cancer Prevention Trial.Journal of the National Cancer Institute, 87 18
A. Lipton, R. Theriault, G. Hortobagyi, Joseph Simeone, Robert Knight, K. Mellars, D. Reitsma, M. Heffernan, J. Seaman (2000)
Pamidronate prevents skeletal complications and is effective palliative treatment in women with breast carcinoma and osteolytic bone metastasesCancer, 88
D. Karnofsky (1949)
The clinical evaluation of chemotherapeutic agents in cancer
F. Dam, S. Schagen, M. Muller, W. Boogerd, E. Wall, Maria Fortuyn, S. Rodenhuis (1998)
Impairment of cognitive function in women receiving adjuvant treatment for high-risk breast cancer: high-dose versus standard-dose chemotherapy.Journal of the National Cancer Institute, 90 3
B. Poulsen, Graversen Hp, J. Beckmann, M. Blichert‐Toft (1997)
A comparative study of post-operative psychosocial function in women with primary operable breast cancer randomized to breast conservation therapy or mastectomy.European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 23 4
B. Ferrell, M. Grant, Brandi Funk, S. Otis-Green, N. Garcia (1998)
Quality of life in breast cancer survivors: implications for developing support services.Oncology nursing forum, 25 5
C. Hürny, Jürg Bernhard, R. Gelber, A. Coates, M. Castiglione, M. Isley, Donatus Dreher, H. Peterson, A. Goldhirsch, H. Senn (1992)
Quality of life measures for patients receiving adjuvant therapy for breast cancer: an international trial. The International Breast Cancer Study Group.European journal of cancer, 28 1
M. Sprangers, M. Groenvold, J. Arraras, J. Franklin, A. Velde, M. Muller, L. Franzini, Anna Williams, H. Haes, P. Hopwood, A. Cull, N. Aaronson (1996)
The European Organization for Research and Treatment of Cancer breast cancer-specific quality-of-life questionnaire module: first results from a three-country field study.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 14 10
D. Brambilla, S. Mckinlay, C. Johannes (1994)
Defining the perimenopause for application in epidemiologic investigations.American journal of epidemiology, 140 12
L. Walker, C. Cordiner, F. Gilbert, G. Needham, H. Deans, I. Affleck, D. Hood, D. Mathieson, A. Ah-See, O. Eremin (1994)
How distressing is attendance for routine breast screening?Psycho‐Oncology, 3
T. Whelan, M. Levine, J. Julian, P. Kirkbride, P. Skingley (2000)
The effects of radiation therapy on quality of life of women with breast carcinoma: results of a randomized trial. Ontario Clinical Oncology Group.Cancer, 88
Marlene Frost, Arvizu Rd, S. Jayakumar, A. Schoonover, Paul Novotny, K. Zahasky (1999)
A multidisciplinary healthcare delivery model for women with breast cancer: patient satisfaction and physical and psychosocial adjustment.Oncology nursing forum, 26 10
V. Grann, W. Whang, J. Jacobson, D. Heitjan, K. Antman, A. Neugut (1999)
Benefits and costs of screening Ashkenazi Jewish women for BRCA1 and BRCA2.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 17 2
R. Secker-Walker, Pamela Vacek, Gloria Hooper, Dennis Plante, Allan Detsky (1999)
Screening for breast cancer: time, travel, and out-of-pocket expenses.Journal of the National Cancer Institute, 91 8
T. Smith, B. Hillner (1993)
The efficacy and cost-effectiveness of adjuvant therapy of early breast cancer in premenopausal women.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 11 4
T. Leivo, H. Sintonen, R. Tuominen, M. Hakama, E. Pukkala, O. Heinonen (1999)
The cost‐effectiveness of nationwide breast carcinoma screening in Finland, 1987–1992Cancer, 86
F. Andrews, S. Withey (1976)
Social Indicators of Well-Being: Americans' Perceptions of Life Quality
J. Bernhard, M. Castiglione‐Gertsch, S. Schmitz, B. Thürlimann, F. Cavalli, R. Morant, M. Fey, H. Bonnefoi, A. Goldhirsch, C. Hürny (1999)
Quality of life in postmenopausal patients with breast cancer after failure of tamoxifen: formestane versus megestrol acetate as second-line hormonal treatment. Swiss Group for Clinical Cancer Research (SAKK).European journal of cancer, 35 6
D. Tate, B. Riley, R. Perna, S. Roller (1997)
Quality of life issues among women with physical disabilities or breast cancer.Archives of physical medicine and rehabilitation, 78 12 Suppl 5
M. Andrykowski, C. Greiner, E. Altmaier, T. Burish, J. Antin, R. Gingrich, C. McGarigle, Henslee-Downey Pj (1995)
Quality of life following bone marrow transplantation: findings from a multicentre study.British Journal of Cancer, 71
J. Nabholtz, B. Thuerlimann, W. Bezwoda, D. Melnychuk, L. Deschênes, J. Douma, T. Vandenberg, B. Rapoport, R. Rosso, V. Trillet‐Lenoir, J. Drbal, M. Aapro, M. Alaki, M. Murawsky, A. Riva (1997)
Docetaxel vs mitomycin plus vinblastine in anthracycline-resistant metastatic breast cancer.Oncology, 11 8 Suppl 8
D. Hann, P. Jacobsen, S. Martin, L. Kronish, L. Azzarello, K. Fields (1997)
Quality of life following bone marrow transplantation for breast cancer: a comparative studyBone Marrow Transplantation, 19
E. Hannisdal, S. Gundersen, S. Kvaløy, H. Høst, M. Lindegaard, M. Aas, A. Finnanger, O. Jørgensen, L. Theodorsen (1993)
Follow-up of breast cancer patients stage I-II: a baseline strategy.European journal of cancer, 29A 7
(1983)
Structured clinical interview for DSM-III-R. Patient edition
S. Orden, N. Bradburn (1969)
Working Wives and Marriage HappinessAmerican Journal of Sociology, 74
A. Bull, L. Mountney, H. Sanderson (1991)
Stage distribution of breast cancer: a basis for the evaluation of breast screening programmes.The British journal of radiology, 64 762
R. Hultborn, S. Gundersen, S. Rydén, E. Holmberg, J. Carstensen, U. Wallgren, S. Killany, L. Andreassen, G. Carlsson, N. Fahl, T. Hatschek, H. Sommer, Y. Hessman, B. Hornmark-Stenstam, S. Johnsborg, R. Klepp, R. Laiño, L. Niklasson, C. Rudenstam, A. Sundbeck, M. Söderberg, G. Tejler (1999)
Efficacy of pamidronate in breast cancer with bone metastases: a randomized double-blind placebo controlled multicenter study.Acta oncologica, 35 Suppl 5
C. Lee (1997)
Quality of life and breast cancer survivors. Psychosocial and treatment issues.Cancer practice, 5 5
J. Nabholtz, H. Senn, W. Bezwoda, D. Melnychuk, L. Deschênes, J. Douma, T. Vandenberg, B. Rapoport, R. Rosso, V. Trillet‐Lenoir, J. Drbal, A. Molino, J. Nortier, D. Richel, T. Nagykálnai, P. Siedlecki, N. Wilking, J. Genot, P. Hupperets, F. Pannuti, D. Skarlos, E. Tomiak, M. Murawsky, M. Alakl, A. Riva, M. Aapro (1999)
Prospective Randomized Trial of Docetaxel Versus Mitomycin Plus Vinblastine in Patients With Metastatic Breast Cancer Progressing Despite Previous Anthracycline-Containing ChemotherapyJournal of Clinical Oncology, 17
M. Stefanek, K. Helzlsouer, P. Wilcox, F. Houn (1995)
Predictors of and satisfaction with bilateral prophylactic mastectomy.Preventive medicine, 24 4
M. Rubin, K. Horiuchi, N. Joy, W. Haun, R. Read, E. Ratzer, M. Fenoglio (1997)
Use of fine needle aspiration for solid breast lesions is accurate and cost-effective.American journal of surgery, 174 6
L. Northouse, M. Swain (1987)
Adjustment of Patients and Husbands to the Initial Impact Of Breast CancerNursing Research, 36
(1959)
Short martial adjustment and predictive tests: their reliability and validity
W. Jonat, Anthony Howell, C. Blomqvist, W. Eiermann, G. Winblad, C. Tyrrell, L. Mauriac, Henri Roché, S. Lundgren, R. Hellmund, M. Azab (1996)
A randomised trial comparing two doses of the new selective aromatase inhibitor anastrozole (Arimidex) with megestrol acetate in postmenopausal patients with advanced breast cancer.European journal of cancer, 32A 3
L. Radloff (1977)
The CES-D ScaleApplied Psychological Measurement, 1
(1997)
Version 4 ed. Chicago (IL): Evanston Northwestern Healthcare and Northwestern University
G. Macquart‐Moulin, P. Viens, D. Genre, Marie‐Laure Bouscary, M. Resbeut, G. Gravis, J. Camerlo, D. Maraninchi, J. Moatti (1999)
Concomitant chemoradiotherapy for patients with nonmetastatic breast carcinomaCancer, 85
(1978)
117) Test d2 Aufmerksamkeitsbelastungstest
E. Dajczman, Ann Gordon, Harvey Kreisman, N. Wolkove (1991)
Long-term postthoracotomy pain.Chest, 99 2
P. Ganz, A. Coscarelli, C. Fred, B. Kahn, M. Polinsky, L. Petersen (2005)
Breast cancer survivors: Psychosocial concerns and quality of lifeBreast Cancer Research and Treatment, 38
R. Gelber, A. Goldhirsch, B. Cole (1993)
Evaluation of effectiveness: Q-TWiSTCancer Treatment Reviews, 19
J. Burkhardt, J. Sunshine (1999)
Core-needle and surgical breast biopsy: comparison of three methods of assessing cost.Radiology, 212 1
V. Mor, M. Malin, S. Allen (1994)
Age differences in the psychosocial problems encountered by breast cancer patients.Journal of the National Cancer Institute. Monographs, 16
D. Cella, D. Tulsky (1990)
Measuring quality of life today: methodological aspects.Oncology, 4 5
D. Haiart, L. Mckenzie, J. Henderson, W. Pollock, D. Mcqueen, M. Roberts, A. Forrest (1990)
Mobile breast screening: factors affecting uptake, efforts to increase response and acceptability.Public health, 104 4
J. Wolstenholme, Sarah Smith, D. Whynes (1998)
The Costs of Treating Breast Cancer in the United Kingdom: Implications for ScreeningInternational Journal of Technology Assessment in Health Care, 14
P. Geels, E. Eisenhauer, A. Bezjak, B. Zee, A. Day (2000)
Palliative effect of chemotherapy: objective tumor response is associated with symptom improvement in patients with metastatic breast cancer.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 18 12
Andrea Messori, P. Becagli, S. Trippoli, E. Tendi (1996)
Cost-effectiveness of adjuvant chemotherapy with cyclophosphamide + methotrexate + fluorouracil in patients with node-positive breast cancerEuropean Journal of Clinical Pharmacology, 51
C. Sherbourne, A. Stewart (1991)
The MOS social support survey.Social science & medicine, 32 6
D. Haes (1988)
Quality of Life: Conceptual and theoretical considerations
Y. Wengström, C. Häggmark, H. Strander, C. Forsberg (1999)
Effects of a nursing intervention on subjective distress, side effects and quality of life of breast cancer patients receiving curative radiation therapy--a randomized study.Acta oncologica, 38 6
Ruth Brown, John Hutton (1998)
Cost-utility model comparing docetaxel and paclitaxel in advanced breast cancer patients.Anti-cancer drugs, 9 10
T. Hack, L. Cohen, J. Katz, L. Robson, P. Goss (1999)
Physical and psychological morbidity after axillary lymph node dissection for breast cancer.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 17 1
G. Guyatt, D. Feeny, D. Patrick (1993)
Measuring Health-Related Quality of LifeAnnals of Internal Medicine, 118
B. Hillner, Jane Weeks, C. Desch, Thomas Smith (2000)
Pamidronate in prevention of bone complications in metastatic breast cancer: a cost-effectiveness analysis.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 18 1
W. Harten, O. Noort, R. Warmerdam, H. Hendricks, E. Seidel (1998)
Assessment of rehabilitation needs in cancer patientsInternational Journal of Rehabilitation Research, 21
J. Norum, J. Olsen, E. Wist (1997)
Lumpectomy or mastectomy? Is breast conserving surgery too expensive?Breast Cancer Research and Treatment, 45
M. Andrykowski, S. Curran, R. Lightner (1998)
Off-Treatment Fatigue in Breast Cancer Survivors: A Controlled ComparisonJournal of Behavioral Medicine, 21
B. Kelly, P. Edwards, R. Synott, C. Neil, R. Baillie, D. Battistutta (1999)
Predictors of bereavement outcome for family carers of cancer patientsPsycho‐Oncology, 8
J. Lasry, J. Lasry, R. Margolese, R. Poisson, H. Shibata, D. Fleischer, Denise Lafleur, S. Legault, S. Taillefer (1987)
Depression and body image following mastectomy and lumpectomy.Journal of chronic diseases, 40 6
J. Lamarque, J. Pujol, J. Cherifcheikh, J. Laurent, P. Taourel, P. Boulet, J. Daurès, F. Séguret, A. Guizard, G. Delande, M. Negre (1998)
Cost evaluation of breast cancer screening in France.Academic radiology, 5 Suppl 2
H. Koning, B. Ineveld, G. Oortmarssen, J. Haes, H. Collette, J. Hendriks, P. Maas (1991)
Breast cancer screening and cost‐effectiveness; Policy alternatives, quality of life considerations and the possible impact of uncertain factorsInternational Journal of Cancer, 49
M. Cobleigh, C. Vogel, D. Tripathy, N. Robert, S. Scholl, L. Fehrenbacher, J. Wolter, V. Paton, S. Shak, G. Lieberman, D. Slamon (1999)
Multinational study of the efficacy and safety of humanized anti-HER2 monoclonal antibody in women who have HER2-overexpressing metastatic breast cancer that has progressed after chemotherapy for metastatic disease.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 17 9
R. Delaplaine, J. Bottomy, M. Blatt, H. Wiesbader, H. Kupperman (1952)
Effective control of the surgical menopause by estradiol pellet implantation at the time of surgery.Surgery, gynecology & obstetrics, 94 3
W. Logan-Young, A. Dawson, D. Wilbur, Eduardo Avila, Zygmunt Tomkiewicz, L. Sheils, John Laczin, Andrea Taylor (1998)
The cost‐effectiveness of fine‐needle aspiration cytology and 14‐gauge core needle biopsy compared with open surgical biopsy in the diagnosis of breast carcinomaCancer, 82
S. Katz, A. Ford, R. Moskowitz, B. Jackson, M. Jaffe (1963)
STUDIES OF ILLNESS IN THE AGED. THE INDEX OF ADL: A STANDARDIZED MEASURE OF BIOLOGICAL AND PSYCHOSOCIAL FUNCTION.JAMA, 185
A. Goldhirsch, R. Gelber, R. Simes, P. Glasziou, A. Coates (1989)
Costs and benefits of adjuvant therapy in breast cancer: a quality-adjusted survival analysis.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 7 1
International Group, C. Hürny, J. Bernhard, M. Castiglione‐Gertsch, A. Coates, H. Peterson, R. Gelber, J. Forbes, C. Rudenstam, E. Simoncini, D. Crivellari, A. Goldhirsch, H. Senn (1996)
Impact of adjuvant therapy on quality of life in women with node-positive operable breast cancerThe Lancet, 347
H. Rauschecker, R. Sauer, A. Schauer, M. Schumacher, M. Olschewski, W. Sauerbrei, M. Seegenschmiedt, C. Schmoor, T. Group (1995)
Therapy of small breast cancer - four-year results of a prospective non-randomized studyBreast Cancer Research and Treatment, 34
F. Gaston‐Johansson, K. Ohly, J. Fall‐Dickson, J. Nanda, M. Kennedy (1999)
Pain, psychological distress, health status, and coping in patients with breast cancer scheduled for autotransplantation.Oncology nursing forum, 26 8
R. Orr, J. Hoehn, N. Col (1999)
The learning curve for sentinel node biopsy in breast cancer: practical considerations.Archives of surgery, 134 7
Kimbroe Carter, N. Ritchey, Frank Castro, L. Caccamo, Edward Kessler, B. Erickson, Lori Gawdyda (1998)
Treatment of Early-Stage Breast Cancer in the ElderlyMedical Decision Making, 18
A. Longman, C. Braden, M. Mishel (1996)
Side effects burden in women with breast cancer.Cancer practice, 4 5
P. Rubé (1959)
L’examen Clinique en PsychologieAmerican Journal of Psychotherapy, 13
O. Tiggelen, G. Storme, K. Torfs, D. Berge (1999)
USING APPROPRIATE COMPARISONS IN ECONOMIC EVALUATIONSInternational Journal of Technology Assessment in Health Care, 15
L. Fajardo (1996)
Cost-effectiveness of stereotaxic breast core needle biopsy.Academic radiology, 3 Suppl 1
A. Legorreta, R. Brooks, A. Leibowitz, L. Solin (1996)
Cost of breast cancer treatment. A 4-year longitudinal study.Archives of internal medicine, 156 19
S. Smith, J. Botha, R. Goosey, H. Daintith (1991)
Audit of user satisfaction with the Leicestershire Breast Screening Service; women attending for assessment of abnormal mammograms.Journal of public health medicine, 13 3
M. Pol, J. Cairns, F. Gilbert, P. Hendry (1999)
Economic analysis of outreach assessment clinics in breast screening programmes.The International journal of health planning and management, 14 1
Florence Joly, M. Espié, M. Marty, J. Heron, M. Henry-Amar (2000)
Long-term quality of life in premenopausal women with node-negative localized breast cancer treated with or without adjuvant chemotherapyBritish Journal of Cancer, 83
B. Hillner, T. Smith (1991)
Efficacy and cost effectiveness of adjuvant chemotherapy in women with node-negative breast cancer. A decision-analysis model.The New England journal of medicine, 324 3
C. Burgess, A. Ramirez, Patrick Smith, M. Richards (2000)
Do adverse life events and mood disorders influence delayed presentation of breast cancer?Journal of psychosomatic research, 48 2
D. Torgerson, T. Gosden (1997)
The national breast screening service: is it economically efficient?QJM : monthly journal of the Association of Physicians, 90 6
S. Franzoi, S. Shields (1984)
The Body Esteem Scale: multidimensional structure and sex differences in a college population.Journal of personality assessment, 48 2
D. Goldberg (1972)
The detection of psychiatric illness by questionnaire
N. Aaronson (1990)
Quality of Life Assessment in Cancer Clinical Trials
M. Gabel, N. Hilton, S. Nathanson (1997)
Multidisciplinary breast cancer clinicsCancer, 79
R. Daut, C. Cleeland, R. Flanery (1983)
Development of the Wisconsin Brief Pain Questionnaire to assess pain in cancer and other diseasesPain, 17
C. Cleeland, K. Syrjala (1992)
How to assess cancer pain.
Michel Dorval, E. Maunsell, L. Deschênes, J. Brisson (1998)
Type of mastectomy and quality of life for long term breast carcinoma survivorsCancer, 83
W. Biermann, R. Cantor, F. Fellin, J. Jakóbowski, L. Hopkins, R. Newbold (1991)
An evaluation of the potential cost reductions resulting from the use of clodronate in the treatment of metastatic carcinoma of the breast to bone.Bone, 12 Suppl 1
B. Hillner, T. Smith (1992)
A model of chemotherapy in node-negative breast cancer.Journal of the National Cancer Institute. Monographs, 11
F. Ashbury, C. Cameron, S. Mercer, M. Fitch, E. Nielsen (1998)
One-on-one peer support and quality of life for breast cancer patients.Patient education and counseling, 35 2
P. Ganz, C. Schag, J. Lee, M. Polinsky, Shuangfeng Tan (1992)
Breast conservation versus mastectomy. Is there a difference in psychological adjustment or quality of life in the year after surgery?Cancer, 69
J. Hrung, C. Langlotz, S. Orel, K. Fox, M. Schnall, J. Schwartz (1999)
Cost-effectiveness of MR imaging and core-needle biopsy in the preoperative work-up of suspicious breast lesions.Radiology, 213 1
P. Beemsterboer, H. Koning, P. Warmerdam, R. Boer, E. Swart, M. Dierks, B. Robra (1994)
Prediction of the effects and costs of breast‐cancer screening in GermanyInternational Journal of Cancer, 58
R. Tait, J. Chibnall, S. Krause (1990)
The Pain Disability Index: psychometric propertiesPain, 40
R. Adewuyi‐Dalton, S. Ziebland, E. Grunfeld, A. Hall (1998)
Patients' views of routine hospital follow‐up: a qualitative study of women with breast cancer in remissionPsycho‐Oncology, 7
H. Cantril (1965)
The pattern of human concerns
L. Derogatis, N. Melisaratos (1979)
The DSFI: a multidimensional measure of sexual functioning.Journal of sex & marital therapy, 5 3
S. Hunt, J. Mcewen, S. McKenna (1985)
Measuring health status: a new tool for clinicians and epidemiologists.The Journal of the Royal College of General Practitioners, 35 273
D. August, D. Ehrlich, L. Carpenter (1995)
Patient Evaluation of Care Within a Multidisciplinary Breast Care CenterQuality Management in Health Care, 3
D. Mille, Thomas Roy, M. Carrère, I. Ray, N. Ferdjaoui, H. Späth, F. Chauvin, T. Philip (2000)
Economic impact of harmonizing medical practices: compliance with clinical practice guidelines in the follow-up of breast cancer in a French Comprehensive Cancer Center.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 18 8
P. Fayers, Penny Hopwood, A. Harvey, D. Girling, D. Machin, R. Stephens (1997)
Quality of life assessment in clinical trials--guidelines and a checklist for protocol writers: the U.K. Medical Research Council experience. MRC Cancer Trials Office.European journal of cancer, 33 1
K. Johnston, Jackie Brown, K. Gerard, M. O'Hanlon, Alison Morton (1998)
Valuing temporary and chronic health states associated with breast screening.Social science & medicine, 47 2
S. Feig (1995)
Mammographic screening of women aged 40–49 years. Benefit, risk, and cost considerationsCancer, 76
J. Bloom, S. Stewart, M. Johnston, Priscilla Banks (1998)
Intrusiveness of illness and quality of life in young women with breast cancerPsycho‐Oncology, 7
D. Mcnair, M. Lorr, L. Droppleman (1971)
Manual for the Profile of Mood States
J. Zavertnik, C. McCoy, D. Robinson, N. Love (1992)
Cost‐effective management of breast cancerCancer, 69
P. Mosconi, B. Meyerowitz, M. Liberati, A. Liberati (1991)
Disclosure of breast cancer diagnosis: patient and physician reports. GIVIO (Interdisciplinary Group for Cancer Care Evaluation, Italy)Annals of oncology : official journal of the European Society for Medical Oncology, 2 4
(1983)
The Urban Life Stress Scale. Manuscript In press
S. Shapiro, A. López, G. Schwartz, R. Bootzin, A. Figueredo, C. Braden, S. Kurker (2001)
Quality of life and breast cancer: relationship to psychosocial variables.Journal of clinical psychology, 57 4
Deborah Schrag, Karen Kuntz, Judy Garber, Jane Weeks (1997)
Decision analysis--effects of prophylactic mastectomy and oophorectomy on life expectancy among women with BRCA1 or BRCA2 mutations.The New England journal of medicine, 336 20
J. Ware, A. Davies, R. Brook (1979)
Conceptualization and Measurement of Health for Adults in the Health Insurance Study
D. Mazur, D. Hickam (1993)
Patient preferencesJournal of General Internal Medicine, 8
R. Gelber, M. Bonetti, B. Cole, S. Gelber, A. Goldhirsch (1998)
Quality of life assessment in the adjuvant setting: is it relevant? International Breast Cancer Study Group.Recent results in cancer research. Fortschritte der Krebsforschung. Progres dans les recherches sur le cancer, 152
R. Portenoy, H. Thaler, A. Kornblith, J. Lepore, Hamutal Friedlander‐Klar, E. Kiyasu, K. Sobel, N. Coyle, N. Kemeny, Larry Norton, H. Scher (1994)
The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics and distress.European journal of cancer, 30A 9
K. Dow, B. Ferrell, S. Leigh, J. Ly, P. Gulasekaram (2005)
An evaluation of the quality of life among long-term survivors of breast cancerBreast Cancer Research and Treatment, 39
S. Jones, E. Winer, C. Vogel, L. Laufman, L. Hutchins, M. O'Rourke, B. Lembersky, D. Budman, J. Bigley, J. Hohneker (1995)
Randomized comparison of vinorelbine and melphalan in anthracycline-refractory advanced breast cancer.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 13 10
Bruce Hillner (1997)
Decision analysis: MIBI imaging of nonpalpable breast abnormalities.Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 38 11
B. Hillner, Thomas Smith, C. Desch (1992)
Efficacy and cost-effectiveness of autologous bone marrow transplantation in metastatic breast cancer. Estimates using decision analysis while awaiting clinical trial results.JAMA, 267 15
E. Grunfeld, D. Mant, P. Yudkin, R. Adewuyi‐Dalton, D. Cole, J. Stewart, R. Fitzpatrick, M. Vessey (1996)
Routine follow up of breast cancer in primary care: randomised trialBMJ, 313
V. Grann, K. Panageas, W. Whang, K. Antman, A. Neugut (1998)
Decision analysis of prophylactic mastectomy and oophorectomy in BRCA1-positive or BRCA2-positive patients.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 16 3
R. Nease, J. Ross (1995)
The decision to enter a randomized trial of tamoxifen for the prevention of breast cancer in healthy women: an analysis of the tradeoffs.The American journal of medicine, 99 2
Robert Spitzer, J. Endicott, J. Fleiss, Jacob Cohen (1970)
The psychiatric status schedule. A technique for evaluating psychopathology and impairment in role functioning.Archives of general psychiatry, 23 1
Hayes Aj (1998)
An audit of outcome including patient satisfaction with immediate breast reconstruction performed by breast surgeons.Annals of the Royal College of Surgeons of England, 80 6
R. Gelber, S. Gelber, M. Bonetti, A. Goldhirsch (1998)
S37 Quality of life assessment in the adjuvant setting: Is it relevant?European Journal of Cancer, 34
Daniel Buysse, C. Reynolds, T. Monk, S. Berman, D. Kupfer (1989)
The Pittsburgh sleep quality index: A new instrument for psychiatric practice and researchPsychiatry Research, 28
Frazer Gh, Brown Rd, Graves Tk (1998)
Assessment of quality of life indicators among selected patients in a community cancer center.Issues in Mental Health Nursing, 19
J. Bernhard, C. Hürny, AS Coates, HF Peterson, M. Castiglione‐Gertsch, RD Gelber, E. Galligioni, G. Marini, B. Thürlimann, JF Forbes, A. Goldhirsch, Hans-Jörg Senn, C. Rudenstam, for Group (1998)
Factors affecting baseline quality of life in two international adjuvant breast cancer trials. International Breast Cancer Study Group (IBCSG).British Journal of Cancer, 78
L. Bertsch, G. Donaldson (1995)
Quality of life analyses from vinorelbine (Navelbine) clinical trials of women with metastatic breast cancer.Seminars in oncology, 22 2 Suppl 5
C. Roberts, C. Cox, D. Reintgen, W. Baile, M. Gibertini (1994)
Influence of physician communication on newly diagnosed breast patients' psychologic adjustment and decision‐makingCancer, 74
B. Hillner, Thomas Smith, C. Desch (2004)
Assessing the cost effectiveness of adjuvant therapies in early breast cancer using a decision analysis modelBreast Cancer Research and Treatment, 25
Cella Df, Cherin Ea (1988)
Quality of life during and after cancer treatment.Comprehensive Therapy, 14
J. Lokich, C. Moore, N. Anderson (1996)
Comparison of costs for infusion versus bolus chemotherapy administration: analysis of five standard chemotherapy regimens in three common tumors‐‐Part one: Model projections for cost based on chargesCancer, 78
I. Gram, E. Lund, SE Slenker (1990)
Quality of life following a false positive mammogram.British Journal of Cancer, 62
C. Hürny, J. Bernhard, M. Bacchi, B. Wegberg, M. Tomamichel, Ursula Spek, A. Coates, M. Castiglione, A. Goldhirsch, H. Senn, Swiss Research, Coordinating Group (1993)
The Perceived Adjustment to Chronic Illness Scale (PACIS): a global indicator of coping for operable breast cancer patients in clinical trialsSupportive Care in Cancer, 1
J. Silber, Moshe Fridman, A. Shpilsky, O. Even-Shoshan, D. Smink, J. Jayaraman, K. Fox, M. Pauly (1998)
Modeling the cost-effectiveness of granulocyte colony-stimulating factor use in early-stage breast cancer.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 16 7
R. Gelber, Bernard Cole, A. Goldhirsch, Carsten Rose, B. Fisher, CK Osborne, F. Boccardo, Richard Gray, N. Gordon, N. Bengtsson, Paul Sevelda (1996)
Adjuvant chemotherapy plus tamoxifen compared with tamoxifen alone for postmenopausal breast cancer: meta-analysis of quality-adjusted survivalThe Lancet, 347
D. Patrick, P. Erickson (1988)
What constitutes quality of life? Concepts and dimensions, 13
F. Gaston‐Johansson, J. Fall‐Dickson, Alexis Bakos, M. Kennedy (1999)
Fatigue, pain, and depression in pre-autotransplant breast cancer patients.Cancer practice, 7 5
A. Kornblith, D. Hollis, E. Zuckerman, A. Lyss, G. Canellos, M. Cooper, J. Herndon, C. Phillips, J. Abrams, J. Aisner (1993)
Effect of megestrol acetate on quality of life in a dose-response trial in women with advanced breast cancer. The Cancer and Leukemia Group B.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 11 11
S. Spencer, Jessica Lehman, C. Wynings, Patricia Arena, C. Carver, M. Antoni, R. Derhagopian, G. Ironson, N. Love (1999)
Concerns about breast cancer and relations to psychosocial well-being in a multiethnic sample of early-stage patients.Health psychology : official journal of the Division of Health Psychology, American Psychological Association, 18 2
H. Joensuu, Kaija Holli, Mirja Heikkinen, Eero Suonio, Aria Aro, Pivi Hietanen, R. Huovinen (1998)
Combination chemotherapy versus single-agent therapy as first- and second-line treatment in metastatic breast cancer: a prospective randomized trial.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 16 12
J. Hayman, B. Hillner, J. Harris, J. Weeks (1998)
Cost-effectiveness of routine radiation therapy following conservative surgery for early-stage breast cancer.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 16 3
R. Boer, H. Koning, P. Maas (1999)
A longer breast carcinoma screening interval for women age older than 65 years?Cancer, 86
R. Watts (1982)
Sexual Functioning, Health Beliefs, and Compliance with High Blood Pressure MedicationsNursing Research, 31
J. Carpenter, M. Andrykowski (1999)
Menopausal symptoms in breast cancer survivors.Oncology nursing forum, 26 8
E. Grunfeld, E. Grunfeld, A. Gray, D. Mant, D. Mant, P. Yudkin, R. Adewuyi‐Dalton, D. Coyle, D. Cole, J. Stewart, R. Fitzpatrick, M. Vessey (1999)
Follow-up of breast cancer in primary care vs specialist care: results of an economic evaluationBritish Journal of Cancer, 79
Manfred Kaufmann, E. Bajetta, L. Dirix, L. Fein, Stephen Jones, N. Zilembo, J. Dugardyn, C. Nasurdi, R. Mennel, J. Červek, C. Fowst, A. Polli, E. Salle, A. Arkhipov, G. Piscitelli, L. Miller, G. Massimini (2000)
Exemestane is superior to megestrol acetate after tamoxifen failure in postmenopausal women with advanced breast cancer: results of a phase III randomized double-blind trial. The Exemestane Study Group.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 18 7
H. Burstein, S. Gelber, E. Guadagnoli, J. Weeks (1999)
Use of alternative medicine by women with early-stage breast cancer.The New England journal of medicine, 340 22
M. Allen, P. Hendi, L. Bassett, M. Phelps, S. Gambhir (1999)
A study on the cost effectiveness of sestamibi scintimammography for screening women with dense breasts for breast cancerBreast Cancer Research and Treatment, 55
K. Holli, M. Hakama (1993)
Biological, physical, mental and social dimensions of breast cancer: information based on routine case notes.European journal of cancer, 29A 15
C. Spielberger, R. Gorsuch, R. Lushene (1970)
Manual for the State-Trait Anxiety Inventory
J. Bonnema, A. Wersch, A. Geel, J.F.A Pruyn, P.I.M Schmitz, C.A Groot, T. Wiggers (1997)
Cost of care in a randomised trial of early hospital discharge after surgery for breast cancer.European journal of cancer, 34 13
P. Ganz, J. Rowland, B. Meyerowitz, K. Desmond (1998)
Impact of different adjuvant therapy strategies on quality of life in breast cancer survivors.Recent results in cancer research. Fortschritte der Krebsforschung. Progres dans les recherches sur le cancer, 152
N. Evans (1996)
Revolution follows the breast cancer epidemic.Revolution, 6 2
Fiona McKinna, L. Gothard, Susan Ashley, Stephen Ebbs, John Yarnold (1999)
Selective avoidance of lymphatic radiotherapy in the conservative management of women with early breast cancer.Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 52 3
H. Kennedy, N. Kennedy, M. Barclay, M. Horobin (1991)
Cost efficiency of bone scans in breast cancer.Clinical oncology (Royal College of Radiologists (Great Britain)), 3 2
J. Bonnema, A. Wersch, A. Geel, J. Pruyn, P. Schmitz, M. Paul, T. Wiggers (1998)
Medical and psychosocial effects of early discharge after surgery for breast cancer: randomised trialBMJ, 316
Bent Kristensen, Bent Ejlertsen, M. Groenvold, S. Hein, H. Loft, Henning Mouridsen (1999)
Oral clodronate in breast cancer patients with bone metastases: a randomized studyJournal of Internal Medicine, 246
C. Julian-reynier, F. Eisinger, F. Chabal, C. Lasset, C. Noguès, D. Stoppa-Lyonnet, P. Vennin, H. Sobol (2000)
Disclosure to the family of breast/ovarian cancer genetic test results: patient's willingness and associated factors.American journal of medical genetics, 94 1
J. Haes, Fce Knippenberg, J. Neijt (1990)
Measuring psychological and physical distress in cancer patients: structure and application of the Rotterdam Symptom Checklist.British Journal of Cancer, 62
M. Clavel, J. Bonneterre, H. d’Allens, J. Paillarse (1995)
Oral ondansetron in the prevention of chemotherapy-induced emesis in breast cancer patients. French Ondansetron Study Group.European journal of cancer, 31A 1
N. Aaronson, S. Ahmedzai, B. Bergman, M. Bullinger, A. Cull, N. Duez, A. Filiberti, H. Flechtner, S. Fleishman, J. Haes, S. Kaasa, M. Klee, D. Osoba, D. Razavi, Peter Rofe, S. Schraub, K. Sneeuw, M. Sullivan, F. Takeda (1993)
The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology.Journal of the National Cancer Institute, 85 5
D. Lee (1969)
Society and the Adolescent Self-ImageSociology, 3
Michel Dorval, E. Maunsell, L. Deschênes, J. Brisson, B. Mâsse (1998)
Long-term quality of life after breast cancer: comparison of 8-year survivors with population controls.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 16 2
M. Frost, D. Schaid, T. Sellers, J. Slezak, Philip Arnold, J. Woods, P. Petty, Joanne Johnson, Diana Sitta, S. McDonnell, T. Rummans, Robert Jenkins, J. Sloan, L. Hartmann (2000)
Long-term satisfaction and psychological and social function following bilateral prophylactic mastectomy.JAMA, 284 3
W. Spitzer, W. Spitzer, Annette Dobson, A. Dobson, Jane Hall, Jane Hall, E. Chesterman, E. Chesterman, J. Levi, J. Levi, R. Shepherd, R. Shepherd, R. Battista, R. Battista, B. Catchlove, B. Catchlove (1981)
Measuring the quality of life of cancer patients: a concise QL-index for use by physicians.Journal of chronic diseases, 34 12
Paolo Ghezzi, S. Magnanini, Francesco Renzi, F. Berardi, G. Biagio, F. Testare, N. Tavoni, F. Schittulli, C. D'Amico, T. Pedicini, M. Fumagalli, G. Gritti, Marco Braga, Giuseppina Marini, A. Zaniboni, D. Cosentino, C. Epifani, G. Gini, D. Perroni, F. Peradotto, M. Indelli, A. Santini, L. Isa, E. Aitini, G. Cavazzini, F. Smerieri, O. Nascimben, R. Busolin, G. Papaccio, E. Locatelli, M. Monti, E. Ghislandi, O. Gottardi, M. Majno, A. Pluchinotta, L. Armaroli, C. Confalonieri, P. Viola, L. Galletto, M. Sussio, B. Trolli, M. Biasio, A. Rolfo, G. Vaudano, M. Giolito, G. Ambrosini, L. Busana, M. Molteni, A. Richetti, E. Marubini, A. Piffanelli, B. Salvadori, G. Tognoni, P. Zola, A. Liberati, R. Fossati, B. Meyerowitz, V. Torri, G. Apolone, P. Mosconi, S. Marsoni, M. Liberati, A. Alexanian, R. Grilli, A. Nicolucci, N. Monferroni (1994)
Impact of follow-up testing on survival and health-related quality of life in breast cancer patients. A multicenter randomized controlled trial. The GIVIO Investigators.JAMA, 271 20
W. Broadhead, S. Gehlbach, Frank Gruy, B. Kaplan (1988)
The Duke–UNC Functional Social Support Questionnaire: Measurement of Social Support in Family Medicine PatientsMedical Care, 26
J. Vetto, R. Pommier, W. Schmidt, H. Eppich, P. Alexander (1996)
Diagnosis of palpable breast lesions in younger women by the modified triple test is accurate and cost-effective.Archives of surgery, 131 9
J. Ware, C. Sherbourne (1992)
The MOS 36-Item Short-Form Health Survey (SF-36)
H. Schipper, J. Clinch, A. McMurray, M. Levitt (1984)
Measuring the quality of life of cancer patients: the Functional Living Index-Cancer: development and validation.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2 5
F. Ilfeld (1976)
Further Validation of a Psychiatric Symptom Index in a Normal PopulationPsychological Reports, 39
K. Motamedi (1976)
The quality of American life
(1955)
The de Groot Symptom-Transition Scale. Tuscon (AZ): The University of Arizona College of Nursing and Sigma Theta International
B. McNeil, R. Weichselbaum, S. Pauker (1981)
Speech and survival: tradeoffs between quality and quantity of life in laryngeal cancer.The New England journal of medicine, 305 17
V. Velanovich (1998)
Axillary lymph node dissection for breast cancer: A decision analysis of T1 lesionsAnnals of Surgical Oncology, 5
W. Peters, M. Ross, J. Vredenburgh, A. Hussein, P. Rubin, K. Dukelow, C. Cavanaugh, R. Beauvais, S. Kasprzak (1994)
The use of intensive clinic support to permit outpatient autologous bone marrow transplantation for breast cancer.Seminars in oncology, 21 4 Suppl 7
A. Kristal, A. Shattuck, H. Henry (1990)
Patterns of dietary behavior associated with selecting diets low in fat: reliability and validity of a behavioral approach to dietary assessment.Journal of the American Dietetic Association, 90 2
L. Derogatis, R. Lipman, K. Rickels, E. Uhlenhuth, L. Covi (1974)
The Hopkins Symptom Checklist (HSCL). A measure of primary symptom dimensions.Modern problems of pharmacopsychiatry, 7 0
W. Demark-Wahnefried, B. Peterson, Colleen Mcbride, I. Lipkus, E. Clipp (2000)
Current health behaviors and readiness to pursue life‐style changes among men and women diagnosed with early stage prostate and breast carcinomasCancer, 88
X. Wang, L. Cosby, M. Harris, T. Liu (1999)
Major concerns and needs of breast cancer patients.Cancer nursing, 22 2
V. Morize, D. Nguyen, C. Lorente, G. Desfosses (1999)
Descriptive epidemiological survey on a given day in all palliative care patients hospitalized in a French university hospitalPalliative Medicine, 13
T. Gill, A. Feinstein (1994)
A critical appraisal of the quality of quality-of-life measurements.JAMA, 272 8
D. Patrick, R. Deyo (1989)
Generic and Disease-Specific Measures in Assessing Health Status and Quality of LifeMedical Care, 27
E. Diener, Robert Emmons, R. Larsen, S. Griffin (1985)
The Satisfaction with Life ScaleSustainability & Economics eJournal
E. Grunfeld, R. Fitzpatrick, D. Mant, P. Yudkin, R. Adewuyi‐Dalton, J. Stewart, D. Cole, M. Vessey (1999)
Comparison of breast cancer patient satisfaction with follow-up in primary care versus specialist care: results from a randomized controlled trial.The British journal of general practice : the journal of the Royal College of General Practitioners, 49 446
S. Levy, L. Haynes, R. Herberman, J. Lee, S. McFeeley, J. Kirkwood (1992)
Mastectomy versus breast conservation surgery: mental health effects at long-term follow-up.Health psychology : official journal of the Division of Health Psychology, American Psychological Association, 11 6
M. Schweitzer, M. French, S. Ullmann, C. Mccoy (1998)
Cost-Effectiveness of Detecting Breast Cancer in Lower Socioeconomic Status African American and Hispanic Women through Mobile Mammography ServicesMedical Care Research and Review, 55
J. Haes, H. Koning, G. Oortmarssen, H. Agt, A. Bruyn, P. Maas (1991)
The impact of a breast cancer screening programme on quality‐adjusted life‐yearsInternational Journal of Cancer, 49
M. Brown (1992)
Economic considerations in breast cancer screening of older women.Journal of gerontology, 47 Spec No
Peter Ganz, C. Schag, J. Lee, M. Sim (1992)
The CARES: a generic measure of health-related quality of life for patients with cancerQuality of Life Research, 1
J. Norum (2000)
Adjuvant Cyclophosphamide, Methotrexate, Fluorouracil (CMF) in Breast Cancer: Is it Cost-effective?Acta Oncologica, 39
J. Norum (1999)
Breast cancer screening by mammography in Norway. Is it cost-effective?Annals of oncology : official journal of the European Society for Medical Oncology, 10 2
V. McManus, J. Desautels, H. Benediktsson, J. Pasieka, R. Lafrenière (1992)
Enhancement of true-positive rates for nonpalpable carcinoma of the breast through mammographic selection.Surgery, gynecology & obstetrics, 175 3
L. Marks, P. Hardenbergh, Eric Winer, L. Prosnitz (1999)
Assessing the cost-effectiveness of postmastectomy radiation therapy.International journal of radiation oncology, biology, physics, 44 1
(1976)
Germany): Informationssystem (PSYCHIS Munchen)
I. Sarason, James Johnson, J. Siegel (1978)
Assessing the impact of life changes: development of the Life Experiences Survey.Journal of consulting and clinical psychology, 46 5
L. Oliveira (2005)
Quality of Life Issues
J. Hayman, B. Hillner, J. Harris, L. Pierce, J. Weeks (2000)
Cost-effectiveness of adding an electron-beam boost to tangential radiation therapy in patients with negative margins after conservative surgery for early-stage breast cancer.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 18 2
K. Morris, R. Pommier, John Vetto (2000)
Office-based wire-guided open breast biopsy under local anesthesia is accurate and cost effective.American journal of surgery, 179 5
(1998)
Eur J Cancer
C. Lerman, B. Trock, B. Rimer, C. Jepson, David Brody, A. Boyce (1991)
Psychological side effects of breast cancer screening.Health psychology : official journal of the Division of Health Psychology, American Psychological Association, 10 4
C. Desch, B. Hillner, Thomas Smith, S. Retchin (1993)
Should the elderly receive chemotherapy for node-negative breast cancer? A cost-effectiveness analysis examining total and active life-expectancy outcomes.Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 11 4
P. Borgen, A. Hill, K. Tran, K. Zee, M. Massie, D. Payne, C. Biggs (1998)
Patient regrets after bilateral prophylactic mastectomyAnnals of Surgical Oncology, 5
R. Gelber, A. Goldhirsch, B. Cole (1993)
Evaluation of effectiveness: Q-TWiST. The International Breast Cancer Study Group.Cancer treatment reviews, 19 Suppl A
F. Gaston‐Johansson (1996)
Measurement of pain: the psychometric properties of the Pain-O-Meter, a simple, inexpensive pain assessment tool that could change health care practices.Journal of pain and symptom management, 12 3
J. Carpenter, M. Andrykowski, P. Sloan, L. Cunningham, Matthew Cordova, J. Studts, P. Mcgrath, David Sloan, D. Kenady (1998)
Postmastectomy/postlumpectomy pain in breast cancer survivors.Journal of clinical epidemiology, 51 12
G. Barrenetxea, J. Schneider, M. Centeno, H. Romero, M. Rica, Francisco Rodríguez-Escuderoo (1996)
Chemotherapy-induced emesis: management of early and delayed emesis in milder emetogenic regimensCancer Chemotherapy and Pharmacology, 38
Jackie Brown, S. Bryan, R. Warren (1996)
Mammography screening: an incremental cost effectiveness analysis of double versus single reading of mammogramsBMJ, 312
Tapash Palit, D. Miltenburg, F. Brunicardi (2000)
Cost analysis of breast conservation surgery compared with modified radical mastectomy with and without reconstruction.American journal of surgery, 179 6
A. Richardson, J. Elwood, B. McNoe, E. Bang (1994)
A survey of urban and rural participants in the Otago-Southland pilot breast cancer screening programme.The New Zealand medical journal, 107 971
C. Rosenquist, K. Lindfors (1998)
Screening mammography beginning at age 40 yearsCancer, 82
P. Selby, J. Chapman, J. Etazadi-Amoli, D. Dalley, N. Boyd (1984)
The development of a method for assessing the quality of life of cancer patients.British Journal of Cancer, 50
R. Hultborn, I. Johansson-Terje, J. Bergh, U. Glas, L. Hallsten, T. Hatschek, E. Holmberg, K. Ideström, B. Norberg, J. Ranstam, M. Söderberg, U. Wallgren (1996)
Second-line endocrine treatment of advanced breast cancer--a randomized cross-over study of medroxy-progesterone acetate and aminoglutethimide.Acta oncologica, 35 Suppl 5
Abstract Background: There is increasing interest in the incorporation of nonbiomedical outcomes into cancer research. Objective: Our goal was to review the use of nonbiomedical outcomes in research on breast cancer care. Data sources: We conducted a MEDLINE search of all studies on breast cancer quality of life, preferences, satisfaction, and economics that were published during the period from January 1, 1990, through December 31, 2000. We also searched bibliographies of published articles. Study selection: We included original primary research and excluded reviews, methods papers, studies conducted outside the United States and Western Europe, or studies with fewer than 100 subjects. Data abstraction: Data were abstracted by using a structured tool. Data synthesis: There were 1089 articles identified; 230 were included. The greatest proportion of research focused on survivorship followed by screening. The most frequently reported outcomes were health-related quality of life (54%) followed by economic analyses (38%) and patient satisfaction (14%); only 9% measured patient preferences. Few studies included more than 10% nonwhite populations or focused on the elderly. No single instrument was used in more than 10% of the studies, and many authors developed de novo tools for use in their study. Methodologic flaws were prevalent and included use of nonstandard economic methods, insufficient power, low or differential response rates, and lack of control for baseline status. Conclusion: At present, outcomes measurement is variable in its approach and application to breast cancer care. More research is needed to develop practical approaches that are reliable, valid, and feasible in routine practice, that are applicable to diverse populations, and that can inform interventions to improve the quality of care across the full spectrum of services. The most general health outcome measure is survival. For breast and other cancers, 5-year survival or the interval of disease-free survival has customarily been used to evaluate the success of treatment. Clinical events, such as severity of illness, tumor response, or stage shifts, have served as intermediate measures of outcome, principally because they are believed to be associated with differences in survival. For many diseases, such as advanced breast cancer, curative treatment is not always possible. Still, the outcomes of noncurative care may be very different. For instance, therapeutic strategies may be associated with similar survival but different toxic effects; alternatively, one therapy may yield better survival but more severe side effects, while another may offer poorer survival but better quality of life (QOL) during the patient's remaining months or years. Thus, decisions about alternative therapies are often based on QOL considerations, in addition to the likelihood of survival (1,2). Even when cures are possible, the costs of treatment may exceed an individual's or society's willingness to pay. Although QOL has been an implied medical outcome since the time of Hippocrates (3,4), the landmark paper by Karnofsky et al. (5) marked the first explicit effort of physicians to systematically assess the impact of cancer treatments on the patient's QOL and not quantity of life. The next major tools developed to assess the impact of cancer and breast cancer therapy on QOL were not developed until the early 1980s. In the prototype, the Spitzer Quality of Life Index, QOL continued to be physician rated (6). Thus, physician assessment of symptoms, toxic effects, and/or QOL remained the standard in breast cancer outcomes research for almost four decades. Increasing consumerism and patient participation in health care decisions, occurring in parallel with the growth in interest in outcomes of care in the late 1970s and the 1980s, set the stage for the development of patient-based measures of general and breast cancer-related QOL (4,7). For example, in 1979, Ware et al. (8) presented results validating a patient's self-reported measure of general health status from the Rand Health Insurance Experiment. Preliminary incorporation of such measures into cancer cooperative group randomized controlled trials (RCTs) occurred in the late 1980s (4,9). Despite the recent explosion of QOL measures, particularly for breast cancer, routine incorporation of QOL outcomes into cancer research has been slow, and when used, outcomes have often been poorly measured. For instance, in a review of QOL measurement across a variety of medical conditions, Gill and Feinstein (10) found that 159 different measures of QOL were used in 75 studies, but fewer than half defined the target domains, only 17% included a patient-rated QOL, and just 9% elicited patients' preferences for health outcomes. Thus, there is a clear need for expanded research on practice-based outcomes measures. For such measures to be clinically relevant and feasible to collect, it is key that the research and clinical communities work together to take an active leadership role in this process. To set the stage for such activities, we review the current use of health outcomes across the spectrum of breast cancer care—from primary prevention and early detection through survivorship or death—that could be used as the basis of a research agenda for measuring the outcomes of breast cancer care. This review is intended to serve as a focal point for discussion and extension of existing efforts to improve the outcomes of breast cancer services. Methods We conducted a qualitative review of the literature on breast cancer health outcomes across all phases of breast cancer care, including primary prevention, early detection, diagnosis, local treatment, adjuvant treatment, treatment of metastatic disease, survivorship, and the dying experience (11). Conceptualization and Definition of Health Outcomes Outcomes research is the study of the net effects of the health care process on the health and well-being of individuals and populations. As such, it can encompass a wide breadth of issues, including research on satisfaction with care, effectiveness, costs of care, and measurement of patient preferences and QOL. The current construct of QOL draws on earlier use of social indicators, such as housing and employment status, to measure the well-being of populations (12-14). Breslow (15) expanded the measurement of population well-being to include the World Health Organization definition of health as “not only the absence of disease or of disability, but an overall state of physical, mental, and social well-being.” de Haes (16) later defined QOL as “the subjective evaluation of life as a whole,” and Cella and Cherin (17) expanded this definition to include patients' satisfaction with their level of functioning compared with an ideal level. Both of these latter definitions reflect the importance of the individual's subjective experience; the second definition highlights the role of personal values, or preferences, for health outcomes (3). The current consensus among outcomes researchers is that QOL is a multidimensional concept (3,18-23). The term “health-related QOL” (HRQOL) is used to refer to overall QOL in a health context (24). Although there is variation in the number and types of HRQOL domains suggested by different researchers, there is substantial overlap. Most researchers would agree that the following domains should be considered when deciding on HRQOL measures: 1) somatic concerns, such as pain and symptoms; 2) functional ability; 3) family well-being; 4) emotional well-being; 5) spirituality; 6) treatment satisfaction, including financial impact of illness; 7) future orientation; 8) sexuality, intimacy, and body image; 9) social functioning; 10) occupational functioning; and 11) preferences (3,22,25-28). The precise number and types of domains should be sufficiently broad to capture the impact of the illness or treatment on the patient but not to impose an undue burden on the patient or researcher; if the impact is largely unknown, the largest number of dimensions should be included while maintaining parsimony. Any one domain may be an outcome in and of itself. A 1991 National Cancer Institute-sponsored workshop on the measurement of QOL in cancer clinical trials (22) recommended that assessment be multidimensional, include general and cancer-specific tools, be patient self-reported, be measured at more than one point in time, and be evaluated after controlling for relevant medical and sociodemographic characteristics. These considerations guided our data abstraction. For the purposes of this review, health outcomes were defined as HRQOL or any of its domains, preferences for outcomes, satisfaction with health care or treatment decisions, and economic outcomes, such as costs of care, cost-effectiveness analysis (CEA), decision analysis, and cost-benefit analysis. Data Sources Multiple sources were used to identify all potential research for inclusion in the analysis. A MEDLINE search was conducted for all English language articles published during the period from January 1, 1990, through December 31, 2000. The earlier date of 1990 was selected to include research that was representative of current health outcomes and QOL research methods. The following key words were used for the search: Breast Neoplasms and Quality of Life, Health Status, Economics, Health Services Research, Delivery of Health Care, or Quality of Health Care. To limit our search more narrowly to QOL, satisfaction with health care or treatment decisions, or economic outcomes, our search of Quality of Health Care and Delivery of Health Care was restricted to articles listing these key words as a major MeSH term. For the other key words, we selected articles using these terms as major or minor MeSH headings. Because this search did not identify any articles on outcomes associated with the dying experience of breast cancer patients (other than survival), we conducted a supplemental search on this topic using the following terms: Palliative Care or Death and Dying and Breast Neoplasms or Cancer. Study Selection The “Methods” and “Results” sections were reviewed for eligibility by two investigators using a standardized abstraction form (29). Study inclusion criteria consisted of being conducted in the United States and Western Europe, being published in a peer-reviewed journal, and presenting data on a health outcome. We excluded 859 articles, including phase I or II randomized trials (n = 7), studies with fewer than 100 subjects (n = 67) (since there would be insufficient power for the majority of measures), reviews (n = 180), comments/letters (n = 140), reports focusing on outcomes methodology (n = 68), studies conducted outside the United States or Western Europe (n = 45) (for comparability of health care systems, attitudes, and culture), studies that did not include breast cancer (n = 7), and studies that did not include a QOL outcome (n = 345). If outcomes data, or data subsets, had been published in more than one journal or time period, the largest dataset that contained the highest quality of information was selected for abstraction, although all of the measures were noted. The full listing of articles retrieved by the search is available from the authors. Data Abstraction For studies eligible for inclusion, the following data were abstracted: the phase of care, study design, population characteristics (e.g., age and race), country, number of subjects, outcomes included, tools or methods used to measure these outcomes, language of measurement, assessment of comorbid conditions, mode of administration of measures, and whether the authors reported any reliability testing for instrument performance in their study population or a statement about the power to detect clinically meaningful differences in outcomes between groups. Data Analysis Data were summarized by use of descriptive statistics, Student's t tests for differences in means, analysis of variance for differences in groups, and chi-square tests for differences in proportions and trends over time. Results There were 1089 original research articles identified by the search; 230 (21%) of these met the criteria for study inclusion (seeAppendix Table 1) (30-264). These 230 articles reported on 155 distinct study samples. In the study period, there was a general increase in the number of articles that included breast cancer outcomes (Fig. 1; Table 1). This increase was largely due to increases in studies of QOL in the treatment and survivorship phases of care and economic studies of screening. Appendix Table 1. Characteristics of studies on the outcomes of primary prevention: January 1, 1990 through December 31, 2000* Author, y (reference No.) Phase of care Study design Setting and population Sample size Outcomes Measures† Mode of assessment Report of reliability Power *BCPT = Breast Cancer Prevention Trial; CEA = cost-effectiveness analysis; LYS = life years saved; N/A = not available; QALY = quality-adjusted life years; QOL = quality of life; RCT = randomized controlled trial; SEER = Surveillance, Epidemiology, and End Results [Program]. † See Table 3 for definitions of abbreviations of measures. Lerman et al., 1995 (30) Primary prevention Cross-section Female first-degree relatives of breast cancer patients aged 30-75 y; 96% white; United States 105 Anxiety, depression, impaired QOL MHI; IES Phone interview Yes N/A Ganz et al., 1995 (96) Primary prevention RCT Women enrolled in the BCPT comparing tamoxifen and placebo; >35 y old and at high risk for breast cancer or ≥60 y old; United States 9749 QOL CES-D; MOS SF-36; BCPT Symptom Checklist; MOS sexual function Self-administered No Yes Stefanek et al., 1995 (32) Primary prevention Cross-section Women with family history (≥1 first-degree relative) of breast cancer; 6-30 mo after surgery; United States 164 Satisfaction; depression, cancer-related worry De novo tools; CES-D Mail survey No Unknown Nease and Ross, 1995 (33) Primary prevention Decision analysis Women eligible for the BCPT; United States N/A Life expectancy Survival N/A N/A N/A Schrag et al., 1997 (34) Primary prevention Decision analysis Women at high-risk of BRCA 1/2 mutations; United States N/A LYS Survival N/A N/A N/A Borgen et al., 1998 (35) Primary prevention Cross-section Women 15 y (range, 1-50 y) after bilateral prophylactic mastectomy; mean age of 46 y at surgery (range, 25-73 y); 96% white; United States 370 Regrets about decision; satisfaction De novo tool Mail survey No N/A Grann et al., 1999 (36) and 1998 (37) Primary prevention CEA Ashkenazi Jewish women; United States N/A Utility; costs per LYS; QALYs Medicare costs; survival; TTO (n = 54) N/A N/A N/A Grann et al., 1999 (38) Primary prevention Cross-section Women aged 20-50 y with breast cancer, a personal history of multiple breast biopsies, or family history of breast cancer; United States 184 Preferences/utility; QOL TTO; visual analog scale N/A N/A N/A Noe et al., 1999 (39) Primary prevention CEA Women considered to be at high risk; received tamoxifen; enrolled in the National Surgical Adjuvant Breast and Bowel Project P-1 BCPT; United States N/A Utility; costs per life-year gained Data on the benefits and risks of tamoxifen as observed in the BCPT N/A N/A N/A Brain et al., 2000 (40) Primary prevention RCT Trial of Genetic Assessment in Breast Cancer (TRACE); Wales 735; subset of 545 at time of follow-up QOL; costs BCW; Satisfaction With Genetic Counseling Questionnaire; STAI; de novo tools Self-administered Yes Unknown Frost et al., 2000 (41) Primary prevention Cross-section Women with family history who elected to undergo bilateral prophylactic mastectomy (1960-1993); United States 609; 94% response rate QOL; long-term satisfaction De novo tool Mail survey Yes Unknown Grann et al., 2000 (42) Primary prevention CEA Women who tested positive for BRCA1/2 mutations; chemo-prevention with tamoxifen, raloxifene, or oral contraceptives vs. prophylactic surgery; United States N/A Preferences/utility; costs; QALY Cumulative incidence rates from published literature; survival figures from SEER data; TTO to calculate QALYs; cost estimates based on Centers for Medicare and Medicaid Services payments, the SEER-Centers for Medicare and Medicaid Services database, and the Pharmacy Fundamental Reference Julian-Reynier et al., 2000 (43) Primary prevention Cross-section Women receiving genetic testing; France 471; 84% response rate Patient willingness to diffuse information; attitude toward preventive options De novo tools Self-administered No Unknown Smith and Hillner 2000 (44) Primary prevention CEA Women enrolled in the National Surgical Adjuvant Breast Program P-1 BCPT receiving tamoxifen vs. placebo; United States N/A LYS; costs; preferences/utility Medical care costs were estimated from the Agency for Health Care Policy and Research website; other parameters estimated from published literature N/A N/A N/A Author, y (reference No.) Phase of care Study design Setting and population Sample size Outcomes Measures† Mode of assessment Report of reliability Power *BCPT = Breast Cancer Prevention Trial; CEA = cost-effectiveness analysis; LYS = life years saved; N/A = not available; QALY = quality-adjusted life years; QOL = quality of life; RCT = randomized controlled trial; SEER = Surveillance, Epidemiology, and End Results [Program]. † See Table 3 for definitions of abbreviations of measures. Lerman et al., 1995 (30) Primary prevention Cross-section Female first-degree relatives of breast cancer patients aged 30-75 y; 96% white; United States 105 Anxiety, depression, impaired QOL MHI; IES Phone interview Yes N/A Ganz et al., 1995 (96) Primary prevention RCT Women enrolled in the BCPT comparing tamoxifen and placebo; >35 y old and at high risk for breast cancer or ≥60 y old; United States 9749 QOL CES-D; MOS SF-36; BCPT Symptom Checklist; MOS sexual function Self-administered No Yes Stefanek et al., 1995 (32) Primary prevention Cross-section Women with family history (≥1 first-degree relative) of breast cancer; 6-30 mo after surgery; United States 164 Satisfaction; depression, cancer-related worry De novo tools; CES-D Mail survey No Unknown Nease and Ross, 1995 (33) Primary prevention Decision analysis Women eligible for the BCPT; United States N/A Life expectancy Survival N/A N/A N/A Schrag et al., 1997 (34) Primary prevention Decision analysis Women at high-risk of BRCA 1/2 mutations; United States N/A LYS Survival N/A N/A N/A Borgen et al., 1998 (35) Primary prevention Cross-section Women 15 y (range, 1-50 y) after bilateral prophylactic mastectomy; mean age of 46 y at surgery (range, 25-73 y); 96% white; United States 370 Regrets about decision; satisfaction De novo tool Mail survey No N/A Grann et al., 1999 (36) and 1998 (37) Primary prevention CEA Ashkenazi Jewish women; United States N/A Utility; costs per LYS; QALYs Medicare costs; survival; TTO (n = 54) N/A N/A N/A Grann et al., 1999 (38) Primary prevention Cross-section Women aged 20-50 y with breast cancer, a personal history of multiple breast biopsies, or family history of breast cancer; United States 184 Preferences/utility; QOL TTO; visual analog scale N/A N/A N/A Noe et al., 1999 (39) Primary prevention CEA Women considered to be at high risk; received tamoxifen; enrolled in the National Surgical Adjuvant Breast and Bowel Project P-1 BCPT; United States N/A Utility; costs per life-year gained Data on the benefits and risks of tamoxifen as observed in the BCPT N/A N/A N/A Brain et al., 2000 (40) Primary prevention RCT Trial of Genetic Assessment in Breast Cancer (TRACE); Wales 735; subset of 545 at time of follow-up QOL; costs BCW; Satisfaction With Genetic Counseling Questionnaire; STAI; de novo tools Self-administered Yes Unknown Frost et al., 2000 (41) Primary prevention Cross-section Women with family history who elected to undergo bilateral prophylactic mastectomy (1960-1993); United States 609; 94% response rate QOL; long-term satisfaction De novo tool Mail survey Yes Unknown Grann et al., 2000 (42) Primary prevention CEA Women who tested positive for BRCA1/2 mutations; chemo-prevention with tamoxifen, raloxifene, or oral contraceptives vs. prophylactic surgery; United States N/A Preferences/utility; costs; QALY Cumulative incidence rates from published literature; survival figures from SEER data; TTO to calculate QALYs; cost estimates based on Centers for Medicare and Medicaid Services payments, the SEER-Centers for Medicare and Medicaid Services database, and the Pharmacy Fundamental Reference Julian-Reynier et al., 2000 (43) Primary prevention Cross-section Women receiving genetic testing; France 471; 84% response rate Patient willingness to diffuse information; attitude toward preventive options De novo tools Self-administered No Unknown Smith and Hillner 2000 (44) Primary prevention CEA Women enrolled in the National Surgical Adjuvant Breast Program P-1 BCPT receiving tamoxifen vs. placebo; United States N/A LYS; costs; preferences/utility Medical care costs were estimated from the Agency for Health Care Policy and Research website; other parameters estimated from published literature N/A N/A N/A View Large Fig. 1. View largeDownload slide Time trends in numbers of breast cancer outcomes research articles: 1990 through 2000 (seeTable 1 for breakdown by phase of care). Fig. 1. View largeDownload slide Time trends in numbers of breast cancer outcomes research articles: 1990 through 2000 (seeTable 1 for breakdown by phase of care). Table 1. Number of included articles on breast cancer outcomes* published during 1990 through 2000; breakdown of articles by year and phase of cancer care* 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Total, n *Chi-square for trend P<.001. Total adds to more than 230 articles because some studies assessed more than one phase of care. Primary prevention 0 0 0 0 0 4 0 1 2 3 5 15 Screening 2 2 5 2 3 3 2 4 10 7 1 41 Diagnosis 1 1 1 2 0 0 2 2 2 6 2 19 Local treatment 1 1 2 1 0 2 2 7 6 10 4 36 Adjuvant treatment 0 4 5 5 1 1 7 1 5 11 5 45 Treatment of metastatic disease 0 2 2 1 1 4 5 1 3 12 8 39 Survivorship and surveillance 1 0 1 2 4 7 5 5 16 7 3 51 Total 5 10 16 13 9 21 23 21 44 56 28 246 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Total, n *Chi-square for trend P<.001. Total adds to more than 230 articles because some studies assessed more than one phase of care. Primary prevention 0 0 0 0 0 4 0 1 2 3 5 15 Screening 2 2 5 2 3 3 2 4 10 7 1 41 Diagnosis 1 1 1 2 0 0 2 2 2 6 2 19 Local treatment 1 1 2 1 0 2 2 7 6 10 4 36 Adjuvant treatment 0 4 5 5 1 1 7 1 5 11 5 45 Treatment of metastatic disease 0 2 2 1 1 4 5 1 3 12 8 39 Survivorship and surveillance 1 0 1 2 4 7 5 5 16 7 3 51 Total 5 10 16 13 9 21 23 21 44 56 28 246 View Large Among the 230 articles, the most common outcome reported was HRQOL (54.4%) followed by costs/economic outcomes (38.3%), whereas there were statistically significantly fewer satisfaction (13.9%) or preference (9%) outcomes reported (P<.001). The proportion of these different types of outcomes varied across phase of care, with studies of survivorship having the greatest proportion of outcomes focused on QOL (69.1%) and studies of screening (9.7%) and diagnostic care (0%) having the lowest proportion of QOL outcomes (P<.001). These latter two phases had the highest proportion of economic studies compared with the other phases of care (P<.001) (data not shown). These findings are likely to be due to the nature of screening and diagnosis where the QOL outcomes are short term and difficult to capture, whereas the economic impact of differing strategies on survival may be large. We did not identify any studies about the quality of the dying experience for breast cancer patients per se. Within the metastatic treatment phase, there were 10 studies about palliative care that met our inclusion criteria (52-61); most were cross-sectional in design. The studies measured “will to live” (55), pain and symptom control (52-54,56,60,61), satisfaction (58), psychologic distress (52,57), and insight into prognosis (56). One study measured outcomes of the patients' caregivers (59). Among the study sample, the most prevalent type of study was an economic study (n = 91); 65.9% of these were CEAs and 24.2% were descriptions of the costs of care (Table 2). Among the 139 noneconomic studies, slightly more than one half (55.4%) were controlled studies (RCTs, longitudinal cohorts, or case-control studies), whereas almost one half were uncontrolled cross-sectional analyses. In a comparison of study design by phase of care, there were twice as many RCTs among studies of local and metastatic disease phases of care than among studies of other phases, whereas an uncontrolled, cross-sectional design was employed twice as often in studies of the survivorship phase of care as in studies of other phases (P<.01). Table 2. Study design in outcomes research by phase of breast cancer care Study design Phase of care RCT* Cohort Cross-sectional Economic† Case-control Total‡ *Randomized controlled trial. † Economic studies include cost-effectiveness analyses, costs of care, and decision analyses. ‡ Totals add to more than 230 because some studies assessed more than one phase of care. Primary prevention 2 0 6 7 0 15 Screening, diagnosis 1 2 7 50 0 60 Local treatment 36 3 15 25 2 81 Treatment of metastatic disease 24 3 1 11 0 39 Survivorship and surveillance 9 10 28 2 2 51 Total 72 18 57 95 4 246 Study design Phase of care RCT* Cohort Cross-sectional Economic† Case-control Total‡ *Randomized controlled trial. † Economic studies include cost-effectiveness analyses, costs of care, and decision analyses. ‡ Totals add to more than 230 because some studies assessed more than one phase of care. Primary prevention 2 0 6 7 0 15 Screening, diagnosis 1 2 7 50 0 60 Local treatment 36 3 15 25 2 81 Treatment of metastatic disease 24 3 1 11 0 39 Survivorship and surveillance 9 10 28 2 2 51 Total 72 18 57 95 4 246 View Large The overwhelming majority of studies focused on white populations speaking the dominant language; only 24 (62-85) included more than 10% minority patients, and only three (68,70,86) reported more than 30% minority subjects. Five studies (69,87-90) noted use of translation of outcomes assessments into another language or languages. Few studies [e.g., (76,91-93)] concentrated on elderly women (women aged ≥65 years). There was a wide variety of instruments used in the study sample (Table 3) (94-195). The most commonly used tool was the Medical Outcomes Study SF-36 (8), but no single instrument was used in more than 10% of the studies (Table 4). Among the 139 noneconomic studies, 54.0% (n = 75) used previously validated tools, 20.1% (n = 28) relied solely on nonvalidated measurements developed de novo for the study, 19.4% (n = 27) used a combination of validated and de novo instruments, and 2.1% (n = 2) did not state what measures were used (see Appendix Tables 1, 2, 3, 4, 5, 6, 7). There were 127 validated tools represented in the 75 studies that used one or more validated measures. The average number of instruments used per noneconomic study was 2.8 (range, 1-10). Studies about survivorship or local therapy had the highest average number of measures per study (3.7 and 2.9, respectively), and studies of screening, metastatic disease, and primary prevention used the lowest number of measures per study (1.7, 2, and 2.1, respectively). With the exception of the studies of chemotherapy-induced nausea and vomiting-prevention interventions, all QOL studies included more than one domain of QOL. Table 3. Measures used in studies of breast cancer outcomes: 1990 through 2000 ADL = Activities of Daily Living (108) ADQ = Adherence Determinants Questionnaire (94) Andrews and Withey Quality of Life = Social Indicators of Well-Being (95) BCPT Symptom Checklist = Breast Cancer Prevention Trial Symptom Checklist (96) BCQ = Breast Cancer Quality of Life (97) BCW = Breast Cancer Worries Scale (98) BDI = Beck Depression Inventory (99) Bedford College Life Events and Difficulties Schedules (100) Berkman's Social Network Index (101) BES = Body Esteem Scale (102) bFs = Befindlichkeits-Skala (103) Blatt Menopausal Index (104) BPI = Brief Pain Inventory (105) Bradburn's Positive Affect Scale (106) Canada Health and Activity Limitation Survey (107) Cancer Problem Scale (109) Caplan Role and Emotional Function (110) CARES = Cancer Rehabilitation and Evaluation System (111) CDIS = Cancer Diagnostic Interview Scale (113) CES-D = Center for Epidemiologic Studies—Depression (114) Chalder Fatigue Scale (115) Complex Figure Test (116) D2 test (117) DAS = Dyadic Adjustment Scale (121) de Groot's Symptom Transition Scale (118) Digit span of WAIS = digit span of Weschler Adult Intelligence Scale (119) Duke-UNC Functional Social Support Questionnaire (120) Eating Patterns Questionnaire (122) ECOG (i.e., Eastern Cooperative Oncology Group) Analgesics Requirement Scale (123) ECOG Performance Status (123) Emotional Support Scale (160) EORTC-QLQ-BR23 = European Organization for Research and Treatment of Cancer QLQ-BR23 (124) EORTC-QLQ-C30 = European Organization for Research and Treatment of Cancer QLQ-C30 (125) FACT = Functional Assessment of Cancer Illness Therapy (126) FACT SP = Spirituality Profile (126) Fepsy Tests (127) FLIC = Functional Living Index—Cancer (128) FPQLI = Ferrans and Powers Quality of Life Index (129) Gaston-Johansson Pain-O-Meter (130) GHQ = General Health Questionnaire (131) HADS = Hospital Anxiety and Depression Scale (132) House Social Support (133) HQ = Health Questionnaire (134) HSCL = Hopkins Symptoms Checklist (135) IADL = Instrumental Activities of Daily Living (136) IARB = Inventory of Adult Role Behavior and Self-Care (137) IES = Impact of Event Scale (138) Illness Intrusiveness Scale (139) IWB = Index of Well-Being (140) KPS = Karnofsky Performance Status (141) Ladder = Self-Anchoring Scale of Hadley Cantril (142) Lasry and Margoliese (143) Lerman Cancer Worry Scale (144) LES = Life Experiences Survey (145) LWMAT = Locke-Wallace Martial Adjustment Test (146) Massachusetts Women's Health Study Questionnaire (147) McGill = McGill Pain Questionnaire (148) Medical Research Council Quality of Life (149) MHI = Mental Health Inventory of the Medical Outcomes Study (150) Mini-MAC = Mini Mental Adjustment to Cancer (154) MOS SF-36 = Medical Outcomes Study—Short Form 36 (151) MOS Social Support Scale = Medical Outcomes Study Social Support Scale (152) MPSSQ = Michigan Perceived Social Support Questionnaire (153) MSAS = Memorial Symptom Assessment Scale (155) Negative Affect Scale (156) NHP = Nottingham Health Profile (157) OTTAT = Oncology Treatment Toxicity Assessment Tool (158) PACIS = Personal Adjustment to Chronic Illness (161) PAIS-SR = Psychosocial Adjustment to Illness Scale (167) PCQ = Psychological Consequences Questionnaire (168) PDI = Pain Disability Index (159) Perceived Social Support Scale (160) Piper Fatigue Scale (162) Pittsburgh Sleep Quality Index (163) POMS = Profile of Mood States (166) Postoperative Pain Questionnaire (164) Principles of Living Survey (165) PSI = Psychiatric Symptom Index (169) Psychiatric Evaluation Form (170) QOL-BC = Quality of Life in Breast Cancer (172) QOL-CS = Quality of Life Cancer Survivors Tool (171) Qtwist = Quality-Adjusted Time Without Symptoms or Toxicity (173) Rand Health Survey (94) Rey Auditory Verbal Learning Test (174) Rosenberg's Scale of Self-Esteen (175) RSCL = Rotterdam Symptom Checklist (176) Satisfaction With Genetic Counseling Questionnaire (177) SCID = Structured Clinical Interview Disease (178) SCIWPR = Self-Care Inventory Wellness Promotion Scale (179) SCL-90-R = Symptom Checklist (112) SDS = Symptom Distress Scale (180) Sexual Functioning Inventory (181) SIP = Sickness Impact Profile (224) Social Health Index (183) Social Support Questionnaire (184) STAI = State-Trait Anxiety Inventory (185) Stroop Test (186) SWLS = Statisfaction With Life Scale (187) SWOG QOL Questionnaire = Southwest Oncology Group Quality of Life Questionnaire (188) Symptom Experience Report (189) Trial Making (190) TTO = Time-tradeoff (191) Urban Life Stress Scale (192) Wisconsin Brief Pain Inventory Questionnaire (193) WSFQ = Watts Sexual Function Questionnaire (194) WTP = Willingness to Pay (195) ADL = Activities of Daily Living (108) ADQ = Adherence Determinants Questionnaire (94) Andrews and Withey Quality of Life = Social Indicators of Well-Being (95) BCPT Symptom Checklist = Breast Cancer Prevention Trial Symptom Checklist (96) BCQ = Breast Cancer Quality of Life (97) BCW = Breast Cancer Worries Scale (98) BDI = Beck Depression Inventory (99) Bedford College Life Events and Difficulties Schedules (100) Berkman's Social Network Index (101) BES = Body Esteem Scale (102) bFs = Befindlichkeits-Skala (103) Blatt Menopausal Index (104) BPI = Brief Pain Inventory (105) Bradburn's Positive Affect Scale (106) Canada Health and Activity Limitation Survey (107) Cancer Problem Scale (109) Caplan Role and Emotional Function (110) CARES = Cancer Rehabilitation and Evaluation System (111) CDIS = Cancer Diagnostic Interview Scale (113) CES-D = Center for Epidemiologic Studies—Depression (114) Chalder Fatigue Scale (115) Complex Figure Test (116) D2 test (117) DAS = Dyadic Adjustment Scale (121) de Groot's Symptom Transition Scale (118) Digit span of WAIS = digit span of Weschler Adult Intelligence Scale (119) Duke-UNC Functional Social Support Questionnaire (120) Eating Patterns Questionnaire (122) ECOG (i.e., Eastern Cooperative Oncology Group) Analgesics Requirement Scale (123) ECOG Performance Status (123) Emotional Support Scale (160) EORTC-QLQ-BR23 = European Organization for Research and Treatment of Cancer QLQ-BR23 (124) EORTC-QLQ-C30 = European Organization for Research and Treatment of Cancer QLQ-C30 (125) FACT = Functional Assessment of Cancer Illness Therapy (126) FACT SP = Spirituality Profile (126) Fepsy Tests (127) FLIC = Functional Living Index—Cancer (128) FPQLI = Ferrans and Powers Quality of Life Index (129) Gaston-Johansson Pain-O-Meter (130) GHQ = General Health Questionnaire (131) HADS = Hospital Anxiety and Depression Scale (132) House Social Support (133) HQ = Health Questionnaire (134) HSCL = Hopkins Symptoms Checklist (135) IADL = Instrumental Activities of Daily Living (136) IARB = Inventory of Adult Role Behavior and Self-Care (137) IES = Impact of Event Scale (138) Illness Intrusiveness Scale (139) IWB = Index of Well-Being (140) KPS = Karnofsky Performance Status (141) Ladder = Self-Anchoring Scale of Hadley Cantril (142) Lasry and Margoliese (143) Lerman Cancer Worry Scale (144) LES = Life Experiences Survey (145) LWMAT = Locke-Wallace Martial Adjustment Test (146) Massachusetts Women's Health Study Questionnaire (147) McGill = McGill Pain Questionnaire (148) Medical Research Council Quality of Life (149) MHI = Mental Health Inventory of the Medical Outcomes Study (150) Mini-MAC = Mini Mental Adjustment to Cancer (154) MOS SF-36 = Medical Outcomes Study—Short Form 36 (151) MOS Social Support Scale = Medical Outcomes Study Social Support Scale (152) MPSSQ = Michigan Perceived Social Support Questionnaire (153) MSAS = Memorial Symptom Assessment Scale (155) Negative Affect Scale (156) NHP = Nottingham Health Profile (157) OTTAT = Oncology Treatment Toxicity Assessment Tool (158) PACIS = Personal Adjustment to Chronic Illness (161) PAIS-SR = Psychosocial Adjustment to Illness Scale (167) PCQ = Psychological Consequences Questionnaire (168) PDI = Pain Disability Index (159) Perceived Social Support Scale (160) Piper Fatigue Scale (162) Pittsburgh Sleep Quality Index (163) POMS = Profile of Mood States (166) Postoperative Pain Questionnaire (164) Principles of Living Survey (165) PSI = Psychiatric Symptom Index (169) Psychiatric Evaluation Form (170) QOL-BC = Quality of Life in Breast Cancer (172) QOL-CS = Quality of Life Cancer Survivors Tool (171) Qtwist = Quality-Adjusted Time Without Symptoms or Toxicity (173) Rand Health Survey (94) Rey Auditory Verbal Learning Test (174) Rosenberg's Scale of Self-Esteen (175) RSCL = Rotterdam Symptom Checklist (176) Satisfaction With Genetic Counseling Questionnaire (177) SCID = Structured Clinical Interview Disease (178) SCIWPR = Self-Care Inventory Wellness Promotion Scale (179) SCL-90-R = Symptom Checklist (112) SDS = Symptom Distress Scale (180) Sexual Functioning Inventory (181) SIP = Sickness Impact Profile (224) Social Health Index (183) Social Support Questionnaire (184) STAI = State-Trait Anxiety Inventory (185) Stroop Test (186) SWLS = Statisfaction With Life Scale (187) SWOG QOL Questionnaire = Southwest Oncology Group Quality of Life Questionnaire (188) Symptom Experience Report (189) Trial Making (190) TTO = Time-tradeoff (191) Urban Life Stress Scale (192) Wisconsin Brief Pain Inventory Questionnaire (193) WSFQ = Watts Sexual Function Questionnaire (194) WTP = Willingness to Pay (195) View Large Table 4. Instruments most commonly used in breast cancer outcomes studies: 1990 through 2000 Instrument No. of studies (%) Author of instrument, reference No. MOS SF-36 = Medical Outcomes Study—Shortform 36 20 (8.7) (151) EORTC-QLQ-C30 = European Organization for Research and Treatment of Cancer QLQ-C30 15 (6.5) (125) CARES = Cancer Rehabilitation and Evaluation System 11 (4.8) (111) FLIC = Functional Living Index—Cancer 10 (4.4) (228) CES-D = Center for Epidemiologic Studies—Depression 8 (3.5) (114) RSCL = Rotterdam Symptom Checklist 8 (3.5) (176) HADS = Hospital Anxiety and Depression Scale 7 (3.0) (132) Linear Rating Scale 6 (2.6) POMS = Profile of Mood States 6 (2.6) (166) BCPT Symptom Checklist = Breast Cancer Prevention Trial Symptom Checklist 5 (2.2) (31) KPS = Karnofsky Performance Status 5 (2.2) (226) IES = Impact of Event Scale 4 (1.7) (138) LES = Life Experiences Survey 4 (1.7) (145) STAI = State-Trait Anxiety Inventory 4 (1.7) (185) TTO = Time-tradeoff 4 (1.7) (191) Instrument No. of studies (%) Author of instrument, reference No. MOS SF-36 = Medical Outcomes Study—Shortform 36 20 (8.7) (151) EORTC-QLQ-C30 = European Organization for Research and Treatment of Cancer QLQ-C30 15 (6.5) (125) CARES = Cancer Rehabilitation and Evaluation System 11 (4.8) (111) FLIC = Functional Living Index—Cancer 10 (4.4) (228) CES-D = Center for Epidemiologic Studies—Depression 8 (3.5) (114) RSCL = Rotterdam Symptom Checklist 8 (3.5) (176) HADS = Hospital Anxiety and Depression Scale 7 (3.0) (132) Linear Rating Scale 6 (2.6) POMS = Profile of Mood States 6 (2.6) (166) BCPT Symptom Checklist = Breast Cancer Prevention Trial Symptom Checklist 5 (2.2) (31) KPS = Karnofsky Performance Status 5 (2.2) (226) IES = Impact of Event Scale 4 (1.7) (138) LES = Life Experiences Survey 4 (1.7) (145) STAI = State-Trait Anxiety Inventory 4 (1.7) (185) TTO = Time-tradeoff 4 (1.7) (191) View Large Appendix Table 2. Characteristics of studies on the outcomes of screening: January 1, 1990 through December 31, 2000* Author, y (reference No.) Phase of care Study design Setting and population Sample size Outcomes Measures† Mode of assessment Report of reliability Power *CBE = clinical breast exam; CEA = cost-effective analysis; FN = false negative; FP = false positive; HC = health care; LYS = life years saved; N/A = not available; PCQ = psychological consequences questionnaire; QALY = quality-adjusted life years; RCT = randomized controlled trial. † SeeTable 3 for definitions of abbreviations of measures. Haiart et al., 1990 (45) Screening Costs of care Mobile mammography using single view for women 40-65 y old; Scotland 6080 Costs; feasibility Direct costs in NHP; patient time, travel, and lost opportunity costs N/A N/A N/A Gram et al., 1990 (46) Screening Cross-section Women with negative and false-positive mammograms 6 mo after screen; average age 47 y; Norway 278; 89% response rate QOL Ladder; WTP; TTO; de novo anxiety and depression items Mail survey No Unknown Smith et al., 1991 (47) Screening RCT Women attending the Leicestershire Breast Screening Service for abnormal mammograms; United Kingdom 103; 87% response rate Satisfaction De novo tool In-person interview; mail survey No Unknown Zappa et al., 1995 (227) Screening Costs of care Population screening of women aged 50-70 y; Italy 38 676 Costs per woman screened; cost per cancer detected Costs of recruitment, screening, and follow-up from the NHP N/A N/A N/A de Haes et al., 1991 (228); de Koning et al., 1991 (229) Screening CEA Women of different ages and intervals of screening; The Netherlands N/A Costs per LYS; costs per QALYs Costs and charges; survival; utilities from expert opinion (n = 27) with the use of published literature Not stated N/A N/A Brown, 1992 (230) Screening CEA Women ≥50 y old; test effects of increasing age; United States N/A Costs; LYS Direct medical costs only; survival based on published literature N/A N/A N/A Zavertnik et al., 1992 (231) Screening Costs of care Costs of delivering low-cost mammography; United States 9452 Costs per cancer detected Fixed and variable costs of screening program; cases detected N/A N/A N/A Mandelblatt et al., 1992 (76) Screening Decision analysis/CEA Women aged ≥65 y with comorbid illnesses; black and white; United States N/A Costs; LYS; QALYs Direct medical costs only; survival based on published literature; utility estimated from expert opinion Not stated N/A N/A Vaile et al., 1993 (232) Screening Longitudinal cohort Women aged 50-64 y invited for screening who attended and had a negative test; England 2060; 65% response rate; 12% lost to follow-up Satisfaction De novo tool Mail survey No No Roworth et al., 1993 (233) Screening Cross-section Women aged 50-64 y attending screening; Scotland 3000; 86% response rate Satisfaction with screening; pain and pressure experienced; intention to return Cockburn Satisfaction With Screening Tool; de novo questions Mail survey No Unknown Richardson et al., 1994 (234) Screening Cross-section Women aged 50-64 y attending screening in urban and rural areas; New Zealand (included since dealing with satisfaction with screening—very few studies) 474; 93% response rate Satisfaction with screening; anxiety De novo tool Mail survey No Unknown Nutting et al., 1994 (77) Screening CEA Mammogram + CBE vs. CBE in community of 750 American Indian women aged ≥50 y; United States N/A Costs; deaths averted; 5-y survival Indian health service costs; survival based on published literature N/A N/A N/A Beemsterboer et al., 1994 (235) Screening CEA Women aged 50-69 y; Germany N/A Costs per LYS Direct medical costs; survival with the use of local data N/A N/A N/A Boer et al., 1995 (236) and 1998 (237) Screening CEA Determination of upper-age limit for screening; The Netherlands N/A Costs per QALYs Direct medical care costs; survival; utilities with the use of published data; source for utilities not described N/A N/A N/A Brown et al., 1995 (240) Screening CEA of nonrandom trial Screening using one-vs. two-view mammography among women aged 50-64 y; England 26 430 Costs per cancer detected Costs of screen and diagnostic follow-up in NHS; patient time costs N/A N/A N/A Feig, 1995 (239) Screening CEA Women aged 40-49 y; United States N/A Costs of screening and diagnosis per woman screened or per LYS Charges and cost estimates based on published literature N/A N/A N/A Brown et al., 1996 (240) Screening CEA Mammography among women aged 50-64 y; one vs. two readings with or without consensus on films; England 33 734 Costs per cancer detected Direct medical and nonmedical care costs to NHS and women based on local data N/A N/A N/A Evans et al., 1996 (241) Screening CEA Women aged 50-64 y; Spain 100 000 Costs per cancer detected Costs based on local data N/A N/A N/A Mandelblatt et al., 1997 (78) Screening CEA Women seeking care in an urban public hospital emergency room; United States N/A Costs per LYS Direct medical care costs and hospital charges; survival based on local data and published literature N/A N/A N/A Salzmann et al., 1997 (242) Screening CEA Women starting mammography at ages 40-49 y vs. 50-69 y; United States N/A Costs; LYS Direct medical costs only; survival based on published literature N/A N/A N/A Torgerson and Gosden, 1997 (243) Screening CEA Women aged 66-69 y vs. 51-65 y; England N/A Deaths averted; LYS Age-specific effects; number of deaths and survival; assumes resources are equal in the 2 age groups N/A N/A N/A Warmerdam et al., 1997 (244) Screening CEA Women aged 50-69 y; The Netherlands N/A Costs; LYS Costs in the German HC system; survival based on published literature and local data N/A N/A N/A Bakker et al., 1998 (245) Screening Cross-section; description Convenient sample of women ≥50 y old (mean age, 61 y; range, 50-85 y) interviewed after mammography; Canada 256; 81% response rate Satisfaction; distress PCQ; de novo items Telephone interview No No Boer et al., 1998 (237) Screening CEA Women living in the northwest region of England N/A Preferences/utility; costs; life-years saved; number of deaths prevented Screening and cost data from the NHS breast-screening program N/A N/A N/A Gilbert et al., 1998 (246) Screening Cohort; longitudinal Women aged 50-64 y following a false-positive screening mammography; Scotland 124 Psychologic distress HADS; health questionnaire Self-administered; mail survey; in-person interview No Unknown Johnston et al., 1998 (206) Screening Cross-section Women aged 40-64 y screened within 6 mo of screen or invited to be screened; England 440 Preferences for temporary states (FP, FN, etc.) TTO In-person interview Yes Yes Lamarque et al., 1998 (247) Screening CEA Women aged 40-60 y; France N/A Costs per case detected Direct and non-direct medical costs (travel and time); biopsyproven disease based on local data N/A N/A N/A Rosenquist and Lindfors, 1998 (248) Screening CEA Women beginning screening at age 40 y at different intervals until age 79 y; United States N/A Incremental costs per LYS Direct medical costs; survival based on published literature N/A N/A N/A Schweitzer et al., 1998 (79) Screening CEA Low-income black and Hispanic women using a mobile mammography van; United States N/A Costs per cancer detected Microcosting of actual van services; biopsy-proven cancer based on published literature N/A N/A N/A Boer et al., 1998, (237) Screening CEA Women at 2-y vs. 3-y intervals; stop screening at age 64 y vs. age 69 y; England N/A Costs; LYS NHS costs; survival based on published literature N/A N/A N/A Wolstenholme et al., 1998 (249) Screening CEA Costs of screening, incorporating the downstream costs of treatment among a regional sample diagnosed in 1991; England 137 Costs; LYS Costs in the NHS; observed survival based on published literature and local data N/A N/A N/A Allen et al., 1999 (250) Screening CEA Sestamibi scintimammography for women >40 y old with dense breasts; United States N/A Preferences/utility; costs Single time-point analysis N/A N/A N/A Boer et al., 1999 (51) Screening CEA Women aged ≥65 y; The Netherlands N/A Preferences/ utility; costs; LYS; extra incidence; extra life-years with disease Data from the Dutch screening projects N/A N/A N/A Gyrd-Hansen, 1999 (251) Screening CEA Costs of screening for colorectal, cervical, and breast cancers from national health care sector perspective; Denmark N/A Preferences/utility; costs Published data from Swedish and Dutch screening programs and trials N/A N/A N/A Leivo et al., 1999 (252) Screening CEA Women aged 50-64 y screened in the Finnish nationwide screening program (1987-1992); Finland 90 000 Preferences/utility; costs; LYS Published studies and national cancer statistics, health market sources N/A N/A N/A Norum, 1999 (253) Screening CEA Women aged 50-64 y screened every 2 y in a demonstration program; Norway 46 329 Costs per cancer detected; costs per LYS Costs in the screening project; survival with the use of local data; production gains or losses N/A N/A N/A Secker-Walker et al., 1999 (91) Screening Costs of care Women attending screening in 2 geographic areas; majority 65-79 y old (range, <50-80+); United States 445; 49% response rate Patient time and costs associated with screening and diagnosis Time and travel time; out-of-pocket costs Telephone interview No Unknown van der Pol et al., 1999 (254) Screening CEA Women in sparsely populated areas; island communities of Scotland N/A Preferences/utility; costs Time and travel costs N/A N/A No Haas et al., 2000 (84) Screening Cross-section Women who had abnormal mammograms or mammography for clinical breast concern; United States 751; 77% response rate Quality of care Cross-sectional patient survey and medical record review Telephone interview No Unknown Author, y (reference No.) Phase of care Study design Setting and population Sample size Outcomes Measures† Mode of assessment Report of reliability Power *CBE = clinical breast exam; CEA = cost-effective analysis; FN = false negative; FP = false positive; HC = health care; LYS = life years saved; N/A = not available; PCQ = psychological consequences questionnaire; QALY = quality-adjusted life years; RCT = randomized controlled trial. † SeeTable 3 for definitions of abbreviations of measures. Haiart et al., 1990 (45) Screening Costs of care Mobile mammography using single view for women 40-65 y old; Scotland 6080 Costs; feasibility Direct costs in NHP; patient time, travel, and lost opportunity costs N/A N/A N/A Gram et al., 1990 (46) Screening Cross-section Women with negative and false-positive mammograms 6 mo after screen; average age 47 y; Norway 278; 89% response rate QOL Ladder; WTP; TTO; de novo anxiety and depression items Mail survey No Unknown Smith et al., 1991 (47) Screening RCT Women attending the Leicestershire Breast Screening Service for abnormal mammograms; United Kingdom 103; 87% response rate Satisfaction De novo tool In-person interview; mail survey No Unknown Zappa et al., 1995 (227) Screening Costs of care Population screening of women aged 50-70 y; Italy 38 676 Costs per woman screened; cost per cancer detected Costs of recruitment, screening, and follow-up from the NHP N/A N/A N/A de Haes et al., 1991 (228); de Koning et al., 1991 (229) Screening CEA Women of different ages and intervals of screening; The Netherlands N/A Costs per LYS; costs per QALYs Costs and charges; survival; utilities from expert opinion (n = 27) with the use of published literature Not stated N/A N/A Brown, 1992 (230) Screening CEA Women ≥50 y old; test effects of increasing age; United States N/A Costs; LYS Direct medical costs only; survival based on published literature N/A N/A N/A Zavertnik et al., 1992 (231) Screening Costs of care Costs of delivering low-cost mammography; United States 9452 Costs per cancer detected Fixed and variable costs of screening program; cases detected N/A N/A N/A Mandelblatt et al., 1992 (76) Screening Decision analysis/CEA Women aged ≥65 y with comorbid illnesses; black and white; United States N/A Costs; LYS; QALYs Direct medical costs only; survival based on published literature; utility estimated from expert opinion Not stated N/A N/A Vaile et al., 1993 (232) Screening Longitudinal cohort Women aged 50-64 y invited for screening who attended and had a negative test; England 2060; 65% response rate; 12% lost to follow-up Satisfaction De novo tool Mail survey No No Roworth et al., 1993 (233) Screening Cross-section Women aged 50-64 y attending screening; Scotland 3000; 86% response rate Satisfaction with screening; pain and pressure experienced; intention to return Cockburn Satisfaction With Screening Tool; de novo questions Mail survey No Unknown Richardson et al., 1994 (234) Screening Cross-section Women aged 50-64 y attending screening in urban and rural areas; New Zealand (included since dealing with satisfaction with screening—very few studies) 474; 93% response rate Satisfaction with screening; anxiety De novo tool Mail survey No Unknown Nutting et al., 1994 (77) Screening CEA Mammogram + CBE vs. CBE in community of 750 American Indian women aged ≥50 y; United States N/A Costs; deaths averted; 5-y survival Indian health service costs; survival based on published literature N/A N/A N/A Beemsterboer et al., 1994 (235) Screening CEA Women aged 50-69 y; Germany N/A Costs per LYS Direct medical costs; survival with the use of local data N/A N/A N/A Boer et al., 1995 (236) and 1998 (237) Screening CEA Determination of upper-age limit for screening; The Netherlands N/A Costs per QALYs Direct medical care costs; survival; utilities with the use of published data; source for utilities not described N/A N/A N/A Brown et al., 1995 (240) Screening CEA of nonrandom trial Screening using one-vs. two-view mammography among women aged 50-64 y; England 26 430 Costs per cancer detected Costs of screen and diagnostic follow-up in NHS; patient time costs N/A N/A N/A Feig, 1995 (239) Screening CEA Women aged 40-49 y; United States N/A Costs of screening and diagnosis per woman screened or per LYS Charges and cost estimates based on published literature N/A N/A N/A Brown et al., 1996 (240) Screening CEA Mammography among women aged 50-64 y; one vs. two readings with or without consensus on films; England 33 734 Costs per cancer detected Direct medical and nonmedical care costs to NHS and women based on local data N/A N/A N/A Evans et al., 1996 (241) Screening CEA Women aged 50-64 y; Spain 100 000 Costs per cancer detected Costs based on local data N/A N/A N/A Mandelblatt et al., 1997 (78) Screening CEA Women seeking care in an urban public hospital emergency room; United States N/A Costs per LYS Direct medical care costs and hospital charges; survival based on local data and published literature N/A N/A N/A Salzmann et al., 1997 (242) Screening CEA Women starting mammography at ages 40-49 y vs. 50-69 y; United States N/A Costs; LYS Direct medical costs only; survival based on published literature N/A N/A N/A Torgerson and Gosden, 1997 (243) Screening CEA Women aged 66-69 y vs. 51-65 y; England N/A Deaths averted; LYS Age-specific effects; number of deaths and survival; assumes resources are equal in the 2 age groups N/A N/A N/A Warmerdam et al., 1997 (244) Screening CEA Women aged 50-69 y; The Netherlands N/A Costs; LYS Costs in the German HC system; survival based on published literature and local data N/A N/A N/A Bakker et al., 1998 (245) Screening Cross-section; description Convenient sample of women ≥50 y old (mean age, 61 y; range, 50-85 y) interviewed after mammography; Canada 256; 81% response rate Satisfaction; distress PCQ; de novo items Telephone interview No No Boer et al., 1998 (237) Screening CEA Women living in the northwest region of England N/A Preferences/utility; costs; life-years saved; number of deaths prevented Screening and cost data from the NHS breast-screening program N/A N/A N/A Gilbert et al., 1998 (246) Screening Cohort; longitudinal Women aged 50-64 y following a false-positive screening mammography; Scotland 124 Psychologic distress HADS; health questionnaire Self-administered; mail survey; in-person interview No Unknown Johnston et al., 1998 (206) Screening Cross-section Women aged 40-64 y screened within 6 mo of screen or invited to be screened; England 440 Preferences for temporary states (FP, FN, etc.) TTO In-person interview Yes Yes Lamarque et al., 1998 (247) Screening CEA Women aged 40-60 y; France N/A Costs per case detected Direct and non-direct medical costs (travel and time); biopsyproven disease based on local data N/A N/A N/A Rosenquist and Lindfors, 1998 (248) Screening CEA Women beginning screening at age 40 y at different intervals until age 79 y; United States N/A Incremental costs per LYS Direct medical costs; survival based on published literature N/A N/A N/A Schweitzer et al., 1998 (79) Screening CEA Low-income black and Hispanic women using a mobile mammography van; United States N/A Costs per cancer detected Microcosting of actual van services; biopsy-proven cancer based on published literature N/A N/A N/A Boer et al., 1998, (237) Screening CEA Women at 2-y vs. 3-y intervals; stop screening at age 64 y vs. age 69 y; England N/A Costs; LYS NHS costs; survival based on published literature N/A N/A N/A Wolstenholme et al., 1998 (249) Screening CEA Costs of screening, incorporating the downstream costs of treatment among a regional sample diagnosed in 1991; England 137 Costs; LYS Costs in the NHS; observed survival based on published literature and local data N/A N/A N/A Allen et al., 1999 (250) Screening CEA Sestamibi scintimammography for women >40 y old with dense breasts; United States N/A Preferences/utility; costs Single time-point analysis N/A N/A N/A Boer et al., 1999 (51) Screening CEA Women aged ≥65 y; The Netherlands N/A Preferences/ utility; costs; LYS; extra incidence; extra life-years with disease Data from the Dutch screening projects N/A N/A N/A Gyrd-Hansen, 1999 (251) Screening CEA Costs of screening for colorectal, cervical, and breast cancers from national health care sector perspective; Denmark N/A Preferences/utility; costs Published data from Swedish and Dutch screening programs and trials N/A N/A N/A Leivo et al., 1999 (252) Screening CEA Women aged 50-64 y screened in the Finnish nationwide screening program (1987-1992); Finland 90 000 Preferences/utility; costs; LYS Published studies and national cancer statistics, health market sources N/A N/A N/A Norum, 1999 (253) Screening CEA Women aged 50-64 y screened every 2 y in a demonstration program; Norway 46 329 Costs per cancer detected; costs per LYS Costs in the screening project; survival with the use of local data; production gains or losses N/A N/A N/A Secker-Walker et al., 1999 (91) Screening Costs of care Women attending screening in 2 geographic areas; majority 65-79 y old (range, <50-80+); United States 445; 49% response rate Patient time and costs associated with screening and diagnosis Time and travel time; out-of-pocket costs Telephone interview No Unknown van der Pol et al., 1999 (254) Screening CEA Women in sparsely populated areas; island communities of Scotland N/A Preferences/utility; costs Time and travel costs N/A N/A No Haas et al., 2000 (84) Screening Cross-section Women who had abnormal mammograms or mammography for clinical breast concern; United States 751; 77% response rate Quality of care Cross-sectional patient survey and medical record review Telephone interview No Unknown View Large Appendix Table 3. Characteristics of studies on the outcomes of diagnosis: January 1, 1990 through December 31, 2000* Author, y (reference No.) Phase of care Study design Setting and population Sample size Outcomes Measures† Mode of assessment Report of reliability Power *AND = axillary node dissection; CBE = clinical breast exam; CEA = cost-effectiveness analysis; CNB = core needle biopsy; FNA = fine-needle aspiration; GIVIO = Interdisciplinary Group for Cancer Care Evaluation; MD = medical doctor; N/A = not applicable; QALY = quality-adjusted life years; RCT = randomized controlled trial. † SeeTable 3 for definitions of abbreviations of measures. Kennedy et al,. 1991 (255) Diagnosis Costs of care Women being evaluated for staging: England 103 Costs per detection of bone metastases Costs in NHP N/A N/A N/A Mosconi et al., 1991 (256) Diagnosis Cross-section Women in GIVIO RCT; stages I, II, and III, age <70 y; Italy 1171: 81.5% response rate Satisfaction with communication; information received De novo items Mail survey N/A Unknown McManus et al., 1992 (257) Diagnosis Costs of care Women with needle localization biopsies for nonpalpable lesions vs. triaging mammograms by probability of malignancy and use of selective biopsy; Canada 332 Costs per biopsy; avoided biopsy costs Direct costs of biopsy in the national health system N/A N/A N/A Layfield et al., 1993 (258) Diagnosis CEA FNA vs. open biopsy in women with palpable masses and negative mammography; United States N/A Costs per 10-y survival Diagnostic charges at one center and Medicare costs for ongoing treatment and follow-up; survival N/A N/A N/A Velanovich, 1995 (259) Diagnosis CEA Immediate biopsy vs. repeat mammagraphy in 6 mo women with abnormal mammograms; United States N/A Costs per QALY Based on published literature N/A N/A N/A Fajardo, 1996 (260) Diagnosis Costs of care Women with nonpalpable lesions seen on mammography evaluated with stereotaxic core needle biopsy; United, States 400 Costs per case correctly diagnosed vs. delayed vs. missed diagnosis Costs in one institution based on cost-to-charge ratio N/A N/A N/A Vetto et al., 1996 (262) Diagnosis Costs of care CBE, sonogram, and FNA vs. CBE and open biopsy for women <40 y old with papable lesions; mean age 33 y; United States 55 (included because of paucity of dx studies) Costs per correct diagnosis Charges N/A N/A N/A Hillner 1997 (262) Diagnosis CEA Sestamibi vs. core biopsy vs. open biopsy in women with nonpalpable lesions; United States N/A Costs; number of cancer diagnoses missed; number of delayed diagnoses Institutional costs; missed or delayed diagnosis of cancer based on published literature and RCT N/A N/A N/A Rubin et., 1997 (263) Diagnosis Costs of care FNA to avoid open biopsy in women with palpable lesions: United States N/A Costs saved per averted biopsy Biopsy charges N/A N/A N/A Logan-Young et al., 1998 (264) Diagnosis CEA FNA vs. core vs. open biopsy in one practice; United States > 40 000 patients Costs per case diagnosed Charges based on case series; cancer cases N/A N/A N/A Velanovich, 1998 (265) Diagnosis Decision analysis AND in patients with lesions <2 cm; United States N/A QALYs Survival; utilities from expert and patient opinion or literature; values not given N/A N/A N/A Burkhardt and Sunshine, 1999 (266) Diagnosis Costs of care Costs of biopsy methods (core needle and open surgery); United States N/A Costs Costs; charges; actual payments; excludes “overhead costs” N/A N/A N/A Heimdal et al., 1999 (267) Diagnosis CEA Cost-effectiveness of survelliance program for women at risk for inherited disease; Norway N/A Preference/utility; costs Based on results from surveillance program; Norwegian National Insurance Service reimbursement fees N/A N/A N/A Hrung et al., 1999 (268) Diagnosis CEA Imaging and CNB Magnetic resonance in the preoperative work-up of suspicious breast lesions; United States N/A Preferences/utility; costs Stage-specific cancer prevalence, tumor recurrence, progression rates, and magnetic resonance imaging and CNB sensitivity and specificity were obtained from published literature. Cost estimates were obtained from the literature and from the Medicare fee schedule N/A N/A N/A Boer et al., 1999 (51) Diagnosis CEA Two-view mammography at incident screens; England and Wales N/A Perferences/utility; costs Previously collected data from screening programs N/A N/A N/A Leivo et al., 1999 (269) Diagnosis CEA Nationwide semiannual screening program for women 50-59 y old; Finland 95 423; 91% participation rate Preferences/utility; costs All mammographies performed during 1990-1995 in 3 screening centers of the Finnish Cancer Society N/A N/A N/A Orr et al., 1999 (270) Diagnosis CEA Sentinel node biopsy vs. AND; threshold of accuracy (learning curve); United States 10 000 women per arm Costs, % correct staging; survival; QALYs; Costs; survival; MD-rated utility based on published literature N/A N/A N/A Allen et al., 2000 (49) Diagnosis CEA Sestamibi scintimammography; with mammography; United States N/A Preferences/utility; costs Based on Medicare reimbursement values N/A N/A N/A Morris et al., 2000 (212) Diagnosis CEA Women who underwent wire-guided open breast biopsy; United States 164 Preferences/utility; costs Biopsy records review; Current Procedure Terminology-based charges N/A N/A N/A Author, y (reference No.) Phase of care Study design Setting and population Sample size Outcomes Measures† Mode of assessment Report of reliability Power *AND = axillary node dissection; CBE = clinical breast exam; CEA = cost-effectiveness analysis; CNB = core needle biopsy; FNA = fine-needle aspiration; GIVIO = Interdisciplinary Group for Cancer Care Evaluation; MD = medical doctor; N/A = not applicable; QALY = quality-adjusted life years; RCT = randomized controlled trial. † SeeTable 3 for definitions of abbreviations of measures. Kennedy et al,. 1991 (255) Diagnosis Costs of care Women being evaluated for staging: England 103 Costs per detection of bone metastases Costs in NHP N/A N/A N/A Mosconi et al., 1991 (256) Diagnosis Cross-section Women in GIVIO RCT; stages I, II, and III, age <70 y; Italy 1171: 81.5% response rate Satisfaction with communication; information received De novo items Mail survey N/A Unknown McManus et al., 1992 (257) Diagnosis Costs of care Women with needle localization biopsies for nonpalpable lesions vs. triaging mammograms by probability of malignancy and use of selective biopsy; Canada 332 Costs per biopsy; avoided biopsy costs Direct costs of biopsy in the national health system N/A N/A N/A Layfield et al., 1993 (258) Diagnosis CEA FNA vs. open biopsy in women with palpable masses and negative mammography; United States N/A Costs per 10-y survival Diagnostic charges at one center and Medicare costs for ongoing treatment and follow-up; survival N/A N/A N/A Velanovich, 1995 (259) Diagnosis CEA Immediate biopsy vs. repeat mammagraphy in 6 mo women with abnormal mammograms; United States N/A Costs per QALY Based on published literature N/A N/A N/A Fajardo, 1996 (260) Diagnosis Costs of care Women with nonpalpable lesions seen on mammography evaluated with stereotaxic core needle biopsy; United, States 400 Costs per case correctly diagnosed vs. delayed vs. missed diagnosis Costs in one institution based on cost-to-charge ratio N/A N/A N/A Vetto et al., 1996 (262) Diagnosis Costs of care CBE, sonogram, and FNA vs. CBE and open biopsy for women <40 y old with papable lesions; mean age 33 y; United States 55 (included because of paucity of dx studies) Costs per correct diagnosis Charges N/A N/A N/A Hillner 1997 (262) Diagnosis CEA Sestamibi vs. core biopsy vs. open biopsy in women with nonpalpable lesions; United States N/A Costs; number of cancer diagnoses missed; number of delayed diagnoses Institutional costs; missed or delayed diagnosis of cancer based on published literature and RCT N/A N/A N/A Rubin et., 1997 (263) Diagnosis Costs of care FNA to avoid open biopsy in women with palpable lesions: United States N/A Costs saved per averted biopsy Biopsy charges N/A N/A N/A Logan-Young et al., 1998 (264) Diagnosis CEA FNA vs. core vs. open biopsy in one practice; United States > 40 000 patients Costs per case diagnosed Charges based on case series; cancer cases N/A N/A N/A Velanovich, 1998 (265) Diagnosis Decision analysis AND in patients with lesions <2 cm; United States N/A QALYs Survival; utilities from expert and patient opinion or literature; values not given N/A N/A N/A Burkhardt and Sunshine, 1999 (266) Diagnosis Costs of care Costs of biopsy methods (core needle and open surgery); United States N/A Costs Costs; charges; actual payments; excludes “overhead costs” N/A N/A N/A Heimdal et al., 1999 (267) Diagnosis CEA Cost-effectiveness of survelliance program for women at risk for inherited disease; Norway N/A Preference/utility; costs Based on results from surveillance program; Norwegian National Insurance Service reimbursement fees N/A N/A N/A Hrung et al., 1999 (268) Diagnosis CEA Imaging and CNB Magnetic resonance in the preoperative work-up of suspicious breast lesions; United States N/A Preferences/utility; costs Stage-specific cancer prevalence, tumor recurrence, progression rates, and magnetic resonance imaging and CNB sensitivity and specificity were obtained from published literature. Cost estimates were obtained from the literature and from the Medicare fee schedule N/A N/A N/A Boer et al., 1999 (51) Diagnosis CEA Two-view mammography at incident screens; England and Wales N/A Perferences/utility; costs Previously collected data from screening programs N/A N/A N/A Leivo et al., 1999 (269) Diagnosis CEA Nationwide semiannual screening program for women 50-59 y old; Finland 95 423; 91% participation rate Preferences/utility; costs All mammographies performed during 1990-1995 in 3 screening centers of the Finnish Cancer Society N/A N/A N/A Orr et al., 1999 (270) Diagnosis CEA Sentinel node biopsy vs. AND; threshold of accuracy (learning curve); United States 10 000 women per arm Costs, % correct staging; survival; QALYs; Costs; survival; MD-rated utility based on published literature N/A N/A N/A Allen et al., 2000 (49) Diagnosis CEA Sestamibi scintimammography; with mammography; United States N/A Preferences/utility; costs Based on Medicare reimbursement values N/A N/A N/A Morris et al., 2000 (212) Diagnosis CEA Women who underwent wire-guided open breast biopsy; United States 164 Preferences/utility; costs Biopsy records review; Current Procedure Terminology-based charges N/A N/A N/A View Large Appendix Table 4. Characteristics of studies on the short-term outcomes of local treatment: January 1, 1990 through December 31, 2000* Author, y (reference No.) Phase of care Study design Setting and population Sample size Outcomes Measures† Mode of assessment Report of reliability Power *ALND = axillary lymph node dissection; AND = axillary node dissection; CEA = cost-effectiveness analysis; N/A = not available; QALY = quality-adjusted life years; QOL = quality of life; RCT = randomized controlled trial; RT = radiation therapy. † SeeTable 3 for definitions of abbreviations of measures. Verhoef et al., 1991 (271) Local treatment CEA Women receiving BCS vs. MST, compared for recurrence N/A Costs per QALY Costs; survival with the use of published data; source of costs or types of costs not included; no data on how utilities were derived N/A N/A N/A Ganz et al., 1990 (273), 1992 (73, 272), 1993 (274) Local treatment RCT Women with state I or II cancer enrolled in trial comparing rehabilitation case management with minimal intervention after surgery; compares MST with BCS; 15% black; United States 229 [109 in (73,273)]; 139 in 50% response rate QOL; symptoms FLIC; CARES; KPS; POMS; GAIS In-person interview No Unknown August et al., 1995 (275) Local treatment Cross-section Women attending a multidisciplinary breast cancer service; average age approximately 50 y; United States 601; 59% response rate Satisfaction De novo tool Mail survey Yes Unknown Holcombe et al., 1995 (265) Local treatment Cross-section Women after AND; mean age 59 y (range, 29-76 y), England 101 Satisfaction De novo tool Unknown No Unknown Legorreta et al., 1996 (277) Local treatment Costs of care Women with newly diagnosed breast cancers in a health maintenance organization population (U.S. Healthcare, Blue Bell, PA); mean age 54 y (range, 29-82 y); United States 200 4-y costs; clinical stage; use of mammography screening Medical records; claims data; all health maintenance organization expenditures for non-primary care services N/A N/A N/A Maunsell et al., 1996 (278) Local treatment RCT Women newly diagnosed with local- or regional-stage disease at 1 regional cancer center from 1990 to 1992; counseling plus monthly telephone screening vs. counseling only; Canada 261; 96% response rate Distress; QOL; marital satisfaction; return to usual activities QHC; social support questionnaire; LES; LWMAT; Psychiatric Symptom Index; Canada Health and Activity Limitation Survey In-person interview; telephone interview Yes Unknown Berry et al., 1998 (279) Local treatment Cross-section Women undergoing breast reconstruction with a prosthesis at a median age of 52 y (range, 25-74 y); England 100 Satisfaction De novo tool Mail survey No Unknown Degner et al., 1997 (280) Local treatment Cross-section Women treated for breast cancer seen in 2 cancer centers and 2 community oncology clinics; mean age 58 y (±12.7 y); Canada 1012 Preferences about participation in treatment decisions; information needs De novo tool In-person interview Yes Unknown Gabel et al., 1997 (223) Local treatment Case-control; historical controls Patients seen before and after institution of a multidisciplinary breast cancer clinic at a teaching hospital; United States 339; bias: 67% response for control subjects and 44% for case subjects Satisfaction; time to treatment Unknown Mail survey No Unknown Hayman et al., 1997 (281) Local treatment Cross-section Women with stage I or II cancer who underwent BCS plus RT; 6-24 mo after treatment; United States 117 Preferences Standard Gamble In-person interview No Unknown Liljegren et al., 1997 (282) Local treatment CEA of RCT; 5-y time horizon Patients with stage I disease who were <80 y old when receiving BCS and AND ± RT; Sweden 381 Incremental costs; QALYs (double counted production loss and disutility) Direct and nondirect medical costs, production costs; survival; primary data collection; intend to Rx; utility from MDs N/A N/A N/A Norum et al., 1997 (196) Local treatment CEA Stage I or II; Norway N/A Incremental costs; QALYs Direct and nondirect medical costs based on published literature; survival; patient-rated utility with the use of Euro-QoL N/A N/A N/A Weitzner et al., 1997 (74) Local treatment Cross-section Women treated with MRM plus adjuvant therapy; age <70 y (mean age 54 y) surviving >5 y from stage I, II, or III breast cancer compared with control subjects with normal screening; 13% black; United States 153 QOL BDI; STAI; FPQLI Self-administered No Unknown Andrykowski et al., 1998 (283) Local treatment RCT Women ≥18 y old with a first-time diagnosis of stage 0, I, II, or IIIA disease with a history of fine-needle aspiration and/or diagnosis or fibrocystic disease; United States 176 QOL; fatigue MOS SF-36; CES-D; Chalder Fatigue Scale; Piper Fatigue Scale; Pittsburgh Sleep Quality Index; Symptom Experience Report Mail survey Yes Unknown Bonnema et al., 1998 (284) Local treatment RCT RCT of short or long stay in postsurgical hospital; stage I or II disease, follow-up of 4 mo; The Netherlands 125 QOL; satisfaction De novo items Self-administered Yes Unknown Bonnema et al., 1998 (284,285) Local treatment Cost minimization based on RCT RCT of short or long stay in postsurgical hospital; stage I or II disease, follow-up of 4 mo; The Netherlands 139; 79 completed 4-month diaries Costs per arm 4-mo postsurgical period Direct and nondirect medical costs; patient diaries for resource use; national costs Self-administered N/A N/A Hayman et al., 1998 (286) Local treatment CEA using local and published data Compare RT after BCS with no RT in a cohort of 60-y-old women; United States N/A Costs per QALY Charges at one institution and nonmedical directs (time, travel); survival; utilities; standard gamble in a sample of 97 patients N/A N/A N/A Maslin et al., 1998 (287) Local treatment RCT Women with local disease and mean age 52 y (range, 28-73 y) randomly assigned to interactive video support plus team vs. multidisciplinary shared decision-making; England 100; subset response rate 94% for QOL QOL; acceptability of video MOS SF-36; HADS; de novo tool satisfaction Self-administered No Unknown Burstein et al., 1999 (288) Local treatment Longitudinal cohort Women with stages I or II disease; United States 480; 69% response rate; 73% completed follow-up QOL; use of alternative medicine MOS SF-36; MOS sexual satisfaction; CES-D; NCPT symptom checklist; Lasry and Margoles Fear of Recurrence Scale In-person interview No Unknown Frost et al., 1999 (289) Local treatment Cross-section Newly diagnosed women who received their medical oncology consult in a hospital vs. in a multidisciplinary outpatient clinic; United States 121; 72% response rate QOL; satisfaction CARES; de novo tool Self-administered Yes Unknown Ganz et al., 1999 (81) Local treatment Cross-section Women in a partnered relationship and sexually active in the past 6 mo with a diagnosis of stage 0, I, or II disease; living in Los Angeles, CA, or in Washington, DC; United States 1134 Sexual health CARES Body Image Subscale; Sexual Functioning Inventory Scale; Sexual Interest and Dysfunction Subscale; BCPT Symptom Checklist; revised DAS; RAND Health Survey; WSFQ Mail survey No Unknown Hack et al., 1999 (290) Local treatment Cross-section Women who had ALND at least 6 mo before without advanced disease; Canada 89.5% response rate QOL; pain; mental health Range of arm/shoulder motion; modified Postoperative Pain Questionnaire; PDI; short-form McGill Pain Questionnaire; EORTC QLQ-C30 In-person interview No Unknown Marks et al., 1999 (65) Local treatment CEA Women undergoing postmastectomy RT; United States N/A Cost per QALY; cost per averted relapse Charges; nonmedical direct costs of time and travel; survival with the use of published literature N/A N/A N/A Pusic et al., 1999 (83) Local treatment Cross-section Women who had a lumpectomy with RT or a mastectomy listed in the hospital tumor registry and plastic surgery clinical records; United States and Canada 525; 50.9% response rate QOL; patient choice MOS SF-36; Illness Intrusiveness Scale Self-administered No Unknown Shimozuma et al., 1999 (86) Local treatment RCT Women who lived in Los Angeles County, CA; randomly assigned to MRM vs. BCT; United States 227 QOL CARES; KPS; POMS In-person interview No Unknown Wang et al., 1999 (75) Local treatment Cross-section Women seen for first follow-up after surgery; mean age 49 y (range, 27-78 y); 84% white; United States 102 QOL; concerns and needs De novo tool In-person interview No Unknown Wengstrom et al., 1999 (291) Local treatment RCT Women beginning curative RT; Sweden 175; 77% response rate QOL IES; OTTAT; CARES—short form In-person interview; mail survey Yes Unknown Wenzel 1999 (292) Local treatment Cross-section Subset from intervention trial testing the efficacy of a telephone counseling program; United States 354; 86% response rate QOL CES-D; IES; Breast FACT-B; Sexual Functioning and Body Images Scale Mail survey Yes Unknown Hayman et al., 2000 (293) Local treatment CEA Women with negative margins after conservative surgery who experienced an addition of an electrobeam boost to tangential RT; United States N/A Preferences/utility; costs; QALYS Based on the Lyon trial N/A N/A N/A Mille et al., 2000 (294) Local treatment Costs of care Compliant vs. noncompliant clinical practice guidelines; France 200 Cost evaluation from Social Security perspective; in medical practice Number of medical procedures performed; medical records N/A N/A Unknown Palit et al., 2000 (295) Local treatment Costs of care Women having breast conservation surgery or modified radical mastectomy; United States 230 Costs Medical records and billing N/A N/A Unknown Whelan et al., 2000 (296) Local treatment RCT Women treated by lumpectomy and ALND referred to specific cancer centers; Canada 837; 75% response rate at follow-up QOL Breast Cancer Chemotherapy Questionnaire (BCQ) In-person interview No Unknown Author, y (reference No.) Phase of care Study design Setting and population Sample size Outcomes Measures† Mode of assessment Report of reliability Power *ALND = axillary lymph node dissection; AND = axillary node dissection; CEA = cost-effectiveness analysis; N/A = not available; QALY = quality-adjusted life years; QOL = quality of life; RCT = randomized controlled trial; RT = radiation therapy. † SeeTable 3 for definitions of abbreviations of measures. Verhoef et al., 1991 (271) Local treatment CEA Women receiving BCS vs. MST, compared for recurrence N/A Costs per QALY Costs; survival with the use of published data; source of costs or types of costs not included; no data on how utilities were derived N/A N/A N/A Ganz et al., 1990 (273), 1992 (73, 272), 1993 (274) Local treatment RCT Women with state I or II cancer enrolled in trial comparing rehabilitation case management with minimal intervention after surgery; compares MST with BCS; 15% black; United States 229 [109 in (73,273)]; 139 in 50% response rate QOL; symptoms FLIC; CARES; KPS; POMS; GAIS In-person interview No Unknown August et al., 1995 (275) Local treatment Cross-section Women attending a multidisciplinary breast cancer service; average age approximately 50 y; United States 601; 59% response rate Satisfaction De novo tool Mail survey Yes Unknown Holcombe et al., 1995 (265) Local treatment Cross-section Women after AND; mean age 59 y (range, 29-76 y), England 101 Satisfaction De novo tool Unknown No Unknown Legorreta et al., 1996 (277) Local treatment Costs of care Women with newly diagnosed breast cancers in a health maintenance organization population (U.S. Healthcare, Blue Bell, PA); mean age 54 y (range, 29-82 y); United States 200 4-y costs; clinical stage; use of mammography screening Medical records; claims data; all health maintenance organization expenditures for non-primary care services N/A N/A N/A Maunsell et al., 1996 (278) Local treatment RCT Women newly diagnosed with local- or regional-stage disease at 1 regional cancer center from 1990 to 1992; counseling plus monthly telephone screening vs. counseling only; Canada 261; 96% response rate Distress; QOL; marital satisfaction; return to usual activities QHC; social support questionnaire; LES; LWMAT; Psychiatric Symptom Index; Canada Health and Activity Limitation Survey In-person interview; telephone interview Yes Unknown Berry et al., 1998 (279) Local treatment Cross-section Women undergoing breast reconstruction with a prosthesis at a median age of 52 y (range, 25-74 y); England 100 Satisfaction De novo tool Mail survey No Unknown Degner et al., 1997 (280) Local treatment Cross-section Women treated for breast cancer seen in 2 cancer centers and 2 community oncology clinics; mean age 58 y (±12.7 y); Canada 1012 Preferences about participation in treatment decisions; information needs De novo tool In-person interview Yes Unknown Gabel et al., 1997 (223) Local treatment Case-control; historical controls Patients seen before and after institution of a multidisciplinary breast cancer clinic at a teaching hospital; United States 339; bias: 67% response for control subjects and 44% for case subjects Satisfaction; time to treatment Unknown Mail survey No Unknown Hayman et al., 1997 (281) Local treatment Cross-section Women with stage I or II cancer who underwent BCS plus RT; 6-24 mo after treatment; United States 117 Preferences Standard Gamble In-person interview No Unknown Liljegren et al., 1997 (282) Local treatment CEA of RCT; 5-y time horizon Patients with stage I disease who were <80 y old when receiving BCS and AND ± RT; Sweden 381 Incremental costs; QALYs (double counted production loss and disutility) Direct and nondirect medical costs, production costs; survival; primary data collection; intend to Rx; utility from MDs N/A N/A N/A Norum et al., 1997 (196) Local treatment CEA Stage I or II; Norway N/A Incremental costs; QALYs Direct and nondirect medical costs based on published literature; survival; patient-rated utility with the use of Euro-QoL N/A N/A N/A Weitzner et al., 1997 (74) Local treatment Cross-section Women treated with MRM plus adjuvant therapy; age <70 y (mean age 54 y) surviving >5 y from stage I, II, or III breast cancer compared with control subjects with normal screening; 13% black; United States 153 QOL BDI; STAI; FPQLI Self-administered No Unknown Andrykowski et al., 1998 (283) Local treatment RCT Women ≥18 y old with a first-time diagnosis of stage 0, I, II, or IIIA disease with a history of fine-needle aspiration and/or diagnosis or fibrocystic disease; United States 176 QOL; fatigue MOS SF-36; CES-D; Chalder Fatigue Scale; Piper Fatigue Scale; Pittsburgh Sleep Quality Index; Symptom Experience Report Mail survey Yes Unknown Bonnema et al., 1998 (284) Local treatment RCT RCT of short or long stay in postsurgical hospital; stage I or II disease, follow-up of 4 mo; The Netherlands 125 QOL; satisfaction De novo items Self-administered Yes Unknown Bonnema et al., 1998 (284,285) Local treatment Cost minimization based on RCT RCT of short or long stay in postsurgical hospital; stage I or II disease, follow-up of 4 mo; The Netherlands 139; 79 completed 4-month diaries Costs per arm 4-mo postsurgical period Direct and nondirect medical costs; patient diaries for resource use; national costs Self-administered N/A N/A Hayman et al., 1998 (286) Local treatment CEA using local and published data Compare RT after BCS with no RT in a cohort of 60-y-old women; United States N/A Costs per QALY Charges at one institution and nonmedical directs (time, travel); survival; utilities; standard gamble in a sample of 97 patients N/A N/A N/A Maslin et al., 1998 (287) Local treatment RCT Women with local disease and mean age 52 y (range, 28-73 y) randomly assigned to interactive video support plus team vs. multidisciplinary shared decision-making; England 100; subset response rate 94% for QOL QOL; acceptability of video MOS SF-36; HADS; de novo tool satisfaction Self-administered No Unknown Burstein et al., 1999 (288) Local treatment Longitudinal cohort Women with stages I or II disease; United States 480; 69% response rate; 73% completed follow-up QOL; use of alternative medicine MOS SF-36; MOS sexual satisfaction; CES-D; NCPT symptom checklist; Lasry and Margoles Fear of Recurrence Scale In-person interview No Unknown Frost et al., 1999 (289) Local treatment Cross-section Newly diagnosed women who received their medical oncology consult in a hospital vs. in a multidisciplinary outpatient clinic; United States 121; 72% response rate QOL; satisfaction CARES; de novo tool Self-administered Yes Unknown Ganz et al., 1999 (81) Local treatment Cross-section Women in a partnered relationship and sexually active in the past 6 mo with a diagnosis of stage 0, I, or II disease; living in Los Angeles, CA, or in Washington, DC; United States 1134 Sexual health CARES Body Image Subscale; Sexual Functioning Inventory Scale; Sexual Interest and Dysfunction Subscale; BCPT Symptom Checklist; revised DAS; RAND Health Survey; WSFQ Mail survey No Unknown Hack et al., 1999 (290) Local treatment Cross-section Women who had ALND at least 6 mo before without advanced disease; Canada 89.5% response rate QOL; pain; mental health Range of arm/shoulder motion; modified Postoperative Pain Questionnaire; PDI; short-form McGill Pain Questionnaire; EORTC QLQ-C30 In-person interview No Unknown Marks et al., 1999 (65) Local treatment CEA Women undergoing postmastectomy RT; United States N/A Cost per QALY; cost per averted relapse Charges; nonmedical direct costs of time and travel; survival with the use of published literature N/A N/A N/A Pusic et al., 1999 (83) Local treatment Cross-section Women who had a lumpectomy with RT or a mastectomy listed in the hospital tumor registry and plastic surgery clinical records; United States and Canada 525; 50.9% response rate QOL; patient choice MOS SF-36; Illness Intrusiveness Scale Self-administered No Unknown Shimozuma et al., 1999 (86) Local treatment RCT Women who lived in Los Angeles County, CA; randomly assigned to MRM vs. BCT; United States 227 QOL CARES; KPS; POMS In-person interview No Unknown Wang et al., 1999 (75) Local treatment Cross-section Women seen for first follow-up after surgery; mean age 49 y (range, 27-78 y); 84% white; United States 102 QOL; concerns and needs De novo tool In-person interview No Unknown Wengstrom et al., 1999 (291) Local treatment RCT Women beginning curative RT; Sweden 175; 77% response rate QOL IES; OTTAT; CARES—short form In-person interview; mail survey Yes Unknown Wenzel 1999 (292) Local treatment Cross-section Subset from intervention trial testing the efficacy of a telephone counseling program; United States 354; 86% response rate QOL CES-D; IES; Breast FACT-B; Sexual Functioning and Body Images Scale Mail survey Yes Unknown Hayman et al., 2000 (293) Local treatment CEA Women with negative margins after conservative surgery who experienced an addition of an electrobeam boost to tangential RT; United States N/A Preferences/utility; costs; QALYS Based on the Lyon trial N/A N/A N/A Mille et al., 2000 (294) Local treatment Costs of care Compliant vs. noncompliant clinical practice guidelines; France 200 Cost evaluation from Social Security perspective; in medical practice Number of medical procedures performed; medical records N/A N/A Unknown Palit et al., 2000 (295) Local treatment Costs of care Women having breast conservation surgery or modified radical mastectomy; United States 230 Costs Medical records and billing N/A N/A Unknown Whelan et al., 2000 (296) Local treatment RCT Women treated by lumpectomy and ALND referred to specific cancer centers; Canada 837; 75% response rate at follow-up QOL Breast Cancer Chemotherapy Questionnaire (BCQ) In-person interview No Unknown View Large Appendix Table 5. Characteristics of studies on the outcomes of adjuvant therapy; January 1, 1990 through December 31, 2000* Author, y (reference No.) Phase of care Study design Setting and population Sample size Outcomes Measures† Mode of assessment Report of reliability Power *BMT = bone marrow transplant; CAF = combination chemotherapy with cyclophosphamide, doxorubicin, and 5-fluorouracil; CEA = cost-effectiveness analysis; CMF = combination chemotherapy with cyclophosphamide, methotrexate, and 5-fluorouracil; EORTC = European Organization for Research and Treatment of Cancer; ER = estrogen receptor; LYS = life years saved; MD = medical doctor; N/A = not available; QALY = quality-adjusted life years; QOL = quality of life; RCT = randomized controlled trial; RT = radiation therapy. † SeeTable 3 for definitions of abbreviations of measures. Berglund et al., 1991 (297) Adjuvant therapy RCT; 2- to 10-y follow-up Relapse-free survivors initially randomly assigned to receive RT vs. RT plus tamoxifen vs. adjuvant chemotherapy after MST; >3 cm; lymph node positive; age <65 y; mean age 58 y; Sweden; bias: excluded women with recurrences 448; 82% response rate QOL de novo tool; HADS; 32 symptoms Mail survey Yes for HADS Unknown Gelber et al., 1991 (298) Adjuvant therapy RCT Women with lymph node-positive cancer; 1 vs. 6 cycles of chemotherapy plus tamoxifen; Europe 1229 QOL Qtwist Self and MD rated No Unknown Love et al., 1991 (299) Adjuvant treatment RCT Postmenopausal women <65 y old; lymph node-negative disease; 10 y after diagnosis; United States 140 QOL; symptoms Gynecologic symptoms; de novo tools about QOL and anxiety In-person interview No Unknown Campora et al., 1992 (300) Adjuvant treatment Cross-section Women undergoing chemotherapy (35 with metastatic disease); mean age 55 y (range, 30-70 y); Italy 137 QOL De novo tool; physical, emotional, social, and symptom domains In-person interview No Unknown Hillner and Smith, 1992 (301); Hillner et al., 1993 (302); Smith and Hillner, 1993 (303); Hillner and Smith, 1992 (304); Hillner and Smith, 1991 (305) Adjuvant treatment CEA of published RCT data Effects of using chemotherapy in women aged 45-80 y by lymph node and ER status; United States N/A Cost per LYS and QALYs Direct medical care costs based on one hospital's charges and Medicare data; survival; physician-estimated utility N/A N/A N/A Hurny et al., 1992 (87) Adjuvant therapy RCT Women receiving different numbers and timing of adjuvant chemotherapy cycles (3 vs. 6 and late reintroduction vs. not); Europe 854; 87% complete one QOL set; decrease to 70% over time QOL PACIS; LRS; bFs; POMS; HADS; translated into 11 languages Self-administered Yes Unknown Soukop et al., 1992 (207) Adjuvant therapy RCT Women receiving chemotherapy; randomly assigned to receive ondansetron vs. metoclopramide; England 187 Emesis Rates of emesis; severity of nausea Self-administered No Yes Clavel et al., 1993 (306) Adjuvant therapy RCT Women receiving first course of chemotherapy and participating in 5 RCTs of ondansetron vs. placebo or metclopramide and alizapride 689 QOL; symptoms RSCL; FLIC; FLIC emesis Unknown No Unknown Cox and Hirsch 1993 (307) Adjuvant therapy CEA Comparison of ondansetron and metoclopramide in women receiving chemotherapy; United States N/A Costs per successfully treated patient (i.e., no emesis) Average costs of drugs and medications to control adverse effects; time of providers caring for patients N/A N/A N/A Desch et al., 1993 (93) Adjuvant therapy CEA Chemotherapy vs. no adjuvant therapy for women aged 60-80 y with ER-negative stage I cancer N/A Cost per LYS and QALYs; cost per active life expectancy Direct medical care costs based on one hospital's charges and Medicare data; survival with the use of published data; physician-estimated utility N/A N/A N/A Mapelli et al., 1994 (308) Adjuvant therapy Costs of care in an RCT Women with inflammatory breast cancer randomly assigned to receive high-dose FEC with or without lenograstim; Europe 120 Costs of care Costs of direct medical resources consumed in the RCT N/A N/A N/A Clavel et al., 1995 (50) Adjuvant therapy RCT Women receiving first course of chemotherapy and participating in RCT of ondansetron vs. alizapride to prevent emesis; France 254 QOL; symptoms Symptom checklist; FLIC; FLIC emesis Self-administered; in-person interview No Unknown Barrenetxea et al., 1996 (309) Adjuvant therapy RCT Women receiving mild emetogenic chemotherapy regimens; Spain Unknown QOL; emesis FLIC; de novo tool In-person interview No Unknown Gelber et al., 1996 (310), 1998 (298) Adjuvant therapy RCT Postmenopausal women aged ≥50 y with lymph node-positive disease; EBCTCG; standard chemotherapy plus tamoxifen vs. tamoxifen alone; Europe 3920 QOL Qtwist; source of utility estimates not provided N/A N/A Unknown Hurny et al., 1996 (89) Adjuvant therapy RCT Lymph node-positive women receiving CMF and booster cycles vs. CMF or CMF vs. tamoxifen; 10 languages; Europe 1248 premenopausal (85% response rate); 998 postmenopausal (83% response rate) QOL PACIS; bFs; LRS Self-administered in clinic No Unknown Lokich et al., 1996 (311) Adjuvant therapy Costs of care Women receiving bolus vs. infusion administration of chemotherapy; United States N/A Cost per mode of administration Charges including MD and/or clinic visit; laboratory; drug cost based on average wholesale price; cost of disposables; and pump rental fee N/A N/A N/A Longman et al., 1996 (312) Adjuvant therapy Cross-section Women with mean age 55 y (range, 25-82 y) with all stages of disease; recent diagnosis and recurrences; United States 307 QOL Side effects checklist; de Groot's Symptom Transition Scale; IARB; SCIWPR; Negative Affect Scale; IWB; Cantrill's Ladder Unknown Yes Unknown Messori et al., 1996 (313) Adjuvant therapy CEA using RCT data CMF chemotherapy vs. none in women with lymph node-positive disease; Italy 388 Costs; LYS Direct medical costs; survival “area under the curve” estimated by Gompertz function; assumes downstream costs are equal in both arms; no discounting N/A N/A N/A Hann et al., 1997 (314) Adjuvant therapy; BMT Case-control Cancer center patients with BMT from 1990 to 1995; mean age 44 y (range, 32-57 y); United States 103; 86% response rate QOL MOS SF-36; KPS; MSAS Mail survey No Unknown Bernhard et al., 1998 (88); Hurny et al., 1996 (89) Adjuvant therapy RCT Premenopausal women with lymph node-positive disease receiving CMF plus late CMF vs. CMF or postmenopausal women receiving tamoxifen vs. CMF (with or without delay booster); 9 languages; Europe 2687; subset response rate 82% for QOL QOL PACIS; LRS; bFs Self-administered No Unknown Carter et al., 1998 (315) Adjuvant therapy CEA Treatment of early-stage breast cancer in the elderly; United States N/A Preference/utility; costs Literature data; utilities were determined from the responses of health care professionals to a basic reference gamble N/A N/A N/A Fetting et al., 1998 (219) Adjuvant therapy RCT Women with lymph node-positive, ER-negative disease randomly assigned to receive CAF in six cycles vs. 16 wk (16 wk includes methotrexate and vincristine); median age 47 y (range, 25-78 y); 15% black; United States 646; QOL data only available on 163; 87% complete all time points QOL BCQ Unknown No Unknown Frits et al., 1998 (316) Adjuvant therapy RCT Women <55 y old with lymph node-positive cancer receiving tamoxifen plus standard chemotherapy vs. tamoxifen plus high-dose chemotherapy; controls without chemotherapy; The Netherlands 121 Cognitive impairment; QOL Rey Auditory Verbal Learning Test; Complex Figure Test; digit span of WAIS; Trial Making; D2 test; Dutch aphasia test; Stroop Test; Fepsy Tests; EORTC-QLQ-C30; HSCL In-person interview No Unknown Bernhard et al., 1999 (317) Adjuvant therapy RCT Women who failed prior adjuvant and/or palliative treatment with tamoxifen; randomly assigned to receive forestane vs. megestrol acetate; Switzerland 177; 83% response rate QOL De novo tools Mail survey No Unknown Day et al., 1999 (318) Adjuvant therapy Cohort Women enrolled in the National Surgical Adjuvant Breast and Bowel Project Breast Cancer Prevention Trial 82% response rate QOL HRQL survey Self-administered No Unknown Fairclough et al., 1999 (82) Adjuvant therapy RCT Women with hormone-reecptor-negative, lymph node-positive disease; United States 163; 87% response rate QOL; quality-adjusted survival Breast Chemotherapy Questionnaire (BCQ) Self-administered Yes No Gaston-Johansson et al., 1999 (319) Adjuvant therapy Cross-section Women with stage II, III, or IV disease who were scheduled for autologous bone marrow/peripheral blood stem cell transplant; United States 127 Fatigue; pain; depression Piper Fatigue Scale; MOS Short-form General Health Survey; Gaston-Johannsson Pain-O-Meter Self-administered No Unknown Hoerger et al., 1999 (320) Adjuvant therapy Costs of care Women ≥45 y old using health care for cardiovascular disease, osteoporosis, breast cancer, or gynecologic cancers; United States N/A Costs; health care use Data from Healthcare Cost and Utilization Project-3 (HCUP-3); national health care survey; discharge data; cost/charge ratios; Medicare fee schedule N/A N/A N/A Kurtz et al., 1999 (92) Adjuvant therapy Longitudinal cohort Women >65 y old recruited for on-going study of 6 centers in Michigan; United States 383 QOL; comorbidity MOS SF-36; Symptom Experience Scale Unknown No Unknown Macquart-Moulin et al., 1999 (321) Adjuvant therapy RCT Women with <9 involved axillary lymph nodes; France 109; subset of 97 at follow-up QOL; side effects EORTC QLQ-C30; de novo tool Self-administered Yes No McKinna et al., 1999 (322) Adjuvant therapy RCT Women with operable breast cancer and suitable for breast-conserving surgery (Jan. 1984-Dec. 1994) who were recommended a policy of observation to the lymphatic pathways; United Kingdom 291 Cancer-related morbidity Case record review N/A N/A N/A Silber et al., 1998 (323) Adjuvant therapy CEA Hypothetical cohort of women receiving chemotherapy; use of G-STF to prevent development of neutropenia; United States N/A Costs per LYS Payor charges; survival with the use of published literature N/A N/A N/A Van Tiggelen et al., 1999 (324) Adjuvant therapy CEA Comparison of oophorectomy with chemotherapy in premenopausal women; Belgium N/A Costs (assume equal effects based on one RCT) Charges with the use of country-specified data N/A N/A N/A van Enckevort et al., 1999 (325) Adjuant therapy CEA Women receiving chemotherapy, hormonal treatment, or both; The Netherlands N/A QALY; costs, preference/utility Published studies (Jan 1980-Dec 1997) N/A N/A N/A Joly et al., 2000 (209) Adjuvant therapy RCT Premenopausal women enrolled in a trial testing the efficacy of adjuvant CMF chemotherapy; lymph node negative; France 179; 68% response rate QOL EORTC QLQ-C30; EORTC QLQ-BR23 Mail survey Yes Unknown Kramer et al., 2000 (326) Adjuvant therapy RCT Women with baseline QL data from a trial of paclitaxel vs. doxorubicin as first-line chemotherapy; The Netherlands and Belgium 294; 64% response rate QOL; survival effectiveness EORTC QLQ-C30; RSCL Self-administered No Unknown Norum, 2000 (327) Adjuvant therapy CEA Treatment with CMF; Norway 778 articles QOL; preferences/utility; costs MEDLINE English language literature with incorporated Norwegian Standard Act practice and cost data N/A N/A N/A Pandya et al., 2000 (328) Adjuvant therapy RCT Postmenopausal patients experiencing at least one tamoxifen-induced hot flash per day; United States 194 QOL Diary; de novo tools Mail survey No No Vrieling et al., 2000 (329) Adjuvant therapy RCT Subset of women entered in the EORTC “boost vs. no-boost” trial of tumorectomy axillary dissection 1872 Cosmetic results De novo tools In-person interview No Unknown Author, y (reference No.) Phase of care Study design Setting and population Sample size Outcomes Measures† Mode of assessment Report of reliability Power *BMT = bone marrow transplant; CAF = combination chemotherapy with cyclophosphamide, doxorubicin, and 5-fluorouracil; CEA = cost-effectiveness analysis; CMF = combination chemotherapy with cyclophosphamide, methotrexate, and 5-fluorouracil; EORTC = European Organization for Research and Treatment of Cancer; ER = estrogen receptor; LYS = life years saved; MD = medical doctor; N/A = not available; QALY = quality-adjusted life years; QOL = quality of life; RCT = randomized controlled trial; RT = radiation therapy. † SeeTable 3 for definitions of abbreviations of measures. Berglund et al., 1991 (297) Adjuvant therapy RCT; 2- to 10-y follow-up Relapse-free survivors initially randomly assigned to receive RT vs. RT plus tamoxifen vs. adjuvant chemotherapy after MST; >3 cm; lymph node positive; age <65 y; mean age 58 y; Sweden; bias: excluded women with recurrences 448; 82% response rate QOL de novo tool; HADS; 32 symptoms Mail survey Yes for HADS Unknown Gelber et al., 1991 (298) Adjuvant therapy RCT Women with lymph node-positive cancer; 1 vs. 6 cycles of chemotherapy plus tamoxifen; Europe 1229 QOL Qtwist Self and MD rated No Unknown Love et al., 1991 (299) Adjuvant treatment RCT Postmenopausal women <65 y old; lymph node-negative disease; 10 y after diagnosis; United States 140 QOL; symptoms Gynecologic symptoms; de novo tools about QOL and anxiety In-person interview No Unknown Campora et al., 1992 (300) Adjuvant treatment Cross-section Women undergoing chemotherapy (35 with metastatic disease); mean age 55 y (range, 30-70 y); Italy 137 QOL De novo tool; physical, emotional, social, and symptom domains In-person interview No Unknown Hillner and Smith, 1992 (301); Hillner et al., 1993 (302); Smith and Hillner, 1993 (303); Hillner and Smith, 1992 (304); Hillner and Smith, 1991 (305) Adjuvant treatment CEA of published RCT data Effects of using chemotherapy in women aged 45-80 y by lymph node and ER status; United States N/A Cost per LYS and QALYs Direct medical care costs based on one hospital's charges and Medicare data; survival; physician-estimated utility N/A N/A N/A Hurny et al., 1992 (87) Adjuvant therapy RCT Women receiving different numbers and timing of adjuvant chemotherapy cycles (3 vs. 6 and late reintroduction vs. not); Europe 854; 87% complete one QOL set; decrease to 70% over time QOL PACIS; LRS; bFs; POMS; HADS; translated into 11 languages Self-administered Yes Unknown Soukop et al., 1992 (207) Adjuvant therapy RCT Women receiving chemotherapy; randomly assigned to receive ondansetron vs. metoclopramide; England 187 Emesis Rates of emesis; severity of nausea Self-administered No Yes Clavel et al., 1993 (306) Adjuvant therapy RCT Women receiving first course of chemotherapy and participating in 5 RCTs of ondansetron vs. placebo or metclopramide and alizapride 689 QOL; symptoms RSCL; FLIC; FLIC emesis Unknown No Unknown Cox and Hirsch 1993 (307) Adjuvant therapy CEA Comparison of ondansetron and metoclopramide in women receiving chemotherapy; United States N/A Costs per successfully treated patient (i.e., no emesis) Average costs of drugs and medications to control adverse effects; time of providers caring for patients N/A N/A N/A Desch et al., 1993 (93) Adjuvant therapy CEA Chemotherapy vs. no adjuvant therapy for women aged 60-80 y with ER-negative stage I cancer N/A Cost per LYS and QALYs; cost per active life expectancy Direct medical care costs based on one hospital's charges and Medicare data; survival with the use of published data; physician-estimated utility N/A N/A N/A Mapelli et al., 1994 (308) Adjuvant therapy Costs of care in an RCT Women with inflammatory breast cancer randomly assigned to receive high-dose FEC with or without lenograstim; Europe 120 Costs of care Costs of direct medical resources consumed in the RCT N/A N/A N/A Clavel et al., 1995 (50) Adjuvant therapy RCT Women receiving first course of chemotherapy and participating in RCT of ondansetron vs. alizapride to prevent emesis; France 254 QOL; symptoms Symptom checklist; FLIC; FLIC emesis Self-administered; in-person interview No Unknown Barrenetxea et al., 1996 (309) Adjuvant therapy RCT Women receiving mild emetogenic chemotherapy regimens; Spain Unknown QOL; emesis FLIC; de novo tool In-person interview No Unknown Gelber et al., 1996 (310), 1998 (298) Adjuvant therapy RCT Postmenopausal women aged ≥50 y with lymph node-positive disease; EBCTCG; standard chemotherapy plus tamoxifen vs. tamoxifen alone; Europe 3920 QOL Qtwist; source of utility estimates not provided N/A N/A Unknown Hurny et al., 1996 (89) Adjuvant therapy RCT Lymph node-positive women receiving CMF and booster cycles vs. CMF or CMF vs. tamoxifen; 10 languages; Europe 1248 premenopausal (85% response rate); 998 postmenopausal (83% response rate) QOL PACIS; bFs; LRS Self-administered in clinic No Unknown Lokich et al., 1996 (311) Adjuvant therapy Costs of care Women receiving bolus vs. infusion administration of chemotherapy; United States N/A Cost per mode of administration Charges including MD and/or clinic visit; laboratory; drug cost based on average wholesale price; cost of disposables; and pump rental fee N/A N/A N/A Longman et al., 1996 (312) Adjuvant therapy Cross-section Women with mean age 55 y (range, 25-82 y) with all stages of disease; recent diagnosis and recurrences; United States 307 QOL Side effects checklist; de Groot's Symptom Transition Scale; IARB; SCIWPR; Negative Affect Scale; IWB; Cantrill's Ladder Unknown Yes Unknown Messori et al., 1996 (313) Adjuvant therapy CEA using RCT data CMF chemotherapy vs. none in women with lymph node-positive disease; Italy 388 Costs; LYS Direct medical costs; survival “area under the curve” estimated by Gompertz function; assumes downstream costs are equal in both arms; no discounting N/A N/A N/A Hann et al., 1997 (314) Adjuvant therapy; BMT Case-control Cancer center patients with BMT from 1990 to 1995; mean age 44 y (range, 32-57 y); United States 103; 86% response rate QOL MOS SF-36; KPS; MSAS Mail survey No Unknown Bernhard et al., 1998 (88); Hurny et al., 1996 (89) Adjuvant therapy RCT Premenopausal women with lymph node-positive disease receiving CMF plus late CMF vs. CMF or postmenopausal women receiving tamoxifen vs. CMF (with or without delay booster); 9 languages; Europe 2687; subset response rate 82% for QOL QOL PACIS; LRS; bFs Self-administered No Unknown Carter et al., 1998 (315) Adjuvant therapy CEA Treatment of early-stage breast cancer in the elderly; United States N/A Preference/utility; costs Literature data; utilities were determined from the responses of health care professionals to a basic reference gamble N/A N/A N/A Fetting et al., 1998 (219) Adjuvant therapy RCT Women with lymph node-positive, ER-negative disease randomly assigned to receive CAF in six cycles vs. 16 wk (16 wk includes methotrexate and vincristine); median age 47 y (range, 25-78 y); 15% black; United States 646; QOL data only available on 163; 87% complete all time points QOL BCQ Unknown No Unknown Frits et al., 1998 (316) Adjuvant therapy RCT Women <55 y old with lymph node-positive cancer receiving tamoxifen plus standard chemotherapy vs. tamoxifen plus high-dose chemotherapy; controls without chemotherapy; The Netherlands 121 Cognitive impairment; QOL Rey Auditory Verbal Learning Test; Complex Figure Test; digit span of WAIS; Trial Making; D2 test; Dutch aphasia test; Stroop Test; Fepsy Tests; EORTC-QLQ-C30; HSCL In-person interview No Unknown Bernhard et al., 1999 (317) Adjuvant therapy RCT Women who failed prior adjuvant and/or palliative treatment with tamoxifen; randomly assigned to receive forestane vs. megestrol acetate; Switzerland 177; 83% response rate QOL De novo tools Mail survey No Unknown Day et al., 1999 (318) Adjuvant therapy Cohort Women enrolled in the National Surgical Adjuvant Breast and Bowel Project Breast Cancer Prevention Trial 82% response rate QOL HRQL survey Self-administered No Unknown Fairclough et al., 1999 (82) Adjuvant therapy RCT Women with hormone-reecptor-negative, lymph node-positive disease; United States 163; 87% response rate QOL; quality-adjusted survival Breast Chemotherapy Questionnaire (BCQ) Self-administered Yes No Gaston-Johansson et al., 1999 (319) Adjuvant therapy Cross-section Women with stage II, III, or IV disease who were scheduled for autologous bone marrow/peripheral blood stem cell transplant; United States 127 Fatigue; pain; depression Piper Fatigue Scale; MOS Short-form General Health Survey; Gaston-Johannsson Pain-O-Meter Self-administered No Unknown Hoerger et al., 1999 (320) Adjuvant therapy Costs of care Women ≥45 y old using health care for cardiovascular disease, osteoporosis, breast cancer, or gynecologic cancers; United States N/A Costs; health care use Data from Healthcare Cost and Utilization Project-3 (HCUP-3); national health care survey; discharge data; cost/charge ratios; Medicare fee schedule N/A N/A N/A Kurtz et al., 1999 (92) Adjuvant therapy Longitudinal cohort Women >65 y old recruited for on-going study of 6 centers in Michigan; United States 383 QOL; comorbidity MOS SF-36; Symptom Experience Scale Unknown No Unknown Macquart-Moulin et al., 1999 (321) Adjuvant therapy RCT Women with <9 involved axillary lymph nodes; France 109; subset of 97 at follow-up QOL; side effects EORTC QLQ-C30; de novo tool Self-administered Yes No McKinna et al., 1999 (322) Adjuvant therapy RCT Women with operable breast cancer and suitable for breast-conserving surgery (Jan. 1984-Dec. 1994) who were recommended a policy of observation to the lymphatic pathways; United Kingdom 291 Cancer-related morbidity Case record review N/A N/A N/A Silber et al., 1998 (323) Adjuvant therapy CEA Hypothetical cohort of women receiving chemotherapy; use of G-STF to prevent development of neutropenia; United States N/A Costs per LYS Payor charges; survival with the use of published literature N/A N/A N/A Van Tiggelen et al., 1999 (324) Adjuvant therapy CEA Comparison of oophorectomy with chemotherapy in premenopausal women; Belgium N/A Costs (assume equal effects based on one RCT) Charges with the use of country-specified data N/A N/A N/A van Enckevort et al., 1999 (325) Adjuant therapy CEA Women receiving chemotherapy, hormonal treatment, or both; The Netherlands N/A QALY; costs, preference/utility Published studies (Jan 1980-Dec 1997) N/A N/A N/A Joly et al., 2000 (209) Adjuvant therapy RCT Premenopausal women enrolled in a trial testing the efficacy of adjuvant CMF chemotherapy; lymph node negative; France 179; 68% response rate QOL EORTC QLQ-C30; EORTC QLQ-BR23 Mail survey Yes Unknown Kramer et al., 2000 (326) Adjuvant therapy RCT Women with baseline QL data from a trial of paclitaxel vs. doxorubicin as first-line chemotherapy; The Netherlands and Belgium 294; 64% response rate QOL; survival effectiveness EORTC QLQ-C30; RSCL Self-administered No Unknown Norum, 2000 (327) Adjuvant therapy CEA Treatment with CMF; Norway 778 articles QOL; preferences/utility; costs MEDLINE English language literature with incorporated Norwegian Standard Act practice and cost data N/A N/A N/A Pandya et al., 2000 (328) Adjuvant therapy RCT Postmenopausal patients experiencing at least one tamoxifen-induced hot flash per day; United States 194 QOL Diary; de novo tools Mail survey No No Vrieling et al., 2000 (329) Adjuvant therapy RCT Subset of women entered in the EORTC “boost vs. no-boost” trial of tumorectomy axillary dissection 1872 Cosmetic results De novo tools In-person interview No Unknown View Large Appendix Table 6. Characteristics of studies of treatment of metastatic disease: January 1, 1990 through December 31, 2000* Author, y (reference No.) Phase of care Study design Setting and population Sample size Outcomes Measures† Mode of assessment Report of reliability Power *ABMT = autologous bone marrow transplantation; BMT = bone marrow transplant; CEA = cost-effectiveness analysis; CMF = combination chemotherapy with cyclophosphamide, methotrexate, and 5-fluorouracil; ECOG = Eastern Cooperative Oncology Group; FAC = combination chemotherapy with 5-fluorouracil, doxorubicin, and cyclophosphamide; LYS = life years saved; MDs = medical doctors; N/A = not applicable; QALY = quality-adjusted life years; RCT = randomized controlled trial; RT = radiation therapy; SWOG = Southwest Oncology Group. † SeeTable 3 for definitions of abbreviations of measures. Biermann et al., 1991 (330) Treatment of metastatic disease Costs of care Women with bone metastases; United States 457 LOS; costs per fracture; per hypercalcemia episode; per pain control; functioning Hospital costs for fracture; OPD costs for RT and other care; chart note of inability to perform activities; chart review N/A N/A N/A van Holten-Verzantyoort et al., 1991 (210) Treatment of metastatic disease RCT Women with osteolytic metastases with a life expectancy >6 mo; randomly assigned to receive supportive pamidronate treatment; The Netherlands 1179; 96% response rate QOL De novo tools Mail survey and in-person interview Yes Unknown Hillner et al., 1992 (331) Treatment of metastatic disease CEA Hypothetical cohorts of women with metastatic disease treated with ABMT vs. standard chemotherapy; United States N/A Costs per LYS Costs at one institution and Medicare costs; survival with the use of published literature N/A N/A N/A Koopmanschap et al., 1992 (332) Treatment of metastatic disease Costs of care Care of women with advanced cancer over the course of disease; The Netherlands N/A Costs of advanced care; costs of home care; patient time costs; caregiver time costs Costs of home care, hospital costs, nursing home costs N/A N/A N/A Kornblith et al., 1993 (333) Treatment of metastatic disease RCT Women with stage IV cancer receiving megestrol acetate in 2 doses; average age 61 y; 88% white; United States 131 QOL FLIC: MOS SF-36 and MHI; Body Image Subscale of Sexual Functioning Inventory; de novo side-effect index LRS Mail survey; telephone interview No Unknown Peters et al., 1994 (334) Treatment of metastatic disease Costs of care Women undergoing high-dose chemotherapy with BMT and PBBCs; United States 110 Costs of episode of care Hospital charges N/A N/A N/A Bertsch and Donaldson, 1995 (221) Treatment of metastatic disease RCT Women with refractory advanced disease receiving either vinorelbine or melphalan; United States 179; Differential losses to follow-up; not analyzed by intention QOL Modified SWOG QOL; MOS SF-36; SDS; LRS In-person interview No Unknown Hayes et al., 1995 (335) Treatment of metastatic RCT Women with metastatic disease randomly assigned to receive tamoxifen vs. toremifene in 2 doses; United States 648 QOL; symptoms LRS; ECOG Analgesics Requirement Scale; pain assessment; ECOG Performance Status Unknown No Unknown Jones et al., 1995 (72) Treatment of metastatic disease RCT Women with refractory advanced disease; median age 53 y (range, 29-83 y); 12% black; United States 183 QOL Modified SWOG QOL Self-administered No Unknown McQuellon et al., 1995 (336) Treatment of metastatic disease Cross-section Women with early-stage disease queried about preferences for treatment of metastatic cancer 15 Preferences Modified TTO In-person interview No Unknown Hultborn et al., 1996 (337) Treatment of metastatic disease RCT (crossover at progression) Women receiving methoxyprogesterone vs. aminoglutethimide plus cortisone; Sweden 200 QOL NHP Unknown No Unknown Hultborn et al., 1996 (338) Treatment of metastatic disease RCT Women with skeletal metastases; pamidronate vs. placebo; Sweden 404 Skeletal pain; performance status VAS; performance status Unknown No Unknown Jonat et al., 1996 (339) Treatment of metastatic disease RCT Postmenopausal women randomly assigned to receive arimidex or megase; Europe 378 QOL RSCL; performance status Self-administered No No Launois et al., 1996 (340) Treatment of metastatic disease CEA using local data Docetaxel vs. palitaxel vs. vinorelbine; France N/A Costs per Qaly Direct costs in NHP; survival; utilities; utilities based on opinion of 20 nurses Not stated N/A N/A van Holten-Verzantvoort et al., 1996 341) Treatment of metastatic disease RCT Women with skeletal metastases; pamidronate vs. placebo; The Netherlands 124 Skeletal pain; symptoms; mobility impairment De novo tool Self-administered No Unknown Bates et al., 1997 (342) Treatment of metastatic disease CEA Women with stage IIIB or IV disease receiving FAC and dexrazoxane (administered after 6 courses of FAC) vs. FAC alone; United States N/A Cost per cardiac event prevented; costs per LYS (note: costs of recurrence or any downstream events not included) Medication costs and costs of cardiac events; survival with the use of data from 2 RCTs and expert opinion N/A N/A N/A Ramirez et al., 1998 (61) Treatment of metastatic disease Longitudinal cohort Women with advanced metastatic disease receiving palliative chemotherapy; median age 58 y (range, 30-80 y); England 155; >90% response rate QOL RSCL; de novo items on overall well-being and perceived benefit of treatment Interviewer administered No Unknown Joensuu et al., 1998 (343) Treatment of metastatic disease RCT Women <70 y old (average age 55 y) with metastases receiving epirubicin followed by mitomycin vs. CEF followed by VM; Finland 285 QOL RSCL Unknown Yes Unknown Brown and Hutton, 1998 (344) Treatment of metastatic disease CEA Docetaxel vs. paclitaxel for patients with advanced metastatic disease; England N/A Costs; QALYs Direct costs estimated by MDs and Medicare; nurse-assessed utility; data from published literature N/A N/A N/A Bull et al., 1991 (222) Treatment of recurrence Longitudinal cohort within RCT Women with recurrent disease; <70 y old; stages I-III; Italy 1320; subset of 176 with recurrence QOL; satisfaction; symptoms 25 items used in Italian for 6 domains; LRS for satisfaction; symptom checklist Mail survey No Unknown Cobleigh et al., 1999 (345) Treatment of metastatic disease RCT Women with HER2-over-expressing disease after one or two chemotherapy treatments; United States, Canada, Belguim, France, Germany, United Kingdom, and Australia 222; subset of 154 assessed for QOL QOL EORTC QLQ-C30 In-person interview No Unknown Cotton et al., 1999 (346) Treatment of metastatic disease RCT Women diagnosed with invasive disease within the last 18 mo or recurrence who were participating in a larger study designed to compare the efficacy of two psychosocial support programs; United States 142 Spiritual well-being; QOL; psychologic adjustment FACIT-B; FACTSP; Mini-Mental Adjustment to Cancer; Principles of Living Survey Self-administered No Unknown Harper-Wynne et al., 1999 (208) Treatment of metastatic disease RCT Women with locally advanced or metastatic disease; concluded adjuvant therapy at least 2 y before; randomly assigned to receive CMF vs. MM; England 116 QOL; satisfaction; symptoms HADS; RSCL; patient satisfaction questions In-person interview No Noted to be low Hoerger et al., 1999 (320) Treatment of metastatic disease Costs of care Women ≥45 y old using health care for cardiovascular disease, osteoporosis, breast cancer, or gynecologic cancers; United States N/A Costs; health care use Data from Health care Cost and Utilization Project-3 (HCUP-3); national health care survey; discharge data—cost/charge ratios; Medicare fee schedule N/A N/A N/A Hultborn et al., 1999 (347) Treatment of metastatic disease RCT Women with skeletal metastases not previously treated with bisphosphates randomly assigned to receive pamidronate vs. placebo; Sweden and Norway 404 Pain; skeletal-related events Visual Analogue Scales; analgesic consumption In-person interview No Unknown Kristensen et al. 1999 (348) Treatment of metastatic disease RCT Women who received first-line systemic antineoplastic disease vs. placebo; bone involvement for <6 mo or untreated; Denmark 100 QOL EORTC QLQ-C30; HADS In-person interview No Unknown Leung et al., 1999 (349) Treatment of metastatic disease CEA Women who are anthracycline resistant who had received paclitaxel, docetaxel, or vinorelbine during the past ≥2 y Unknown Preferences/utility; cost per quality-adjusted progression-free year Chart review N/A N/A N/A Nabholtz et al., 1999 (350), 1997 (351) Treatment of metastatic disease RCT Women ≥ 18 y old with progressive metastatic disease; randomly assigned to receive docetaxel or mitomycin and vinblastine; Canada and Europe 392 QOL (global and physical functions) EORTC-QLQ-C30 Self-administered No Unknown Nuijten et al., 1999 (352) Treatment of metastatic disease CEA Hypothetical cohort of postmenopausal women recruited for the AR/BC2 clinical trial treated with letrozole; United Kingdom N/A Preference/utility; costs Based on clinical trial results showing the advantage of letrozole in terms of time to disease progression and duration of response N/A N/A N/A Osoba and Burchmore, 1999 (353) Treatment of metastatic disease RCT Women with progressive HER2-overexpressing metastatic disease treated with Trasuzumab vs. placebo; Canada 222 for phase II and 469 for phase III QOL EORTC QLQ-C30 Self-administered No Unknown Burgess et al., 2000 (354) Treatment of metastatic disease RCT Women who had detected disease symptoms themselves; interviewed 5 mo after diagnosis; United Kingdom 196 Presence of adverse life events and difficulties; psychiatric morbidity LEDS; SCID; DSM III-R diagnostic criteria In-person interview No Unknown Geels et al., 2000 (355) Treatment of metastatic disease Cohort Women with metastatic disease; randomly assigned to receive intravenous doxorubicin or doxorubicin with vinorelbine; Canada 300; 96% response rate QOL EORTC QLQ-C30 Self-administered No Unknown Hakamies-Blomqvist et al., 2000 (356) Treatment of metastatic disease RCT Women with metastatic disease; randomly assigned to receive docetaxel vs. sequential methotrexate and 5-fluorouracil (Dec. 1994 to Oct. 1997); Scandinavia 283 QOL EORTC QLQ-C30 Self-administered No Unknown Hillner et al., 2000 (357) Treatment of metastatic disease CEA Hypothetical group of women with osteolytic bone metastases receiving pamidronate; United States N/A Preference/utility; costs Database of costs at the Massey Cancer Center; based on Aredia Breast Cancer Study Group trials N/A N/A N/A Kaufmann et al., 2000 (358) Treatment of metastatic disease RCT Postmenopausal women with disease progression/relapse during TAM treatment and at least one lytic bony lesion; randomly assigned to receive exemestane vs. megestrol acetate; 19 countries 769 QOL; tolerability Unknown Self-administered No Unknown Kramer et al., 2000 (359) Treatment of metastatic disease RCT Women with metastatic disease; randomly assigned to receive paclitaxel vs. doxorubicin as first-line chemotherapy; The Netherlands, Denmark, and Belgium 294; subset of 187 (64%) for QOL analysis QOL EORTC QLQ-C30; RSCL Self-administered No Unknown Lipton et al., 2000 (360) Treatment of metastatic disease RCT Women with osteolytic bone metastases receiving pamidronate; United States, Canada, Australia, and New Zealand 754 Skeletal complications Biological markers N/A No Unknown Norris et al., 2000 (361) Treatment of metastatic disease RCT National Cancer Institute of Canada Clinical Trials Group Study MA8; patients 18-75 y old; life expectancy >16 wk; randomly assigned to receive vinorelbine and doxorubicin vs. doxorubicin; Canada 303 QOL EORTC QLQ-C30; de novo tool In-person interview No Unknown Author, y (reference No.) Phase of care Study design Setting and population Sample size Outcomes Measures† Mode of assessment Report of reliability Power *ABMT = autologous bone marrow transplantation; BMT = bone marrow transplant; CEA = cost-effectiveness analysis; CMF = combination chemotherapy with cyclophosphamide, methotrexate, and 5-fluorouracil; ECOG = Eastern Cooperative Oncology Group; FAC = combination chemotherapy with 5-fluorouracil, doxorubicin, and cyclophosphamide; LYS = life years saved; MDs = medical doctors; N/A = not applicable; QALY = quality-adjusted life years; RCT = randomized controlled trial; RT = radiation therapy; SWOG = Southwest Oncology Group. † SeeTable 3 for definitions of abbreviations of measures. Biermann et al., 1991 (330) Treatment of metastatic disease Costs of care Women with bone metastases; United States 457 LOS; costs per fracture; per hypercalcemia episode; per pain control; functioning Hospital costs for fracture; OPD costs for RT and other care; chart note of inability to perform activities; chart review N/A N/A N/A van Holten-Verzantyoort et al., 1991 (210) Treatment of metastatic disease RCT Women with osteolytic metastases with a life expectancy >6 mo; randomly assigned to receive supportive pamidronate treatment; The Netherlands 1179; 96% response rate QOL De novo tools Mail survey and in-person interview Yes Unknown Hillner et al., 1992 (331) Treatment of metastatic disease CEA Hypothetical cohorts of women with metastatic disease treated with ABMT vs. standard chemotherapy; United States N/A Costs per LYS Costs at one institution and Medicare costs; survival with the use of published literature N/A N/A N/A Koopmanschap et al., 1992 (332) Treatment of metastatic disease Costs of care Care of women with advanced cancer over the course of disease; The Netherlands N/A Costs of advanced care; costs of home care; patient time costs; caregiver time costs Costs of home care, hospital costs, nursing home costs N/A N/A N/A Kornblith et al., 1993 (333) Treatment of metastatic disease RCT Women with stage IV cancer receiving megestrol acetate in 2 doses; average age 61 y; 88% white; United States 131 QOL FLIC: MOS SF-36 and MHI; Body Image Subscale of Sexual Functioning Inventory; de novo side-effect index LRS Mail survey; telephone interview No Unknown Peters et al., 1994 (334) Treatment of metastatic disease Costs of care Women undergoing high-dose chemotherapy with BMT and PBBCs; United States 110 Costs of episode of care Hospital charges N/A N/A N/A Bertsch and Donaldson, 1995 (221) Treatment of metastatic disease RCT Women with refractory advanced disease receiving either vinorelbine or melphalan; United States 179; Differential losses to follow-up; not analyzed by intention QOL Modified SWOG QOL; MOS SF-36; SDS; LRS In-person interview No Unknown Hayes et al., 1995 (335) Treatment of metastatic RCT Women with metastatic disease randomly assigned to receive tamoxifen vs. toremifene in 2 doses; United States 648 QOL; symptoms LRS; ECOG Analgesics Requirement Scale; pain assessment; ECOG Performance Status Unknown No Unknown Jones et al., 1995 (72) Treatment of metastatic disease RCT Women with refractory advanced disease; median age 53 y (range, 29-83 y); 12% black; United States 183 QOL Modified SWOG QOL Self-administered No Unknown McQuellon et al., 1995 (336) Treatment of metastatic disease Cross-section Women with early-stage disease queried about preferences for treatment of metastatic cancer 15 Preferences Modified TTO In-person interview No Unknown Hultborn et al., 1996 (337) Treatment of metastatic disease RCT (crossover at progression) Women receiving methoxyprogesterone vs. aminoglutethimide plus cortisone; Sweden 200 QOL NHP Unknown No Unknown Hultborn et al., 1996 (338) Treatment of metastatic disease RCT Women with skeletal metastases; pamidronate vs. placebo; Sweden 404 Skeletal pain; performance status VAS; performance status Unknown No Unknown Jonat et al., 1996 (339) Treatment of metastatic disease RCT Postmenopausal women randomly assigned to receive arimidex or megase; Europe 378 QOL RSCL; performance status Self-administered No No Launois et al., 1996 (340) Treatment of metastatic disease CEA using local data Docetaxel vs. palitaxel vs. vinorelbine; France N/A Costs per Qaly Direct costs in NHP; survival; utilities; utilities based on opinion of 20 nurses Not stated N/A N/A van Holten-Verzantvoort et al., 1996 341) Treatment of metastatic disease RCT Women with skeletal metastases; pamidronate vs. placebo; The Netherlands 124 Skeletal pain; symptoms; mobility impairment De novo tool Self-administered No Unknown Bates et al., 1997 (342) Treatment of metastatic disease CEA Women with stage IIIB or IV disease receiving FAC and dexrazoxane (administered after 6 courses of FAC) vs. FAC alone; United States N/A Cost per cardiac event prevented; costs per LYS (note: costs of recurrence or any downstream events not included) Medication costs and costs of cardiac events; survival with the use of data from 2 RCTs and expert opinion N/A N/A N/A Ramirez et al., 1998 (61) Treatment of metastatic disease Longitudinal cohort Women with advanced metastatic disease receiving palliative chemotherapy; median age 58 y (range, 30-80 y); England 155; >90% response rate QOL RSCL; de novo items on overall well-being and perceived benefit of treatment Interviewer administered No Unknown Joensuu et al., 1998 (343) Treatment of metastatic disease RCT Women <70 y old (average age 55 y) with metastases receiving epirubicin followed by mitomycin vs. CEF followed by VM; Finland 285 QOL RSCL Unknown Yes Unknown Brown and Hutton, 1998 (344) Treatment of metastatic disease CEA Docetaxel vs. paclitaxel for patients with advanced metastatic disease; England N/A Costs; QALYs Direct costs estimated by MDs and Medicare; nurse-assessed utility; data from published literature N/A N/A N/A Bull et al., 1991 (222) Treatment of recurrence Longitudinal cohort within RCT Women with recurrent disease; <70 y old; stages I-III; Italy 1320; subset of 176 with recurrence QOL; satisfaction; symptoms 25 items used in Italian for 6 domains; LRS for satisfaction; symptom checklist Mail survey No Unknown Cobleigh et al., 1999 (345) Treatment of metastatic disease RCT Women with HER2-over-expressing disease after one or two chemotherapy treatments; United States, Canada, Belguim, France, Germany, United Kingdom, and Australia 222; subset of 154 assessed for QOL QOL EORTC QLQ-C30 In-person interview No Unknown Cotton et al., 1999 (346) Treatment of metastatic disease RCT Women diagnosed with invasive disease within the last 18 mo or recurrence who were participating in a larger study designed to compare the efficacy of two psychosocial support programs; United States 142 Spiritual well-being; QOL; psychologic adjustment FACIT-B; FACTSP; Mini-Mental Adjustment to Cancer; Principles of Living Survey Self-administered No Unknown Harper-Wynne et al., 1999 (208) Treatment of metastatic disease RCT Women with locally advanced or metastatic disease; concluded adjuvant therapy at least 2 y before; randomly assigned to receive CMF vs. MM; England 116 QOL; satisfaction; symptoms HADS; RSCL; patient satisfaction questions In-person interview No Noted to be low Hoerger et al., 1999 (320) Treatment of metastatic disease Costs of care Women ≥45 y old using health care for cardiovascular disease, osteoporosis, breast cancer, or gynecologic cancers; United States N/A Costs; health care use Data from Health care Cost and Utilization Project-3 (HCUP-3); national health care survey; discharge data—cost/charge ratios; Medicare fee schedule N/A N/A N/A Hultborn et al., 1999 (347) Treatment of metastatic disease RCT Women with skeletal metastases not previously treated with bisphosphates randomly assigned to receive pamidronate vs. placebo; Sweden and Norway 404 Pain; skeletal-related events Visual Analogue Scales; analgesic consumption In-person interview No Unknown Kristensen et al. 1999 (348) Treatment of metastatic disease RCT Women who received first-line systemic antineoplastic disease vs. placebo; bone involvement for <6 mo or untreated; Denmark 100 QOL EORTC QLQ-C30; HADS In-person interview No Unknown Leung et al., 1999 (349) Treatment of metastatic disease CEA Women who are anthracycline resistant who had received paclitaxel, docetaxel, or vinorelbine during the past ≥2 y Unknown Preferences/utility; cost per quality-adjusted progression-free year Chart review N/A N/A N/A Nabholtz et al., 1999 (350), 1997 (351) Treatment of metastatic disease RCT Women ≥ 18 y old with progressive metastatic disease; randomly assigned to receive docetaxel or mitomycin and vinblastine; Canada and Europe 392 QOL (global and physical functions) EORTC-QLQ-C30 Self-administered No Unknown Nuijten et al., 1999 (352) Treatment of metastatic disease CEA Hypothetical cohort of postmenopausal women recruited for the AR/BC2 clinical trial treated with letrozole; United Kingdom N/A Preference/utility; costs Based on clinical trial results showing the advantage of letrozole in terms of time to disease progression and duration of response N/A N/A N/A Osoba and Burchmore, 1999 (353) Treatment of metastatic disease RCT Women with progressive HER2-overexpressing metastatic disease treated with Trasuzumab vs. placebo; Canada 222 for phase II and 469 for phase III QOL EORTC QLQ-C30 Self-administered No Unknown Burgess et al., 2000 (354) Treatment of metastatic disease RCT Women who had detected disease symptoms themselves; interviewed 5 mo after diagnosis; United Kingdom 196 Presence of adverse life events and difficulties; psychiatric morbidity LEDS; SCID; DSM III-R diagnostic criteria In-person interview No Unknown Geels et al., 2000 (355) Treatment of metastatic disease Cohort Women with metastatic disease; randomly assigned to receive intravenous doxorubicin or doxorubicin with vinorelbine; Canada 300; 96% response rate QOL EORTC QLQ-C30 Self-administered No Unknown Hakamies-Blomqvist et al., 2000 (356) Treatment of metastatic disease RCT Women with metastatic disease; randomly assigned to receive docetaxel vs. sequential methotrexate and 5-fluorouracil (Dec. 1994 to Oct. 1997); Scandinavia 283 QOL EORTC QLQ-C30 Self-administered No Unknown Hillner et al., 2000 (357) Treatment of metastatic disease CEA Hypothetical group of women with osteolytic bone metastases receiving pamidronate; United States N/A Preference/utility; costs Database of costs at the Massey Cancer Center; based on Aredia Breast Cancer Study Group trials N/A N/A N/A Kaufmann et al., 2000 (358) Treatment of metastatic disease RCT Postmenopausal women with disease progression/relapse during TAM treatment and at least one lytic bony lesion; randomly assigned to receive exemestane vs. megestrol acetate; 19 countries 769 QOL; tolerability Unknown Self-administered No Unknown Kramer et al., 2000 (359) Treatment of metastatic disease RCT Women with metastatic disease; randomly assigned to receive paclitaxel vs. doxorubicin as first-line chemotherapy; The Netherlands, Denmark, and Belgium 294; subset of 187 (64%) for QOL analysis QOL EORTC QLQ-C30; RSCL Self-administered No Unknown Lipton et al., 2000 (360) Treatment of metastatic disease RCT Women with osteolytic bone metastases receiving pamidronate; United States, Canada, Australia, and New Zealand 754 Skeletal complications Biological markers N/A No Unknown Norris et al., 2000 (361) Treatment of metastatic disease RCT National Cancer Institute of Canada Clinical Trials Group Study MA8; patients 18-75 y old; life expectancy >16 wk; randomly assigned to receive vinorelbine and doxorubicin vs. doxorubicin; Canada 303 QOL EORTC QLQ-C30; de novo tool In-person interview No Unknown View Large Appendix Table 7. Characteristics of studies on the outcomes of breast cancer survivors: January 1, 1990 through December 31, 2000* Author, y (reference No.) Phase of care Study design Setting and population Sample size Outcomes Measures† Mode of assessment Report of reliability Power *ADLs = activities of daily living; BCS = breast conserving surgery; FDA = Food and Drug Administration; MD = medical doctor; N/A = not available; QOL = quality of life; RCT = randomized controlled trial; RT = radiation therapy; SEER = Surveillance, Epidemiology, and End Results. † SeeTable 3 for definitions of abbreviations of measures. Marks et al., 1990 (65) Survivor Longitudinal cohort Women with local- and regional-stage disease; mean age 59 y (range, 40-84 y); 1 y after treatment; population-based registry; 15% black; United States 274; 77% response rate Effect of health on functioning; perceived stress; uncertainty and control; mental health; sexual function; comorbidity symptoms De novo tools; HSCL; Andrews and Withey QOL; Caplan Role and Emotional Function; Bradburn's Positive Affect Scale; Rosenberg's Scale of Self-Esteem; Berkman's Social Network Index; House Social Support Self- and interviewer administered Yes Unknown Levy et al., 1992 (220) Survivor Longitudinal cohort Women undergoing MST or BCS; assessed 3 and 15 mo after surgery; average age 51 y; United States 129; 95% response rate but approximately 50% lost to follow-up QOL POMS; KPS; MPSSQ Unknown No Unknown Hannisdal et al., 1993 (362) Survivor Costs of care Cohort of women treated for stage I or II disease followed-up for 8 y; Norway 430 Costs of follow-up per detected relapse; survival Costs; relapse rates; survival N/A N/A N/A Holli and Hakama, 1993 (363) Survivor Retrospective cohort Women diagnosed between 1977 and 1980; residing in one district and reported to national cancer registry; followed for 5 y; disease stage not stated; Finland 551 QOL Sick leave; KPS; notes on QOL; medical record review N/A No Unknown Bloom and Kessler, 1994 (62) Survivor Longitudinal cohort Women after surgical treatment for early breast cancer, gallbladder disease, or benign breast disease or no surgery; enrolled in Psychological Aspects of Breast Cancer Study; average age 52.5 y (range, 30-69 y); 9.6% black, 3% Asian, and 3% Hispanic; all English speaking; United States 145 Perceived social support; stigma; role functioning Perceived Social Support Scale (unpublished tool); Social Role Function and Daily Activities Scale; Family Interaction Scale from SIP; Social Health Index; MOS PF Self-administered survey; in-person interview; 5-meeting speech sample No Unknown GIVIO, 1994 (364) Survivor RCT Women <70 y old with stage I, II, or III disease, randomly assigned to low- vs. high-intensity follow-up surveillance over 5-6 years; Italy 1320 QOL; satisfaction with care 25 items modified from FLIC, SIP, POMS, and CARES Self-administered Yes Unknown Mor et al., 1994 (365) Survivor Cohort Women enrolled in two RCTs using similar protocols and measures; aged >24 y; state I and II disease; United States 262 QOL MHI; Katz ADL and IADL; de novo financial impact Telephone interview No Unknown Roberts et al., 1994 (211) Survivor Cross-section Women aged 29-82 y 6 mo after surgery; disease stage not stated; United States 100 Patient-MD communication; psychologic distress in 9 domains CDIS; SCL-90-R; MD-rated health; Northhouse social support Telephone interview; bias: PI interviewer Yes Unknown Coleman et al., 1995 (366) Survivor Cross-section Women aged 40-69 y with silicone implants reported to FDA as having problems after mastectomies; 97% white; United States 120 ADL; role relations; coping Open-ended questions Telephone interviews N/A Unknown Couzi et al., 1995 (63) Survivor Cross-section Postmenopausal women diagnosed with in situ or invasive locoregional breast car cer in the years 1988-1992; mean age 55 y (range, 41-65 y); 14% black; United States 190; 77% response rate QOL; symptoms De novo tool Mail survey No Yes German Breast Cancer Study Group, 1995 (367) Survivor Longitudinal cohort Women with stage I disease receiving MST or BCS plus RT; Germany 1036; QOL available for 703 QOL Unknown Self-administered No Unknown Liberati, 1995 (90) Survivor RCT Women treated for stage I, II, or III unilateral primary breast cancer were randomly assigned to intensive surveillance vs. less intensive surveillance; <70 y old; Italy 1320; 639 with 5-y data Overall QOL; perception of health, emotions, body image, social function, symptoms, satisfaction De novo tool in Italian Self-administered Yes Yes Paradiso et al., 1995 (368) Survivor Cross-section Representative sample of specialists, general practitioners, and patients involved in the management of follow-up practice for disease; mean age 58 y (range, 29-83 y); Italy 173; 61% response rate Emotional response to follow-up; satisfaction De novo tools Mail survey No N/A Schover et al., 1995 (215) Survivor Cross-section Women who had partial mastectomy or had immediate breast reconstruction after mastectomy; average age 54 y; mean of 4 y after surgery; United States 218; 44% response rate QOL and satisfaction PAIS-SR; BES; Dyadic Adjustment Inventory; Sexual History Form Mail survey No Unknown Tasmuth et al., 1995 (369) Survivor Cross-section Women who had undergone MRM or BCT; 4-7 y after surgery; ages 29-93 y; Finland 467; 92% response rate Chronic pain McGill; LRS Mail survey No Unknown Dow et al., 1996 (216) Survivor Cross-section Women who are disease free; members of the National Coalition for Cancer Survivorship; mean age 50.9 y (range, 27-77 y); 93% white; United States 294; 43% response rate QOL FACT-G; QOL-CS Mail survey No Unknown Ganz et al., 1996 (85) Survivor Cohort Women who had been interviewed during the 1st year after primary treatment; follow-up at 2-3 y 227; 77% response rate QOL; psychosocial concerns FLIC; CARES; MOS SF-36; GHQ Mail survey; in-person interview No Unknown Grunfeld et al., 1996 (370) Survivor RCT Women with stage I, II or III disease at diagnosis; followed-up for recurrence at hospital vs. primary care sites; mean age 61 y; England 296; 67% response rate QOL MOS SF-36; EORTC-QLQ-C30; HADS Mail survey No Unknown Satariano and DeLorenze, 1996 (64) Survivor Longitudinal cohort Employed women; 3 mo after being diagnosed; ages 40-84 y; reported to a SEER registry; 16% black; United States 296 Return to work De novo tools In-person interview N/A Unknown Grunfeld et al., 1996 (370); Adewuyi-Dalton et al., 1998 (371) Survivor Cross-section Women receiving follow-up care in one arm of RCT (primary care); enrolled in an RCT of primary care follow-up; England 109 Satisfaction Qualitative interview In-person interview N/A Unknown Ashbury et al., 1998 (198) Survivor Case-control Women who received services from Reach for Recovery vs. control subjects in other areas; Canada 192; 69% response rate; QOL data for 175/192 QOL; satisfaction FLIC; FACT; Duke-UNC Functional Social Support Questionnaire; open-ended satisfaction items Interviewer administered for case subjects; mail for control subjects Yes Unknown Gulliford et al., 1997 (372) Survivor RCT Women at two clinics over a 24-mo period; randomly assigned to conventional schedule of clinic visits vs. visits only after mammography; relapse-free for median of 16 mo after treatment; England 196 QOL; satisfaction; use of telephone call-in line; time and costs of follow-up Medical Research Council QOL Mail survey No Unknown Lee, 1997 (199) Survivor Cross-section Women who were up to 14 y after MST; Reach for Recovery volunteers; United States 100; 75% response rate QOL Ferrans and Powers QLI Mail survey Yes Unknown Poulsen et al., 1997 (373) Survivor RCT Women <69 y old receiving MST vs. BCS; Denmark 184; 39.6% response rate QOL; satisfaction LRS; STAI Interviewer administered No Unknown Tate et al., 1997 (374) Survivor Cross-section Women with disabilities and women with breast cancer; United States 216 QOL and life satisfaction FLIC; FACT; FACT SP; SWLS Unknown No Unknown Bloom et al., 1998 (68) Survivor Cross-section Women ≤50 y old (range, 21-51 y); 30% black; 6 mo after diagnosis; United States 336 QOL; MD-patient communication; body image Illness Intrusiveness Scale; Cancer Problem Scale; SDS; Emotional Support Scale; MOS SF-36; Rosenberg's Scale of Self-Esteem Interviewer administered in patient's home Carpenter et al., 1998 (375,376) Survivor Cross-section Women who are disease free, >3 mo after treatment; postmenopausal; 58 y (range, 36-83 y); stage 0-III; 96% white; United States 136; 114 postmenopausal Pain; satisfaction with pain therapy; symptoms (hot flashes) and QOL Wisconsin Brief Pain Inventory; de novo items; MOS SF12, 3 questions on hot flashes; SF12; Phone interview No Unknown Curran et al., 1998 (200) Survivor RCT Women aged 23-70 y with stage I or II cancer receiving MRM vs. BCS 2 y after surgery; Europe 278 QOL; satisfaction with cosmetic result; fear of recurrence Avery QOL Unknown Yes Unknown Dorval et al., 1998 (202) Survivor Longitudinal cohort Women treated for local and regional disease; 8 y after treatment; Canada 124; 96% response rate QOL; psychologic distress PSI; arm problems; hospital stays; LWMAT; LES Telephone interview Yes Unknown Dorval et al., 1998 (201) Survivor Case-Control Women treated for local and regional disease; 8 y after diagnosis (disease-free or with recurrences); randomly selected community control subjects; Canada 386; 96% response rate in case subjects and 61% response rate in control subjects QOL Number of health problems requiring hospitalization; arm problems; de novo functional status; PSI; MOS Social Support Scale; LWMAT; LES Telephone interview Yes Unknown Ferrell et al., 1998 (218) Survivor Cross-section Women who are disease free; stratified by 3 age groups: <40 y old, 40-60 y old, and >60 y old; United States 298; 40% response rate QOL; pain QOL-BC; BPI Mail survey No Unknown Frazer et al., 1998 (203) Survivor Cross-section Women seen at cancer center; average age 61 y; United States 120; 57% response rate QOL HSQ Mail survey Yes Unknwon Ganz et al., 1998 (67,204) Survivor Cross-section Women who are disease-free; mean age 56 y (range, 31-88 y) with stage 0, I, or II disease surveyed 1-5 y after diagnosis in 2 regions; 11%-17% black per region; 1%-6% Hispanic; United States 864 QOL; sexual function MOS SF-36; CES-D; BCPT Symptom Checklist; WSFQ; CARES Mail survey Yes Unknown Jahkola, 1998 (377) Survivor Cross-section Women treated with MST or BCS; 3-8 y after surgery; mean age 60 y (range, 33-84 y); Finland 146 QOL; satisfaction De novo tool Mail survey N/A N/A Lindley et al., 1998 (66) Survivor Cross-section Women with early-stage cancer who were disease free 2-5 y after adjuvant treatment; average age 54 y (range, 29-86 y); 87.1% white; United States 120; 86 completed all data QOL; preferences FLIC; SDS; MOS SF-36; de novo sexuality; modified TTO preferences Telephone interview No Unknown Tomiak et al., 1998 (217) Survivor Costs of care Costs of following-up women with stage I or II disease; Canada 130 MDs; 44% response rate Follow-up costs per patient Unit costs in the NHP Mail survey N/A N/A van Harten et al., 1998 (205) Survivor Cross-section Women who were patients of 4 oncologists; The Netherlands 103; 60% response rate QOL CARES-SF; RSCL; QLQ; EORTC; comorbidity Mail survey Yes Unknown Velanovich and Szymanski, 1999 (378) Survivor Cross-section Patients of one MD at a cancer center; >6 mo to 4 y after surgery; United States 101 Lymphedema; QOL MOS SF-36 Self-administered in MD's office No Unknown Andersen and Urban, 1999 (379) Survivor Cross-section Women who are disease free; 50-85 y old; in rural and suburban communities 292 QOL MOS SF-36; Lerman Cancer Worry Scale; de novo tool Telephone interview No Unknown Ashing-Giwa et al., 1999 (70) Survivor Cross-section Women 6-8 y after surgery; age range; 32-90 y; 42% black; United States 278; 54% overall response rate; 44% in blacks; 65% in whites QOL MOS SF-36; CARES-SF; Ladder; Urban Life Stress Scale; ADQ Mail survey No Unknown Carpenter and Andrykowski, 1999 (380) Survivor Cross-section Women who are disease-free; ≥18 y old 3 mo after treatment of 1st diagnosis; United States 114; 79% response rate QOL; menopausal symptoms Massachusetts Women's Health Study Questionnaire; Blatt Menopausal Index; SF-12 Health Survey Telephone interview Yes Unknown Fogarty et al., 1999 (213) Survivor RCT Women diagnosed at least 6 mo before and presently disease-free or without cancer but an average of 3 friends/relatives with history of breast cancer 210 Patient anxiety; physician compassion STAI; de novo tools Mail survey Yes Unknown Ganz et al., 1999 (81) Survivor Cross-section Women who were in a partnered relationship and sexually active within the past 6 mo in Los Angeles, CA, and Washington, DC, with a diagnosis of stage, 0, I, or II disease and who completed local and adjuvant therapy; United States 1134 Sexual health CARES Body Image Subscale; Sexual Functioning Summary Scale, Sexual Interest and Dysfunction Subscale; BCPT Symptom Checklist; Revised DAS; RAND Health Survey; WSFQ Mail survey No Unknown Grunfeld et al., 1999 (214) Survivor RCT Women who received follow-up care in primary care vs. specialist care; United Kingdom 296 Patient satisfaction De novo tools Self-administered Yes Unknown Spenser et al., 1999 (69) Survivor Cross-section Women 1 y after treatment; stage 0, I, or II disease; approximately 10% black and 20% Hispanic; United States 223; 80% response rate QOL De novo tool on patient concerns; POMS; CES-D; Andrews and Withey adjustment; PAIS-SR; de novo body image; SIP (English and Spanish translations) Mail survey Yes Unknown Bower et al., 2000 (381) Survivor RCT Women treated for early resectable disease; not receiving any treatment besides tamoxifen; in 2 large metropolitan areas; United States 1957 QOL; level of fatigue MOS SF-36; CES-D; BCPT Symptom Checklist; MOS Sleep Scale Mail survey No Unknown Demark-Wahnefried et al., 2000 (382) Survivor Cross-section Women who were identified by the Duke Cancer Database as being diagnosed with early-stage disease but who are now disease free 1666; 58% response rate Current health behaviors; readiness to pursue life-style changes Eating Patterns Questionnaire; de novo tools Mail survey No Unknown Wilson et al., 2000 (48) Survivor Cohort Women who are disease free; in rural communities; during a 5-mo period in 1996; United States 128 Survivors' representations; positive coping strategies; negative coping strategies Focus group In-person interview No Unknown Author, y (reference No.) Phase of care Study design Setting and population Sample size Outcomes Measures† Mode of assessment Report of reliability Power *ADLs = activities of daily living; BCS = breast conserving surgery; FDA = Food and Drug Administration; MD = medical doctor; N/A = not available; QOL = quality of life; RCT = randomized controlled trial; RT = radiation therapy; SEER = Surveillance, Epidemiology, and End Results. † SeeTable 3 for definitions of abbreviations of measures. Marks et al., 1990 (65) Survivor Longitudinal cohort Women with local- and regional-stage disease; mean age 59 y (range, 40-84 y); 1 y after treatment; population-based registry; 15% black; United States 274; 77% response rate Effect of health on functioning; perceived stress; uncertainty and control; mental health; sexual function; comorbidity symptoms De novo tools; HSCL; Andrews and Withey QOL; Caplan Role and Emotional Function; Bradburn's Positive Affect Scale; Rosenberg's Scale of Self-Esteem; Berkman's Social Network Index; House Social Support Self- and interviewer administered Yes Unknown Levy et al., 1992 (220) Survivor Longitudinal cohort Women undergoing MST or BCS; assessed 3 and 15 mo after surgery; average age 51 y; United States 129; 95% response rate but approximately 50% lost to follow-up QOL POMS; KPS; MPSSQ Unknown No Unknown Hannisdal et al., 1993 (362) Survivor Costs of care Cohort of women treated for stage I or II disease followed-up for 8 y; Norway 430 Costs of follow-up per detected relapse; survival Costs; relapse rates; survival N/A N/A N/A Holli and Hakama, 1993 (363) Survivor Retrospective cohort Women diagnosed between 1977 and 1980; residing in one district and reported to national cancer registry; followed for 5 y; disease stage not stated; Finland 551 QOL Sick leave; KPS; notes on QOL; medical record review N/A No Unknown Bloom and Kessler, 1994 (62) Survivor Longitudinal cohort Women after surgical treatment for early breast cancer, gallbladder disease, or benign breast disease or no surgery; enrolled in Psychological Aspects of Breast Cancer Study; average age 52.5 y (range, 30-69 y); 9.6% black, 3% Asian, and 3% Hispanic; all English speaking; United States 145 Perceived social support; stigma; role functioning Perceived Social Support Scale (unpublished tool); Social Role Function and Daily Activities Scale; Family Interaction Scale from SIP; Social Health Index; MOS PF Self-administered survey; in-person interview; 5-meeting speech sample No Unknown GIVIO, 1994 (364) Survivor RCT Women <70 y old with stage I, II, or III disease, randomly assigned to low- vs. high-intensity follow-up surveillance over 5-6 years; Italy 1320 QOL; satisfaction with care 25 items modified from FLIC, SIP, POMS, and CARES Self-administered Yes Unknown Mor et al., 1994 (365) Survivor Cohort Women enrolled in two RCTs using similar protocols and measures; aged >24 y; state I and II disease; United States 262 QOL MHI; Katz ADL and IADL; de novo financial impact Telephone interview No Unknown Roberts et al., 1994 (211) Survivor Cross-section Women aged 29-82 y 6 mo after surgery; disease stage not stated; United States 100 Patient-MD communication; psychologic distress in 9 domains CDIS; SCL-90-R; MD-rated health; Northhouse social support Telephone interview; bias: PI interviewer Yes Unknown Coleman et al., 1995 (366) Survivor Cross-section Women aged 40-69 y with silicone implants reported to FDA as having problems after mastectomies; 97% white; United States 120 ADL; role relations; coping Open-ended questions Telephone interviews N/A Unknown Couzi et al., 1995 (63) Survivor Cross-section Postmenopausal women diagnosed with in situ or invasive locoregional breast car cer in the years 1988-1992; mean age 55 y (range, 41-65 y); 14% black; United States 190; 77% response rate QOL; symptoms De novo tool Mail survey No Yes German Breast Cancer Study Group, 1995 (367) Survivor Longitudinal cohort Women with stage I disease receiving MST or BCS plus RT; Germany 1036; QOL available for 703 QOL Unknown Self-administered No Unknown Liberati, 1995 (90) Survivor RCT Women treated for stage I, II, or III unilateral primary breast cancer were randomly assigned to intensive surveillance vs. less intensive surveillance; <70 y old; Italy 1320; 639 with 5-y data Overall QOL; perception of health, emotions, body image, social function, symptoms, satisfaction De novo tool in Italian Self-administered Yes Yes Paradiso et al., 1995 (368) Survivor Cross-section Representative sample of specialists, general practitioners, and patients involved in the management of follow-up practice for disease; mean age 58 y (range, 29-83 y); Italy 173; 61% response rate Emotional response to follow-up; satisfaction De novo tools Mail survey No N/A Schover et al., 1995 (215) Survivor Cross-section Women who had partial mastectomy or had immediate breast reconstruction after mastectomy; average age 54 y; mean of 4 y after surgery; United States 218; 44% response rate QOL and satisfaction PAIS-SR; BES; Dyadic Adjustment Inventory; Sexual History Form Mail survey No Unknown Tasmuth et al., 1995 (369) Survivor Cross-section Women who had undergone MRM or BCT; 4-7 y after surgery; ages 29-93 y; Finland 467; 92% response rate Chronic pain McGill; LRS Mail survey No Unknown Dow et al., 1996 (216) Survivor Cross-section Women who are disease free; members of the National Coalition for Cancer Survivorship; mean age 50.9 y (range, 27-77 y); 93% white; United States 294; 43% response rate QOL FACT-G; QOL-CS Mail survey No Unknown Ganz et al., 1996 (85) Survivor Cohort Women who had been interviewed during the 1st year after primary treatment; follow-up at 2-3 y 227; 77% response rate QOL; psychosocial concerns FLIC; CARES; MOS SF-36; GHQ Mail survey; in-person interview No Unknown Grunfeld et al., 1996 (370) Survivor RCT Women with stage I, II or III disease at diagnosis; followed-up for recurrence at hospital vs. primary care sites; mean age 61 y; England 296; 67% response rate QOL MOS SF-36; EORTC-QLQ-C30; HADS Mail survey No Unknown Satariano and DeLorenze, 1996 (64) Survivor Longitudinal cohort Employed women; 3 mo after being diagnosed; ages 40-84 y; reported to a SEER registry; 16% black; United States 296 Return to work De novo tools In-person interview N/A Unknown Grunfeld et al., 1996 (370); Adewuyi-Dalton et al., 1998 (371) Survivor Cross-section Women receiving follow-up care in one arm of RCT (primary care); enrolled in an RCT of primary care follow-up; England 109 Satisfaction Qualitative interview In-person interview N/A Unknown Ashbury et al., 1998 (198) Survivor Case-control Women who received services from Reach for Recovery vs. control subjects in other areas; Canada 192; 69% response rate; QOL data for 175/192 QOL; satisfaction FLIC; FACT; Duke-UNC Functional Social Support Questionnaire; open-ended satisfaction items Interviewer administered for case subjects; mail for control subjects Yes Unknown Gulliford et al., 1997 (372) Survivor RCT Women at two clinics over a 24-mo period; randomly assigned to conventional schedule of clinic visits vs. visits only after mammography; relapse-free for median of 16 mo after treatment; England 196 QOL; satisfaction; use of telephone call-in line; time and costs of follow-up Medical Research Council QOL Mail survey No Unknown Lee, 1997 (199) Survivor Cross-section Women who were up to 14 y after MST; Reach for Recovery volunteers; United States 100; 75% response rate QOL Ferrans and Powers QLI Mail survey Yes Unknown Poulsen et al., 1997 (373) Survivor RCT Women <69 y old receiving MST vs. BCS; Denmark 184; 39.6% response rate QOL; satisfaction LRS; STAI Interviewer administered No Unknown Tate et al., 1997 (374) Survivor Cross-section Women with disabilities and women with breast cancer; United States 216 QOL and life satisfaction FLIC; FACT; FACT SP; SWLS Unknown No Unknown Bloom et al., 1998 (68) Survivor Cross-section Women ≤50 y old (range, 21-51 y); 30% black; 6 mo after diagnosis; United States 336 QOL; MD-patient communication; body image Illness Intrusiveness Scale; Cancer Problem Scale; SDS; Emotional Support Scale; MOS SF-36; Rosenberg's Scale of Self-Esteem Interviewer administered in patient's home Carpenter et al., 1998 (375,376) Survivor Cross-section Women who are disease free, >3 mo after treatment; postmenopausal; 58 y (range, 36-83 y); stage 0-III; 96% white; United States 136; 114 postmenopausal Pain; satisfaction with pain therapy; symptoms (hot flashes) and QOL Wisconsin Brief Pain Inventory; de novo items; MOS SF12, 3 questions on hot flashes; SF12; Phone interview No Unknown Curran et al., 1998 (200) Survivor RCT Women aged 23-70 y with stage I or II cancer receiving MRM vs. BCS 2 y after surgery; Europe 278 QOL; satisfaction with cosmetic result; fear of recurrence Avery QOL Unknown Yes Unknown Dorval et al., 1998 (202) Survivor Longitudinal cohort Women treated for local and regional disease; 8 y after treatment; Canada 124; 96% response rate QOL; psychologic distress PSI; arm problems; hospital stays; LWMAT; LES Telephone interview Yes Unknown Dorval et al., 1998 (201) Survivor Case-Control Women treated for local and regional disease; 8 y after diagnosis (disease-free or with recurrences); randomly selected community control subjects; Canada 386; 96% response rate in case subjects and 61% response rate in control subjects QOL Number of health problems requiring hospitalization; arm problems; de novo functional status; PSI; MOS Social Support Scale; LWMAT; LES Telephone interview Yes Unknown Ferrell et al., 1998 (218) Survivor Cross-section Women who are disease free; stratified by 3 age groups: <40 y old, 40-60 y old, and >60 y old; United States 298; 40% response rate QOL; pain QOL-BC; BPI Mail survey No Unknown Frazer et al., 1998 (203) Survivor Cross-section Women seen at cancer center; average age 61 y; United States 120; 57% response rate QOL HSQ Mail survey Yes Unknwon Ganz et al., 1998 (67,204) Survivor Cross-section Women who are disease-free; mean age 56 y (range, 31-88 y) with stage 0, I, or II disease surveyed 1-5 y after diagnosis in 2 regions; 11%-17% black per region; 1%-6% Hispanic; United States 864 QOL; sexual function MOS SF-36; CES-D; BCPT Symptom Checklist; WSFQ; CARES Mail survey Yes Unknown Jahkola, 1998 (377) Survivor Cross-section Women treated with MST or BCS; 3-8 y after surgery; mean age 60 y (range, 33-84 y); Finland 146 QOL; satisfaction De novo tool Mail survey N/A N/A Lindley et al., 1998 (66) Survivor Cross-section Women with early-stage cancer who were disease free 2-5 y after adjuvant treatment; average age 54 y (range, 29-86 y); 87.1% white; United States 120; 86 completed all data QOL; preferences FLIC; SDS; MOS SF-36; de novo sexuality; modified TTO preferences Telephone interview No Unknown Tomiak et al., 1998 (217) Survivor Costs of care Costs of following-up women with stage I or II disease; Canada 130 MDs; 44% response rate Follow-up costs per patient Unit costs in the NHP Mail survey N/A N/A van Harten et al., 1998 (205) Survivor Cross-section Women who were patients of 4 oncologists; The Netherlands 103; 60% response rate QOL CARES-SF; RSCL; QLQ; EORTC; comorbidity Mail survey Yes Unknown Velanovich and Szymanski, 1999 (378) Survivor Cross-section Patients of one MD at a cancer center; >6 mo to 4 y after surgery; United States 101 Lymphedema; QOL MOS SF-36 Self-administered in MD's office No Unknown Andersen and Urban, 1999 (379) Survivor Cross-section Women who are disease free; 50-85 y old; in rural and suburban communities 292 QOL MOS SF-36; Lerman Cancer Worry Scale; de novo tool Telephone interview No Unknown Ashing-Giwa et al., 1999 (70) Survivor Cross-section Women 6-8 y after surgery; age range; 32-90 y; 42% black; United States 278; 54% overall response rate; 44% in blacks; 65% in whites QOL MOS SF-36; CARES-SF; Ladder; Urban Life Stress Scale; ADQ Mail survey No Unknown Carpenter and Andrykowski, 1999 (380) Survivor Cross-section Women who are disease-free; ≥18 y old 3 mo after treatment of 1st diagnosis; United States 114; 79% response rate QOL; menopausal symptoms Massachusetts Women's Health Study Questionnaire; Blatt Menopausal Index; SF-12 Health Survey Telephone interview Yes Unknown Fogarty et al., 1999 (213) Survivor RCT Women diagnosed at least 6 mo before and presently disease-free or without cancer but an average of 3 friends/relatives with history of breast cancer 210 Patient anxiety; physician compassion STAI; de novo tools Mail survey Yes Unknown Ganz et al., 1999 (81) Survivor Cross-section Women who were in a partnered relationship and sexually active within the past 6 mo in Los Angeles, CA, and Washington, DC, with a diagnosis of stage, 0, I, or II disease and who completed local and adjuvant therapy; United States 1134 Sexual health CARES Body Image Subscale; Sexual Functioning Summary Scale, Sexual Interest and Dysfunction Subscale; BCPT Symptom Checklist; Revised DAS; RAND Health Survey; WSFQ Mail survey No Unknown Grunfeld et al., 1999 (214) Survivor RCT Women who received follow-up care in primary care vs. specialist care; United Kingdom 296 Patient satisfaction De novo tools Self-administered Yes Unknown Spenser et al., 1999 (69) Survivor Cross-section Women 1 y after treatment; stage 0, I, or II disease; approximately 10% black and 20% Hispanic; United States 223; 80% response rate QOL De novo tool on patient concerns; POMS; CES-D; Andrews and Withey adjustment; PAIS-SR; de novo body image; SIP (English and Spanish translations) Mail survey Yes Unknown Bower et al., 2000 (381) Survivor RCT Women treated for early resectable disease; not receiving any treatment besides tamoxifen; in 2 large metropolitan areas; United States 1957 QOL; level of fatigue MOS SF-36; CES-D; BCPT Symptom Checklist; MOS Sleep Scale Mail survey No Unknown Demark-Wahnefried et al., 2000 (382) Survivor Cross-section Women who were identified by the Duke Cancer Database as being diagnosed with early-stage disease but who are now disease free 1666; 58% response rate Current health behaviors; readiness to pursue life-style changes Eating Patterns Questionnaire; de novo tools Mail survey No Unknown Wilson et al., 2000 (48) Survivor Cohort Women who are disease free; in rural communities; during a 5-mo period in 1996; United States 128 Survivors' representations; positive coping strategies; negative coping strategies Focus group In-person interview No Unknown View Large Although most of the noneconomic studies did use previously validated and reliable measures, only one quarter (n = 37 of 139; 26.6%) reported the reliability and validity of the measure in their patient population; none reported data on reliability in population subgroups (e.g., by age or race). Among the 91 economic studies, only one (196) met current standards for a good quality analysis (e.g., societal perspective, quality-adjusted using population values, discounted, including nonmedical and medical costs, and all relevant downstream costs and effects), although nonstandard approaches may be appropriate in certain circumstances or for specified purposes [e.g., evaluation within a health maintenance organization (197)]. In terms of power, only 21 studies (63,69,90,96,198-214) presented information on their power to detect clinically meaningful differences in noneconomic outcomes. Comorbidity is an important covariate that has the potential to confound outcomes results. However, comorbidity was only specifically measured in four studies—one CEA (76), two cross-sectional studies of breast cancer survivors (65,205), and one cross-sectional study of newly diagnosed breast cancer patients (92). However, results were not clearly controlled for this potential confounder in the cross-sectional studies. Similarly, a woman's baseline level of QOL is one of the strongest predictors of her long-term QOL. In an RCT, women with low and high levels of baseline QOL should be distributed randomly across study arms. In longitudinal follow-up studies, baseline QOL can be controlled for in analyses of outcomes. However, in the 46% of the noneconomic outcomes studies that employed a cross-sectional design, effects of variations in initial status were not accounted for in describing results. Additional sources of bias in interpreting existing outcomes research include low response rates. Low response rates (≤50%) are threats to internal validity (70,73,91,215-218); potential differential nonresponse, such as seen in many RCTs with QOL components [e.g., (219)], or differential losses to follow-up by treatment arm or health status [e.g., (220-222)] or response rates by group [e.g., (70,201,223)] are threats to internal validity of the results. In the metastatic disease phase, there is the further challenge of poor response rates or losses to follow-up because of severe illness or death; use of proxy respondents was not addressed in any of these studies. Finally, none of the studies evaluated whether floor or ceiling effects limited their ability to detect differences in outcome or evaluated the amount of missing data and their impact on results. Discussion At present, outcomes measurement is variable in its approach and application to the spectrum of breast cancer care. This enormous variability is evidenced by our finding that no one instrument was used in more than 10% of the studies. Although the past decade has witnessed a dramatic increase in the volume of research on breast health outcomes, large gaps exist in certain phases of care, types of outcomes, populations, and standards of measurement. For instance, only one study evaluated the quality of the dying experience for breast cancer patients, only 15.9% considered patient satisfaction, and only 4.1% included patient preferences. Only one half of the studies were controlled, and studies of survivors were the least likely to include a controlled design that accounted for baseline differences in health and functioning and other important covariates. At present, the overwhelming majority of research focuses on white, nonelderly populations. In terms of the quality of the research, this overview highlights certain cross-cutting deficiencies—no studies commented on the potential for floor or ceiling effects to influence results, only one CEA would be considered to be adequate by current standards, and, among the noneconomic studies, only four measured comorbidity, 37 tested reliability in their own patient population, and 21 noted whether they had sufficient power to detect clinically meaningful differences in outcome. These types of limitations have been noted in other reviews as well (379). Thus, we recommend that a common set of standards be established for the design and conduct of outcomes studies (Table 5), including development of standard, practical tools to measure the burden of illness (including the number of illnesses, severity, and impact on function). Table 5. Recommendations for improving breast cancer outcomes measurement Area Recommendation *MOS SF-36 = Medical Outcomes Study—Short Form 36. Instruments Develop a set of reliable, valid “core” instruments that can be used across phases of care; supplement with measures appropriate to each phase of breast cancer care. Selection of candidate instruments should be guided by consideration of patient burden and acceptability, feasibility in nonresearch settings, absence of floor or ceiling effects, applicability to multicultural groups, and sensitivity to change over time. The MOS SF-36* may not be an appropriate instrument for these purposes because of floor and ceiling effects and lack of sensitivity to changes across phases of care. Methods Set standards for the design and conduct of outcomes studies, including controlling for baseline characteristics or using a randomized design, a priori calculation of power for clinically meaningful outcomes, assessment of reliability, and use of proxies; apply current (minimum) standards for cost-effectiveness analyses to all economic outcome studies; and develop statistical methods to address losses to follow-up or nonresponse among severely ill patients. Comorbidity Develop standard, practical tools to measure burden of comorbidity (including number of illnesses, severity, and impact on function). Include comorbidity as a covariate in outcomes research; consider interactions of cancer and comorbidity in assessing outcomes. Preferences There needs to be additional research on practical methods to measure patient preferences; measures need to be transportable into economic analyses that calculate cost per quality-adjusted life-year gained. Populations Increase research in minority, multicultural, and elderly populations. Begin to include family and caregiver outcomes. Setting There needs to be support and partnerships to facilitate translation of outcomes research from research centers to community practices in diverse settings to understand the true effects of interventions and therapies on population-based health outcomes. Phases of care There should be attention to all phases of care, particularly the dying experience, primary prevention, diagnosis, adjuvant therapy, and treatment of metastatic disease. Any new survivor studies should be carefully controlled. Outcomes There should be an emphasis on increasing the number of studies focusing on satisfaction and patient preferences. Outcomes measuring the quality of the dying experience need to be developed, validated, and applied to breast cancer populations. Finding Increase funding for outcomes research especially in vulnerable populations; support the development of an infrastructure for routine outcomes data collection. Area Recommendation *MOS SF-36 = Medical Outcomes Study—Short Form 36. Instruments Develop a set of reliable, valid “core” instruments that can be used across phases of care; supplement with measures appropriate to each phase of breast cancer care. Selection of candidate instruments should be guided by consideration of patient burden and acceptability, feasibility in nonresearch settings, absence of floor or ceiling effects, applicability to multicultural groups, and sensitivity to change over time. The MOS SF-36* may not be an appropriate instrument for these purposes because of floor and ceiling effects and lack of sensitivity to changes across phases of care. Methods Set standards for the design and conduct of outcomes studies, including controlling for baseline characteristics or using a randomized design, a priori calculation of power for clinically meaningful outcomes, assessment of reliability, and use of proxies; apply current (minimum) standards for cost-effectiveness analyses to all economic outcome studies; and develop statistical methods to address losses to follow-up or nonresponse among severely ill patients. Comorbidity Develop standard, practical tools to measure burden of comorbidity (including number of illnesses, severity, and impact on function). Include comorbidity as a covariate in outcomes research; consider interactions of cancer and comorbidity in assessing outcomes. Preferences There needs to be additional research on practical methods to measure patient preferences; measures need to be transportable into economic analyses that calculate cost per quality-adjusted life-year gained. Populations Increase research in minority, multicultural, and elderly populations. Begin to include family and caregiver outcomes. Setting There needs to be support and partnerships to facilitate translation of outcomes research from research centers to community practices in diverse settings to understand the true effects of interventions and therapies on population-based health outcomes. Phases of care There should be attention to all phases of care, particularly the dying experience, primary prevention, diagnosis, adjuvant therapy, and treatment of metastatic disease. Any new survivor studies should be carefully controlled. Outcomes There should be an emphasis on increasing the number of studies focusing on satisfaction and patient preferences. Outcomes measuring the quality of the dying experience need to be developed, validated, and applied to breast cancer populations. Finding Increase funding for outcomes research especially in vulnerable populations; support the development of an infrastructure for routine outcomes data collection. View Large Given the complexity of breast cancer care and the heterogeneity in patient populations, no one instrument is sufficiently comprehensive, is sensitive to clinically meaningful changes in outcomes across all phases of care, and has acceptable respondent and provider burden. However, it should be possible to develop a “core” set of measures for measuring breast cancer outcomes that can be supplemented by sensitive phase-specific tools. Other issues, such as standardizing the optimal timing of measurement within and across phases, were beyond the scope of this review and are important to address in future research. Finally, it will be important to examine whether conclusions about outcomes are affected by choice of instrument. Our review also highlights the paucity of patient preference data. We suggest that additional research be conducted to develop practical methods to measure patient preferences and that these measures be transportable into economic analyses that calculate cost per quality-adjusted life-year gained. More work is also necessary to understand the quality of the dying experience from both the patient's and the caregiver's perspectives. In summary, more research is needed to develop standard approaches that are 1) practical in a variety of health care settings, 2) reliable and valid, 3) applicable to broad age and race groups and culturally diverse populations, 4) useful to track changes in outcomes as individuals move through the phases of cancer care, and 5) informative for designing interventions to improve the quality of breast cancer services across the entire spectrum of care. Partnerships to facilitate translation of outcomes research from research centers to diverse community practices will be essential for reaching these goals. Supported in part by Public Health Service (PHS) grants HS08395 from the Agency for Health Care Policy and Research, Office of the Assistant Secretary for Health, Department of Health and Human Services (DHHS) (J. Mandelblatt); by grant DAMD17-94-J-4212 from the Department of the Army, Breast Cancer Center Grant (J. Mandelblatt, W. Liang, and W. Lawrence); and by PHS grants R01CA72908 (J. Mandelblatt and K. R. Yabroff) and T332CA09314-19 (K. R. Yabroff) from the National Cancer Institute (NCI), National Institutes of Health, DHHS. Prepared for the NCI under contract 263-MQ-112555. We acknowledge the critical reviews of earlier versions of the manuscript by Drs. Joseph Lipscomb and Molla Donaldson, NCI, National Institutes of Health, DHHS, Bethesda, MD, and the manuscript preparation by Trina McClendon, Michelle Rogers, and Nicole S. Lee, Georgetown University, Washington, D.C. References 1 Selby PJ, Chapman JA, Etazadi-Amoli J, Dalley D, Boyd NF. The development of a method for assessing the quality of life of cancer patients. Br J Cancer 1984; 50: 13 -22. Google Scholar 2 Mazur DJ, Hickam DH. Patient preferences: survival vs quality-of-life considerations. J Gen Intern Med 1993 ; 8: 374 -7. Google Scholar 3 Ganz PA. Quality of life measures in cancer chemotherapy: methodology and implications. Pharmacoeconomics 1994 ; 5: 376 -88. Google Scholar 4 Strain JJ. The evolution of quality of life evaluations in cancer therapy. Oncology (Huntingt) 1990 ; 4: 22 -6. Google Scholar 5 Karnofsky DA, Abelmann WH, Craver LF, Burchenal JH. The use of the nitrogen mustards in the palliative treatment of carcinoma. Cancer 1948: 634 -56. Google Scholar 6 Spitzer WO, Dobson AJ, Hall J, Chesterman E, Levi J, Shepherd R, et al. Measuring the quality of life of cancer patients: a concise QL index for use by physicians. J Chronic Dis 1981 ; 34: 585 -97. Google Scholar 7 Heithoff KA. Effectiveness and outcomes in health care . Washington (DC): National Academy Press; 1990 . Google Scholar 8 Ware JE Jr, Johnston SA, Davies-Avery A, Brook RH. Conceptualization and measurement of health for adults in the health insurance study . 1979. Google Scholar 9 Cancer and Leukemia Group B. Assessment of quality of life and cancer treatment. In: Holland JC, editor. Brookline (MA): Elsevier Science Publishers BV (Biomedical Division); 1986 . Google Scholar 10 Gill TM, Feinstein AR. A critical appraisal of the quality-of-life measurements. JAMA 1994 ; 272: 619 -26. Google Scholar 11 Ensuring quality cancer care . Washington (DC): National Academy Press; 1999. Google Scholar 12 Andrews FM. Social indicators of well being: Americans' perception of life quality . New York (NY): Plenum Press; 1976 . Google Scholar 13 Campbell A. Quality of American life: perceptions, evaluations and satisfaction . New York (NY): Russell Sage Foundation; 1976 . Google Scholar 14 Campbell A. The sense of well-being in America: recent patterns and trends . New York (NY): McGraw-Hill; 1981 . Google Scholar 15 Breslow L. A quantitative approach to the World Health Organization definition of health: physical, mental and social well-being. Int J Epidemiol 1972; 1: 347 -55. Google Scholar 16 de Haes JC. Quality of life: conceptual and theoretical considerations. Psychosocial Oncol 1988 ; 11: 61 -70. Google Scholar 17 Cella DF. Cherin EA. Quality of life during and after cancer treatment. Compr Ther 1988 ; 14: 69 -75. Google Scholar 18 Hollandsworth JG Jr. Evaluating the impact of medical treatment on the quality of life: a 5-year update. Soc Sci Med 1988 ; 26: 425 -34. Google Scholar 19 Aaronson NK. Quality of life: what is it? How should it be measured? Oncology (Huntingt) 1988 ; 2: 69 -74. Google Scholar 20 Aaronson NK. Quality of life assessment in clinical trials: methodological issues. Control Clin Trials 1989 ; 10(4 Suppl): 195S -208S. Google Scholar 21 de Haes JC, van Knippenberg FC. The quality of life of cancer patients: a review of the literature. Soc Sci Med 1985 ; 20: 809 -17. Google Scholar 22 Nayfield SG, Hailey BJ, McCabe M. Quality of life assessment in cancer clinical trials . Bethesda (MD): National Institutes of Health; 1991. Google Scholar 23 Guyatt GH, Feeny DH, Patrick DL. Measuring health-related quality of life. Ann Intern Med 1993 ; 118: 622 -9. Google Scholar 24 Patrick DL, Erickson P. What constitutes quality of life? Concepts and dimensions. Clin Nutr 1988 ; 7: 53 -63. Google Scholar 25 Patrick DL, Erickson P. Health status and health policy. Quality of life in health care evaluation and resource . 1993 . Google Scholar 26 Patrick DL, Deyo RA. Generic and disease-specific measures in assessing health status and quality of life. Med Care 1989 ; 27(3 Suppl): S217 -S232. Google Scholar 27 Cella DF, Tulsky DS. Measuring quality of life today: methodological aspects. Oncology 2001 ; 4: 29 -38. Google Scholar 28 Feeny D. Proceedings of the International Conference on the Measurement of Quality of Life as an Outcome in Clinical Trials. Control Clin Trials: Design, Methods, Analysis 1991 ; 12(Suppl): 1S -280S. Google Scholar 29 Chalmers TC, Smith H Jr, Blackburn B, Silverman B, Schroeder B, Reitman D, et al. A method for assessing the quality of a randomized control trial. Control Clin Trials 1981 ; 2: 31 -49. Google Scholar 30 Lerman C, Seay J, Balshem A, Audrain J. Interest in genetic testing among first-degree relatives of breast cancer patients. Am J Med Genet 1995; 57: 385 -92. Google Scholar 31 Ganz PA, Day R, Ware JE Jr, Redmond C, Fisher B. Base-line quality-of-life assessment in the National Surgical Adjuvant Breast and Bowel Project Breast Cancer Prevention Trial. J Natl Cancer Inst 1995 ; 87: 1372 -82. Google Scholar 32 Stefanek ME, Helzlsouer KJ, Wilcox PM, Houn F. Predictors of and satisfaction with bilateral prophylactic mastectomy. Prev Med 1995 ; 24: 412 -9. Google Scholar 33 Nease RF Jr, Ross JM. The decision to enter a randomized trial of tamoxifen for the prevention of breast cancer in healthy women: an analysis of the tradeoffs. Am J Med 1995 ; 99: 180 -9. Google Scholar 34 Schrag D, Kuntz KM, Garber JE, Weeks JC. Decision analysis—effects of prophylactic mastectomy and oophorectomy on life expectancy among women with BRCA1 or BRCA2 mutations. N Engl J Med 1997; 336: 1465 -71. Google Scholar 35 Borgen PI, Hill AD, Tran KN, Van Zee KJ, Massie MJ, Payne D, et al. Patient regrets after bilateral prophylactic mastectomy. Ann Surg Oncol 1998; 5: 603 -6. Google Scholar 36 Grann VR, Whang W, Jacobson JS, Heitjan DF, Antman KH, Neugut AI. Benefits and costs of screening Ashkenazi Jewish women for BRCA1 and BRCA2. J Clin Oncol 1999; 17: 494 -500. Google Scholar 37 Grann VR, Panageas KS, Whang W, Antman KH, Neugut AI. Decision analysis of prophylactic mastectomy and oophorectomy in BRCA1-positive or BRCA2-positive patients. J Clin Oncol 1998 ; 16: 979 -85. Google Scholar 38 Grann VR, Jacobson JS, Sundararajan V, Albert SM, Troxel AB, Neugut AI. The quality of life associated with prophylactic treatments for women with BRCA1/2 mutations. Cancer J Sci Am 1999 ; 5: 283 -92. Google Scholar 39 Noe LL, Becker RV III, Gradishar WJ, Gore M, Trotter JP. The cost effectiveness of tamoxifen in the prevention of breast cancer. Am J Manage Care 1999; 5(6 Suppl): S389 -406. Google Scholar 40 Brain K, Gray J, Norman P, France E, Anglim C, Barton G, et al. Randomized trial of a specialist genetic assessment service for familial breast cancer. J Natl Cancer Inst 2000 ; 92: 1345 -51. Google Scholar 41 Frost MH, Schaid DJ, Sellers TA, Slezak JM, Arnold PG, Woods JE, et al. Long-term satisfaction and psychological and social function following bilateral prophylactic mastectomy. JAMA 2000 ; 284: 319 -24. Google Scholar 42 Grann VR, Jacobson JS, Whang W, Hershman D, Heitjan DF, Antman KH, et al. Prevention with tamoxifen or other hormones versus prophylactic surgery in BRCA1/2-positive women: a decision analysis. Cancer J Sci Am 2000 ; 6: 13 -20. Google Scholar 43 Julian-Reynier C, Eisinger F, Chabal F, Lasset C, Nogues C, Stoppa-Lyonnet D, et al. Disclosure to the family of breast/ovarian cancer genetic test results: patient's willingness and associated factors. Am J Med Genet 2000; 94: 13 -8. Google Scholar 44 Smith TJ, Hillner BE. Tamoxifen should be cost-effective in reducing breast cancer risk in high-risk women. J Clin Oncol 2000 ; 18: 284 -6. Google Scholar 45 Haiart DC, McKenzie L, Henderson J, Pollock W, McQueen DV, Roberts MM, et al. Mobile breast screening: factors affecting uptake, efforts to increase response and acceptability. Public Health 1990 ; 104: 239 -47. Google Scholar 46 Gram IT, Lund E, Slenker SE. Quality of life following a false positive mammogram. Br J Cancer 1990 ; 62: 1018 -22. Google Scholar 47 Smith S, Botha JL, Goosey R, Daintith H. Audit of user satisfaction with the Leicestershire Breast Screening Service; women attending for assessment of abnormal mammograms. J Public Health Med 1991 ; 13: 166 -71. Google Scholar 48 Wilson SE, Andersen MR, Meischke H. Meeting the needs of rural breast cancer survivors: what still needs to be done? J Womens Health Gend Based Med 2000; 9: 667 -77. Google Scholar 49 Allen MW, Hendi P, Schwimmer J, Bassett L, Gambhir SS. Decision analysis for the cost effectiveness of sestamibi scintimammography in minimizing unnecessary biopsies. Q J Nucl Med 2000 ; 44: 168 -85. Google Scholar 50 Clavel M, Bonneterre J, d'Allens H, Paillarse JM. Oral ondansetron in the prevention of chemotherapy-induced emesis in breast cancer patients. French Ondansetron Study Group. Eur J Cancer 1995 ; 31A: 15 -9. Google Scholar 51 Boer R, de Koning HJ, van der Maas PJ. A longer breast carcinoma screening interval for women aged older than 65 years? Cancer 1999 ; 86: 1506 -10. Google Scholar 52 Morize V, Nguyen DT, Lorente C, Desfosses G. Descriptive epidemio-logical survey on a given day in all palliative care patients hospitalized in a French university hospital. Palliat Med 1999 ; 13: 105 -17. Google Scholar 53 Kearsley JH, Schonfeld C, Sheehan M. Quality-of-life assessment during palliative radiotherapy. Australas Radiol 1998 ; 42: 354 -9. Google Scholar 54 Ventafridda V, De Conno F, Ripamonti C, Gamba A, Tamburini M. Quality of life assessment during a palliative care programme. Ann Oncol 1990; 1: 415 -20. Google Scholar 55 Chochinov HM, Tataryn D, Clinch JJ, Dudgeon D. Will to live in the terminally ill. Lancet 1999 ; 354: 816 -9. Google Scholar 56 Ellershaw JE, Peat SJ, Boys LC. Assessing the effectiveness of a hospital palliative care team. Palliat Med 1995 ; 9: 145 -52. Google Scholar 57 Miller RD, Walsh TD. Psychosocial aspects of palliative care in advanced cancer. J Pain Symptom Manage 1991 ; 6: 24 -9. Google Scholar 58 Fakhoury WK. Satisfaction with palliative care: what should we be aware of? Int J Nurs Stud 1998 ; 35: 171 -6. Google Scholar 59 Kelly B, Edwards P, Synott R, Neil C, Baillie R, Battistetta D. Predictors of bereavement outcome for family carers of cancer patients. Psychoonocology 1999; 8: 237 -49. Google Scholar 60 Peruselli C, Di Giulio P, Toscani F, Gallucci M, Brunelli C, Costantini M, et al. Home palliative care for terminal cancer patients: a survey on the final week of life. Palliat Med 1999 ; 13: 233 -41. Google Scholar 61 Ramirez AJ, Towlson KE, Leaning MS, Richards MA, Rubens RD. Do patients with advanced breast cancer benefit from chemotherapy? Br J Cancer 1998; 78: 1488 -94. Google Scholar 62 Bloom JR, Kessler L. Emotional support following cancer: a test of the stigma and social activity hypotheses. J Health Soc Behav 1994 ; 35: 118 -33. Google Scholar 63 Couzi RJ, Helzlsouer KJ, Fetting JH. Prevalence of menopausal symptoms among women with a history of breast cancer and attitudes toward estrogen replacement therapy. J Clin Oncol 1995 ; 13: 2737 -44. Google Scholar 64 Satariano WA, DeLorenze GN. The likelihood of returning to work after breast cancer. Public Health Rep 1996 ; 111: 236 -41. Google Scholar 65 Marks LB, Hardenbergh PH, Winer ET, Prosnitz LR. Assessing the cost-effectiveness of postmastectomy radiation therapy. Int J Radiat Oncol Biol Phys 1999; 44: 91 -8. Google Scholar 66 Lindley C, Vasa S, Sawyer WT, Winer EP. Quality of life and preferences for treatment following systemic adjuvant therapy for early-stage breast cancer. J Clin Oncol 1998 ; 16: 1380 -7. Google Scholar 67 Ganz PA, Rowland JH, Meyerowitz BE, Desmond KA. Impact of different adjuvant therapy strategies on quality of life in breast cancer survivors. Recent Results Cancer Res 1998 ; 152: 396 -411. Google Scholar 68 Bloom JR, Stewart SL, Johnston M, Banks P. Intrusiveness of illness and quality of life in young women with breast cancer. Psychooncology 1998; 7: 89 -100. Google Scholar 69 Spencer SM, Lehman JM, Wynings C, Arena P, Carver CS, Antoni MH, et al. Concerns about breast cancer and relations to psychosocial well-being in a multiethnic sample of early-stage patients. Health Psychol 1999 ; 18: 159 -68. Google Scholar 70 Ashing-Giwa K, Ganz PA, Petersen L. Quality of life of African-American and white long term breast carcinoma survivors. Cancer 1999; 85: 418 -26. Google Scholar 71 Gelber RD, Goldhirsch A, Cole BF. Evaluation of effectiveness: Q-TWiST. The International Breast Cancer Study Group. Cancer Treat Rev 1993; 19 Suppl A: 73 -84. Google Scholar 72 Jones S, Winer E, Vogel C, Laufman L, Hutchins L, O'Rourke M, et al. Randomized comparison of vinorelbine and melphalan in anthracycline-refractory advanced breast cancer. J Clin Oncol 1995 ; 13: 2567 -74. Google Scholar 73 Ganz PA, Schag AC, Lee JJ, Polinsky ML, Tan SJ. Breast conservation versus mastectomy. Is there a difference in psychological adjustment or quality of life in the year after surgery? Cancer 1992 ; 69: 1729 -38. Google Scholar 74 Weitzner MA, Meyers CA, Stuebing KK, Saleeba AK. Relationship between quality of life and mood in long-term survivors of breast cancer treated with mastectomy. Support Care Cancer 1997 ; 5: 241 -8. Google Scholar 75 Wang X, Cosby LG, Harris MG, Liu T. Major concerns and needs of breast cancer patients. Cancer Nurs 1999 ; 22: 157 -63. Google Scholar 76 Mandelblatt JS, Wheat ME, Monane M, Moshief RD, Hollenberg JP, Tang J. Breast cancer screening for elderly women with and without comorbid conditions. A decision analysis model. Ann Intern Med 1992 ; 116: 722 -30. Google Scholar 77 Nutting PA, Calonge BN, Iverson DC, Green LA. The danger of applying uniform clinical policies across populations: the case of breast cancer in American Indians. Am J Public Health 1994 ; 84: 1631 -6. Google Scholar 78 Mandelblatt J, Freeman H, Winczewski D, Cagney K, Williams S, Trowers R, et al. The costs and effects of cervical and breast cancer screening in a public hospital emergency room. The Cancer Control Center of Harlem. Am J Public Health 1997 ; 87: 1182 -9. Google Scholar 79 Schweitzer ME, French MT, Ullmann SG, McCoy CB. Cost-effectiveness of detecting breast cancer in lower socioeconomic status African American and Hispanic women through mobile mammography services. Med Care Res Rev 1998; 55: 99 -115. Google Scholar 80 Gaston-Johansson F, Ohly KV, Fall-Dickson JM, Nanda JP, Kennedy MJ. Pain, psychological distress, health status, and coping in patients with breast cancer scheduled for autotransplantation. Oncol Nurs Forum 1999; 26: 1337 -45. Google Scholar 81 Ganz PA, Desmond KA, Belin TR, Meyerowitz BE, Rowland JH. Predictors of sexual health in women after a breast cancer diagnosis. J Clin Oncol 1999; 17: 2371 -80. Google Scholar 82 Fairclough DL, Fetting JH, Cella D, Wonson W, Moinpour CM. Quality of life and quality adjusted survival for breast cancer patients receiving adjuvant therapy. Eastern Cooperative Oncology Group (ECOG). Qual Life Res 1999; 8: 723 -31. Google Scholar 83 Pusic A, Thompson TA, Kerrigan CL, Sargeant R, Slezak S, Chang BW, et al. Surgical options for the early-stage breast cancer: factors associated with patient choice and postoperative quality of life. Plast Reconstr Surg 1999; 104: 1325 -33. Google Scholar 84 Haas JS, Cook EF, Puopolo AL, Burstin HR, Brennan TA. Differences in the quality of care for women with an abnormal mammogram or breast complaint. J Gen Intern Med 2000 ; 15: 321 -8. Google Scholar 85 Ganz PA, Coscarelli A, Fred C, Kahn B, Polinsky ML, Petersen L. Breast cancer survivors: psychosocial concerns and quality of life. Breast Cancer Res Treat 1996 ; 38: 183 -99. Google Scholar 86 Shimozuma K, Ganz PA, Petersen L, Hirji K. Quality of life in the first year after breast cancer surgery: rehabilitation needs and patterns of recovery. Breast Cancer Res Treat 1999 ; 56: 45 -57. Google Scholar 87 Hurny C, Bernhard J, Gelber RD, Coates A, Castiglione M, Isley M, et al. Quality of life measures for patients receiving adjuvant therapy for breast cancer: an international trial. The International Breast Cancer Study Group. Eur J Cancer 1992 ; 28: 118 -24. Google Scholar 88 Bernhard J, Hurny C, Coates AS, Peterson HF, Castiglione-Gertsch M, Gelber RD, et al. Factors affecting baseline quality of life in two international adjuvant breast cancer trials. International Breast Cancer Study Group (IBCSG). Br J Cancer 1998 ; 78: 686 -93. Google Scholar 89 Hurny C, Bernhard J, Coates AS, Castiglione-Gertsch M, Peterson HF, Gelber RD, et al. Impact of adjuvant therapy on quality of life in women with node-positive operable breast cancer. International Breast Cancer Study Group Lancet 1996; 347: 1279 -84. Google Scholar [published erratum appears in Lancet 1997 ; 350: 298 ]. Google Scholar 90 Liberati A. The GIVIO trial on the impact of follow-up care on survival and quality of life in breast cancer patients. Interdisciplinary Group for Cancer Care Evaluation. Ann Oncol 1995 ; 6 Suppl 2: 41 -4. Google Scholar 91 Secker-Walker RH, Vacek PM, Hooper GJ, Plante DA, Detsky AS. Screening for breast cancer: time, travel, and out-of-pocket expenses. J Natl Cancer Inst 1999; 91: 702 -8. Google Scholar 92 Kurtz ME, Kurtz JC, Stommel M, Given CW, Given B. The influence of symptoms, age, comorbidity and cancer site on physical functioning and mental health of geriatric women patients. Women Health 1999 ; 29: 1 -12. Google Scholar 93 Desch CE, Hillner BE, Smith TJ, Retchin SM. Should the elderly receive chemotherapy for node-negative breast cancer? A cost-effectiveness analysis examining total and active life-expectancy outcomes. J Clin Oncol 1993; 11: 777 -82. Google Scholar 94 DiMatteo MR, Sherbourne CD, Hays RD, Ordway L, Kravitz RL, McGlynn EA, et al. Physicians' characteristics influence patients' adherence to medical treatment: results from the Medical Outcomes Study. Health Psychol 1993; 12: 93 -102. Google Scholar 95 Social indicators of well-being . New York (NY): Plenum Press; 1976. Google Scholar 96 Ganz PA, Day R, Ware JE Jr, Redmond C, Fisher B. Base-line quality-of-life assessment in the National Surgical Adjuvant Breast and Bowel Project Breast Cancer Prevention Trial. J Natl Cancer Inst 1995 ; 87: 1372 -82. Google Scholar 97 Levine MN, Guyatt GH, Gent M, De Pauw S, Goodyear MD, Hryniuk WM, et al. Quality of life in stage II breast cancer: an instrument for clinical trials. J Clin Oncol 1989 ; 7: 542 -4. Google Scholar 98 Lerman C, Trock B, Rimer BK, Jepson C, Brody D, Boyce A. Psychological side effects of breast cancer screening. Health Psychology 1991; 10: 259 -67. Google Scholar 99 Beck AT, Steer RA. Beck depression inventory manual . San Antonio (TX): The Psychological Corp./Harcourt Brace; 1993 . Google Scholar 100 Brown GW, Harris TO. A study of psychosocial disorder in women . 1978. Google Scholar 101 Berkman LF. The assessment of social networks and social support in the elderly. J Am Geriatr Soc 1983 ; 31: 743 -9. Google Scholar 102 Franzoi SL, Shields SA. The body esteem scale: multidimensional structure and sex differences in a college population. J Pers Assess 1984; 48: 173 -8. Google Scholar 103 Zerssen D. Klinische Selbstbeurteilungsskalen (KSb-S) aus dem Munchener Psychiatrischen Weinheim (Germany): Informationssystem (PSYCHIS Munchen); 1976. Google Scholar 104 Delaplaine RW, Bottomy JR, Blatt M, Wiesbader H, Kupperman HS. Effective control of the surgical menopause by estradiol pellet implantation at the time of surgery. Surg Gynecol Obstet 1952 ; 94: 323 -33. Google Scholar 105 Cleeland CS, Syrjala KL. How to assess cancer pain . New York (NY): Guilford Press; 1992. Google Scholar 106 Orden SR, Bradburn NM. Working wives and marriage happiness. Am J Surg 1969; 74: 392 -407. Google Scholar 107 Hamilton MK. The health and activity limitation survey. Health Rep 1989; 1: 175 -87. Google Scholar 108 Katz S. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychological function. JAMA 1963; 185: 914 -9. Google Scholar 109 Schain W. Breast cancer problems checklist . 1979 . Google Scholar 110 Caplan RD, Abbey A, Abramis DJ, Andrews FM, Conway TL. Tranquilizer use and well being: a longitudinal study of social psychological effects . Ann Arbor (MI): Institute for Social Research; 1984 . Google Scholar 111 Ganz PA, Schag CA, Lee JJ, Sim MS. The CARES: a generic measure of health-related quality of life for patients with cancer. Qual Life Res 1992; 1: 19 -29. Google Scholar 112 Derogatis LR, Melisaratos N. The Brief Symptom Inventory: an introductory report. Psychol Med 1983 ; 13: 595 -605. Google Scholar 113 Roberts CS, Cox CE, Reintgen DS, Baile WF, Gibertini M. Influence of physician communication on newly diagnosed breast patients' psychologic adjustment and decision-making. Cancer 1994 ; 74(1 suppl): 336 -41. Google Scholar 114 Radloff LS. The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Measur 2001 ; 1: 385 -401. Google Scholar 115 Chalder T, Berelowitz G, Pawikowska T, Watts L, Wessely S, Wright D, et al. Development of a fatigue scale. J Psychosom Res 1993 ; 37: 147 -53. Google Scholar 116 Ota J. Le test de copie d'une figure complexe: contribution a l'etude de l'aperception et de la memoire. Arch Psychol 1944 ; 30: 205 -353. Google Scholar 117 Test d2 Aufmerksamkeitsbelastungstest ; 1978 . Google Scholar 118 de Groot HA. The de Groot Symptom-Transition Scale . Tuscon (AZ): The University of Arizona College of Nursing and Sigma Theta International; 1989. Google Scholar 119 Wechsler D. Wechsler Adult Intelligence Scale . New York (NY): Psychological Corporation; 1955. Google Scholar 120 Broadhead WE, Gehlbach SH, De Gruy FV, Kaplan BH. The Duke-UNC Functional Social Support Questionnaire. Measurement of social support in family medicine patients. Med Care 1988 ; 26: 709 -23. Google Scholar 121 Spanier GB. Measuring dyadic adjustment: new scales for assessing the quality of marriage and similar dyads. J Marriage Fam 1976 ; 38: 15 -28. Google Scholar 122 Kristal AR, Shattuck AL, Henry HJ. Patterns of dietary behavior associated with selecting diets low in fat: reliability and validity of a behavior approach to dietary assessment. J Am Diet Assoc 1990 ; 90: 214 -20. Google Scholar 123 Beahrs OH, Henson DE, Hutter RV, Myers MH. Manual for staging of cancer . Philadelphia (PA): 1988. Google Scholar 124 Sprangers MA, Groenvald M, Arraras JI, Franklin J, te Velde A, Muller M, et al. The European Organization for Research and Treatment of Cancer breast cancer specific quality-of-life questionnaire module: first results from a three-country field study. J Clin Oncol 1996 ; 14: 2756 -68. Google Scholar 125 Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993 ; 85: 55 -65. Google Scholar 126 Cella D. F.A.C.I.T. (Functional Assessment of Chronic Illness Therapy). Manual, Version 4 ed. Chicago (IL): Evanston Northwestern Healthcare and Northwestern University; 1997 . Google Scholar 127 Alpherts WC, Aldenkamp AP. The Iron Fepsy . Heemsted (The Netherlands): Instituut voor epilepsiebestrijding Heemstede; 1994 . Google Scholar 128 Schipper H, Clinch J, McMurray A, Levitt M. Measuring the quality of life of cancer patients: the Functional Living Index—Cancer: development and validation. J Clin Oncol 1984 ; 2: 472 -83. Google Scholar 129 Ferrans CE, Powers MJ. Quality of life index: development and psychometric properties. ANS Adv Nurs Sci 1985 ; 8: 15 -24. Google Scholar 130 Gaston-Johansson F. Measurement of pain: the psychometric properties of the Pain-O-Meter, a simple inexpensive pain assessment tool that could change health care practices. J Pain Symptom Manage 1996 ; 12: 172 -81. Google Scholar 131 Goldberg D. The detection of psychiatric illness by questionnaire . London (U.K.): Oxford University Press; 1972 . Google Scholar 132 Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983 ; 67: 361 -70. Google Scholar 133 House JS. Work stress and social support . 1981 . Google Scholar 134 Walker LG, Cordiner C, Gilbert FJ. How distressing is attendance for routine breast screening. Psychooncology 1994 ; 3: 299 -304. Google Scholar 135 Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L. The Hopkins Symptoms Checklist (HSCL). A measure of primary symptom dimensions. Mod Probl Psychopharmacol 1974 ; 7: 79 -110. Google Scholar 136 Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969 ; 9: 179 -86. Google Scholar 137 Braden CJ. Learned self-help response to chronic illness experience: a test of three alternative learning theories. Sch Inq Nurs Pract 1990; 4: 23 -41. Google Scholar 138 Horowitz M, Wilner N, Alvarez W. Impact of Event Scale: a measure of subjective stress. Psychosom Med 1979 ; 41: 209 -18. Google Scholar 139 Devins GM. Illness intrusiveness and the psychosocial impact of lifestyle disruptions in chronic life-threatening disease. Adv Ren Replace Ther 1994; 1: 251 -63. Google Scholar 140 Campbell A, Converse P, Rogers W. The quality of American life . New York (NY); 1976. Google Scholar 141 Karnofsky DA, Burchenal JH. The clinical evaluation of chemotherapeutic agents in cancer . New York (NY): Columbia University Press; 1949. Google Scholar 142 The pattern of human concerns . New Brunswick (NJ): Rutgers University Press; 1965. Google Scholar 143 Lasry JC, Margolese RG, Poisson R, Shibata H, Fleischer D, Lafleur D, et al. Depression and body image following mastectomy and lumpectomy. J Chronic Dis 1987; 40: 529 -34. Google Scholar 144 Lerman C, Trock B, Rimer BK, Boyce A, Jepson C, Engstrom PF. Psychological and behavioral implications of abnormal mammograms. Ann Intern Med 1991; 114: 657 -61. Google Scholar 145 Sarason IG, Johnson JH, Siegal JM. Assessing the impact of life changes: development of the Life Experiences Survey. J Consult Clin Psychol 1978; 46: 932 -46. Google Scholar 146 Locke HJ, Wallace RM. Short martial adjustment and predictive tests: their reliability and validity. Marriage Fam Living 1959 ; 21: 251 -5. Google Scholar 147 Brambilla DJ, McKinlay SM, Johannes CB. Defining the perimenopause for application in epidemiologic investigations. Am J Epidemiol 1994 ; 140: 1091 -5. Google Scholar 148 Melzack R. The McGill Pain Questionnaire: major properties and scoring methods. Pain 1975 ; 1: 277 -99. Google Scholar 149 Fayers PM, Hopwood P, Harvey A, Girling DJ, Machin D, Stephens R. Quality of life assessment in clinical trials—guidelines and a checklist for protocol writers: the U.K. Medical Research Council experience. MRC Cancer Trials Office. Eur J Cancer 1997 ; 33: 20 -8. Google Scholar 150 Stewart AL, Ware JE Jr, Sherbourne CD. Psychological Distress/Well-Being and Cognitive Functioning Measures . Durham (NC): Duke University Press; 1992. Google Scholar 151 Ware JE Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 1992 ; 30: 473 -83. Google Scholar 152 Sherbourne CD, Stewart AL. The MOS Social Support Survey. Soc Sci Med 1991; 32: 705 -14. Google Scholar 153 Northouse LL, Swain MA. Adjustment of patients and husbands to the initial impact of breast cancer. Nurs Res 1987 ; 36: 221 -5. Google Scholar 154 Watson M, Law M, dos Santos M, Greer S, Baruch J, Bliss JM. The Mini-Mac further development of the Mental Adjustment to Cancer Scale. Psychooncology 1994; 3: 153 . Google Scholar 155 Portenoy RK, Thaler HT, Kornblith AB, Lepore JM, Friedlander-Klar H, Kiyasu E, et al. The Memorial Symptom Assessment Scale: an instrument for the evaluation of symptom prevalence, characteristics, and distress. Eur J Cancer 1994; 30A: 1326 -36. Google Scholar 156 Watson D, Clark L, Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol 1988; 34: 1063 -70. Google Scholar 157 Hunt SM, McEwen J, McKenna SP. Measuring health status: a new tool for clinicians and epidemiologists. J R Coll Gen Pract 1985 ; 35: 185 -8. Google Scholar 158 Youngblood M, Dauz WP, Eyles H, Waring J, Runyon S. A comparison of two methods of assessing cancer therapy-related symptoms. Cancer Nurs 1994; 17: 37 -44. Google Scholar 159 Tait RC, Chibnall JT, Krause S. The Pain Disability Index: psychometric properties. Pain 1990 ; 40: 171 -82. Google Scholar 160 Flamer DP. Perceived Social Support Scale . San Francisco (CA): West Coast Cancer Foundation; 1977. Google Scholar 161 Hurny C, Bernhard J, Bacchi M, van Wegberg B, Tomamichel M, Spek U, et al.. The Perceived Adjustment to Chronic Illness Scale (PACIS): a global indicator of coping for operable breast cancer patients in clinical trials. Support Care Cancer 1993; 1: 200 -8. Google Scholar 162 Piper BF, Lindsey AM, Dodd MJ, Ferketich S, Paul SM, Weller S. The development of an instrument to measure the subjective dimension of fatigue . 1989. Google Scholar 163 Buysse DJ, Reynolds CF III, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 1989 ; 28: 193 -213. Google Scholar 164 Dajczman E, Gordon A, Kreisman H, Wolkove N. Long-term postthoracotomy pain. Chest 1991 ; 99: 270 -4. Google Scholar 165 Thoresen C, Bowman E, Koopman C, Yang P, Dubs G, Spiegel D. Principles of living survey . Palo Alto (CA): Department of Psychiatry, Stanford University; 1995. Google Scholar 166 McNair PM, Lorr M, Droppelman L. EITS Manual for the Profile of Mood States . San Diego (CA): Educational and Industrial Testing Service; 1971. Google Scholar 167 Derogatis LR. The Psychosocial Adjustment to Illness Scale: administration, scoring and procedures manual . Baltimore (MD): The Johns Hopkins University Press; 1975. Google Scholar 168 Cockburn J, DeLuise T, Hurley S, Clover K. Development and validation of the PCQ: a questionnaire to measure the psychological consequences of screening mammography. Soc Sci Med 1992 ; 34: 1129 -34. Google Scholar 169 Ilfeld FW Jr. Further validation of a psychiatric symptom index in a normal population. Psychol Rep 1976 ; 39: 1215 -28. Google Scholar 170 Spitzer RL, Endicott J, Fleiss JL, Cohen J. The psychiatric status schedule. A technique for evaluating psychopathology and impairment in role functioning. Arch Gen Psychiatry 1970 ; 23: 41 -55. Google Scholar 171 Ferrell BR, Dow KH, Grant M. Measurement of the quality of life in cancer survivors. Qual Life Res 1995 ; 4: 523 -31. Google Scholar 172 Ferrell BR, Grant M, Funk B, Garcia N, Otis-Green S, Schaffner ML. Quality of life in breast cancer. Cancer Pract 1996 ; 4: 331 -40. Google Scholar 173 Goldhirsch A, Gelber RD, Simes RJ, Glasziou P, Coates AS. Costs and benefits of adjuvant therapy in breast cancer: a quality adjusted survival analysis. J Clin Oncol 1989 ; 7: 36 -44. Google Scholar 174 Rey A. L'examen clinique en psychologie . Paris (France): Presses Universitaires de France; 1964. Google Scholar 175 Rosenberg M. Society and the adolescent self image . Princeton (NJ): Princeton University Press; 1965. Google Scholar 176 de Haes JC, van Knippenberg FC, Neijt JP. Measuring psychological and physical distress in cancer patients: structure and application of the Rotterdam Symptom Checklist. Br J Cancer 1990 ; 62: 1034 -8. Google Scholar 177 Shiloh S, Avdor O, Goodman RM. Satisfaction with genetic counseling: dimensions measurement. Am J Med Genet 1990 ; 37: 522 -9. Google Scholar 178 Spitzer RL, Williams JB, Gibbon M, First MB. Structured clinical interview for DSM-III-R . Patient edition. Washington (DC): American Psychiatric Press; 1990. Google Scholar 179 Pardine P, Napoli A, Dytell R. Health behavior change mediating the stress-illness relationship . Anaheim (CA): Ninety First Annual Conference of the American Psychological Association; 1983 . Google Scholar 180 A User's Manual for the Symptom Distress Scale . Philadelphia (PA): University of Pennsylvania; 1998. Google Scholar 181 Derogatis LR, Melisaratos N. The DSFI: a multidimensional measure of sexual functioning. J Sex Marital Therapy 1979 ; 5: 244 -81. Google Scholar 182 Thurstone L. The measurement of value ; 1959 . Google Scholar 183 Donald CA, Ware JE Jr. The qualification of social contacts and resources . Santa Monica (CA): Rand Corporation; 1982 . Google Scholar 184 Sarason IG, Sarason BR. Concomitants of social support: attitudes, personality characteristics, and life experiences. J Pers 1982 ; 50: 331 -44. Google Scholar 185 Spielberger CD. Manual for the State-Trait Anxiety Inventory STAI (form Y) “Self Evaluation Questionnaire.” Palo Alto (CA): Consulting Psychologists Press; 1983. Google Scholar 186 Stroop JR. Studies of interference in serial verbal reactions. J Exp Psychol 1935; 12: 242 -8. Google Scholar 187 Deiner E, Emmons R, Larsen R, Griffin S. The Satisfaction With Life Scale. J Pers Assess 1985 ; 49: 71 -5. Google Scholar 188 Moinpour CM, Hayden KA, Thompson IM, Feigl P, Metch B. Quality of life assessment in Southwest Oncology Group clinical trials. Oncology 1990; 4: 79 -84, 89; discussion 104. Google Scholar 189 Andrykowski MA, Grelner CB, Altmaier EM, Burish TG, Anlin JH, Gingrich R, et al. Quality of life following bone marrow transplantation: findings from a multicentre study. Br J Cancer 1995 ; 71: 1322 -9. Google Scholar 190 Reitan RM. Validity of the Trail Making Test as an indicator of organic brain damage. Percept Mot Skills 1958 ; 8: 271 -6. Google Scholar 191 McNeil BJ, Weichselbaum RR, Pauker SG. Speech and survival: tradeoffs between quality and quantity of life in laryngeal cancer. N Engl J Med 1981; 305: 982 -7. Google Scholar 192 Harrell S, Sanders-Phillips K. The Urban Life Stress Scale . Manuscript In press. 2001. Google Scholar 193 Daut RL, Cleeland CS, Flanery RC. Development of the Wisconsin Brief Pain Questionnaire to assess pain in cancer and other diseases. Pain 1983; 17: 197 -210. Google Scholar 194 Watts RJ. Sexual functioning, health beliefs, and compliance with high blood pressure medications. Nurs Res 1982 ; 31: 278 -83. Google Scholar 195 Fischer GW. Utility models for multiple objective decisions: do they accurately represent human preferences? Decis Sci 1979 ; 10: 451 -79. Google Scholar 196 Norum J, Olsen JA, Wist EA. Lumpectomy or mastectomy? Is breast conserving surgery too expensive? Breast Cancer Res Treat 1997 ; 45: 7 -14. Google Scholar 197 Gold MR, Siegel JE, Russell LB, Weinstein MC, editors. Cost effectiveness in health and medicine . New York (NY): Oxford University Press; 1996. Google Scholar 198 Ashbury FD, Cameron C, Mercer SL, Fitch M, Nielsen E. One-on-one peer support and quality of life for breast cancer patients. Patient Educ Couns 1998; 35: 89 -100. Google Scholar 199 Lee CO. Quality of life and breast cancer survivors. Psychosocial and treatment issues. Cancer Pract 1997 ; 5: 309 -16. Google Scholar 200 Curran D, van Dongen JP, Aaronson NK, Kiebert G, Fentiman IS, Mignolet F, et al. Quality of life of early-stage breast cancer patients treated with radical mastectomy or breast-conserving procedures: results of EORTC Trial 10801. The European Organization for Research and Treatment of Cancer (EORTC), Breast Cancer Co-operative Group (BCCG). Eur J Cancer 1998; 34: 307 -14. Google Scholar 201 Dorval M, Maunsell E, Deschenes L, Brisson J, Masse B. Long-term quality of life after breast cancer: comparison of 8-year survivors with population controls. J Clin Oncol 1998 ; 16: 487 -94. Google Scholar 202 Dorval M, Maunsell E, Deschenes L, Brisson J. Type of mastectomy and quality of life for long term breast carcinoma survivors. Cancer 1998; 83: 2130 -8. Google Scholar 203 Frazer GH, Brown CH III, Graves TK. Assessment of quality of life indicators among selected patients in a community cancer center. Issues Ment Health Nurs 1998; 19: 241 -62. Google Scholar 204 Grunfeld E, Gray A, Mant D, Yudkin P, Adewuyi-Dalton R, Coyle D, et al. Follow-up of breast cancer in primary care vs specialist care: results of an economic evaluation. Br J Cancer 1999 ; 79: 1227 -33. Google Scholar 205 van Harten WH, van Noort O, Warmerdam R, Hendricks H, Seidel E. Assessment of rehabilitation needs in cancer patients. Int J Rehabil Res 1998; 21: 247 -57. Google Scholar 206 Johnston K, Brown J, Gerard K, O'Hanlon M, Morton A. Valuing temporary and chronic health states associated with breast screening. Soc Sci Med 1998; 47: 213 -22. Google Scholar 207 Soukop M, McQuade B, Hunter E, Stewart A, Kaye S, Cassidy J, et al. Ondansetron compared with metoclopramide in the control of emesis and quality of life during repeated chemotherapy for breast cancer. Oncology 1992; 49: 295 -304. Google Scholar 208 Harper-Wynne C, English J, Meyer L, Bower M, Archer C, Sinnett HD, et al. Randomized trial to compare the efficacy and toxicity of cyclophosphamide, methotrexate and 5-fluorouracil (CMF) with methotrexate mitoxantrone (MM) in advanced carcinoma of the breast. Br J Cancer 1999; 81: 316 -22. Google Scholar 209 Joly F, Espie M, Heron JF, Henry-Amar M. Long-term quality of life in premenopausal women with node-negative localized breast cancer treated with or without adjuvant chemotherapy. Br J Cancer 2000 ; 83: 577 -82. Google Scholar 210 van Holten-Verzantvoort AT, Zwinderman AH, Aaronson NK, Hermans J, van Emmerik B, van Dam FS, et al. The effect of supportive pamidronate treatment on aspects of quality of life of patients with advanced breast cancer. Eur J Cancer 1991 ; 27: 544 -9. Google Scholar 211 Roberts CS, Cox CE, Reintgen DS, Baile WF, Gibertini M. Influence of physician communication on newly diagnosed breast patients' psychologic adjustment and decision-making. Cancer 1994 ; 74(1 Suppl): 336 -41. Google Scholar 212 Morria KT, Pommier RF, Vetto JT. Office-based wire-guided open breast biopsy under local anesthesia is accurate and cost effective. Am J Surg 2000; 179: 422 -5. Google Scholar 213 Fogarty LA, Curbow BA, Wingard JR, McDonnell K, Somerfield MR. Can 40 seconds of compassion reduce patient anxiety? J Clin Oncol 1999 ; 17: 371 -9. Google Scholar 214 Grunfeld E, Fitzpatrick R, Mant D, Yudkin P, Adewuyi-Dalton R, Stewart J, et al. Comparison of breast cancer patient satisfaction with follow-up in primary care versus specialist care: results from a randomized controlled trial. Br J Gen Pract 1999 ; 49: 705 -10. Google Scholar 215 Schover LR, Yetman RJ, Tuason LJ, Meisler E, Esselstyn CB, Hermann RE, et al. Partial mastectomy and breast reconstruction. A comparison of their effects on psychosocial adjustment, body image, and sexuality. Cancer 1995; 75: 54 -64. Google Scholar 216 Dow KH, Ferrell BR, Leigh S, Ly J, Gulasekaram P. An evaluation of the quality of life among long-term survivors of breast cancer. Breast Cancer Res Treat 1996; 39: 261 -73. Google Scholar 217 Tomiak EM, Diverty B, Verma S, Evans WK, Le Petit C, Will P, et al. Follow-up practices for patients with early stage breast cancer: a survey of Canadian oncologists. Cancer Prev Control 1998 ; 2: 63 -71. Google Scholar 218 Ferrell BR, Grant MM, Funk BM, Otis-Green SA, Garcia NJ. Quality of life in breast cancer survivors: implications for developing support services. Oncol Nurs Forum 1998; 25: 887 -95. Google Scholar 219 Fetting JH, Gray R, Fairclough DL, Smith TJ, Margolin KA, Citron ML, et al. Sixteen-week multidrug regimen versus cyclophosphamide, doxorubicin, and fluorouracil as adjuvant therapy for node-positive, receptor-negative breast cancer: an Intergroup study. J Clin Oncol 1998; 16: 2382 -91. Google Scholar 220 Levy SM, Haynes LT, Herberman RB, Lee J, McFeeley S, Kirkwood J. Mastectomy versus breast conservation surgery: mental health effects at long-term follow-up. Health Psychol 1992 ; 11: 349 -54. Google Scholar 221 Bertsch LA, Donaldson G. Quality of life analyses from vinorelbine (Navelbine) clinical trials of women with metastatic breast cancer. Semin Oncol 1995; 22(2 Suppl 5): 45-53; discussion 53-4. Google Scholar 222 Bull A, Mountney L, Sanderson H. Stage distribution of breast cancer: a basis for the evaluation of breast screening programmes. Br J Radiol 1991; 64: 516 -9. Google Scholar 223 Gabel M, Hilton NE, Nathanson SD. Multidisciplinary breast cancer clinics. Do they work? Cancer 1997 ; 79: 2380 -4. Google Scholar 224 Bergner M, Bobbitt RA, Carter WB, Gilson BS. The Sickness Impact Profile: development and final revision of a health status measure. Med Care 1981; 19: 787 -805. Google Scholar 225 Schipper H, Clinch J, Mcmurray A, Levitt M. Measuring the quality of life of cancer patients: the Functional Living Index—Cancer: development and validation. J Clin Oncol 1984 ; 2: 472 -83. Google Scholar 226 Schain WS. Psychosocial issues in breast cancer clinical trials. Recent Results Cancer Res 1993 ; 127: 235 -41. Google Scholar 227 Zappa M, Spagnolo G, Ciatto S, Giorgi D, Paci E, Rosseli del Tureo M. Measurement of the costs in two mammographic screening programmes in the province of Florence, Italy. J Med Screen 1995 ; 2: 191 -4. Google Scholar 228 de Haes JC, de Koning HJ, van Oortmarssen GJ, van Agt HM, de Bruyn AE, van der Maas PJ. The impact of a breast cancer screening programme on quality-adjusted life-years. Int J Cancer 1991 ; 49: 538 -44. Google Scholar 229 de Koning HJ, van Ineveld BM, van Oortmarssen GJ, de Haes JC, Collette HJ, Hendriks JH, et al. Breast cancer screening and cost-effectiveness; policy alternatives, quality of life considerations and the possible impact of uncertain factors. Int J Cancer 1991 ; 49: 531 -7. Google Scholar 230 Brown ML. Economic considerations in breast cancer screening of older women. J Gerontol 1992 ; 47 Spec No: 51 -8. Google Scholar 231 Zavertnik JJ, McCoy CB, Robinson DS, Love N. Cost-effective management of breast cancer. Cancer 1992 ; 69(7 Suppl): 1979 -84. Google Scholar 232 Vaile MS, Calnan M, Rutter DR, Wall B. Breast cancer screening services in three areas: uptake and satisfaction. J Public Health Med 1993; 15: 37 -45. Google Scholar 233 Roworth MA, McIlwaine GM, Wallace AM. Women's views of the Scottish Breast Screening Programme: a national consumer opinion survey. Public Health 1993; 107: 185 -92. Google Scholar 234 Richardson AK, Elwood JM, McNoe B, Bang E. A survey of urban and rural participants in the Otago-Southland pilot breast cancer screening programme. N Z Med J 1994 ; 107: 36 -8. Google Scholar 235 Beemsterboer PM, de Koning HJ, Warmerdam PG, Boer R, Swart E, Dierks ML, et al. Prediction of the effects and costs of breast-cancer screening in Germany. Int J Cancer 1994 ; 58: 623 -8. Google Scholar 236 Boer R, de Koning HJ, van Oortmarssen GJ, van der Maas PJ. In search of the best upper age limit for breast cancer screening. Eur J Cancer 1995; 31A: 2040 -3. Google Scholar 237 Boer R, de Koning H, Threlfall A, Warmerdam P, Street A, Friedman E, et al. Cost effectiveness of shortening screening interval or extending age range of NHS breast screening programme: computer simulation study. BMJ 1998; 317: 376 -9. Google Scholar 238 Ganz PA, Coscarelli A, Fred C, Kahn B, Polinsky ML, Petersen L. Breast cancer survivors: psychosocial concerns and quality of life. Breast Cancer Res Treat 1996 ; 38: 183 -99. Google Scholar 239 Feig SA. Mammographic screening of women aged 40-49 years. Benefit, risk, and cost considerations. Cancer 1995 ; 76(10 Suppl): 2097 -106. Google Scholar 240 Brown J, Bryan S, Warren R. Mammography screening: an incremental cost effectiveness analysis of double versus single reading of mammograms. BMJ 1996; 312: 809 -12. Google Scholar 241 Evans N. Revolution follows the breast cancer epidemic. Revolution 1996; 6: 30 -1. Google Scholar 242 Salzmann P, Kerlikowske K, Phillips K. Cost-effectiveness of extending screening mammography guidelines to include women 40 to 49 years of age Ann Intern Med 1997 ; 127: 955 -65. Google Scholar [published erratum appears in Ann Intern Med 1998 ; 128: 878 ]. Google Scholar 243 Torgerson DJ, Gosden T. The national breast screening service: is it economically efficient? QJM 1997 ; 90: 423 -5. Google Scholar 244 Warmerdam PG, de Koning HJ, Boer R, Beemsterboer PM, Dierks ML, Swart E, et al. Quantitative estimates of the impact of sensitivity and specificity in mammographic screening in Germany. J Epidemiol Community Health 1997; 51: 180 -6. Google Scholar 245 Bakker DA, Lightfoot NE, Steggles S, Jackson C. The experience and satisfaction of women attending breast cancer screening. Oncol Nurs Forum 1998; 25: 115 -21. Google Scholar 246 Gilbert FJ, Cordiner CM, Affleck IR, Hood DB, Mathieson D, Walker LG. Breast screening: the psychological sequelae of false-positive recall in women with and without a family history of breast cancer. Eur J Cancer 1998; 34: 2010 -4. Google Scholar 247 Lamarque JL, Pujol J, Cherifcheikh J, Laurent JC, Taourel P, Boulet P, et al. Cost evaluation of breast cancer screening in France. Acad Radiol 1998; 5 Suppl 2: S336 -S339. Google Scholar 248 Rosenquist CJ, Lindfors KK. Screening mammography beginning at age 40 years: a reappraisal of cost-effectiveness. Cancer 1998 ; 82: 2235 -40. Google Scholar 249 Wolstenholme JL, Smith SJ, Whynes DK. The costs of treating breast cancer in the United Kingdom: implications for screening. Int J Technol Assess Health Care 1998; 14: 277 -89. Google Scholar 250 Allen MW, Hendi P, Bassett L, Phelps ME, Gambhir SS. A study on the cost effectiveness of sestamibi scintimammography for screening women with dense breasts for breast cancer. Breast Cancer Res Treat 1999 ; 55: 243 -58. Google Scholar 251 Gyrd-Hansen D. The relative economics of screening for colorectal cancer, breast cancer and cervical cancer. Crit Rev Oncol Hematol 1999; 32: 133 -44. Google Scholar 252 Leivo T, Sintonen H, Tuominen R, Hakama M, Pukkala E, Heinonen OP. The cost-effectiveness of nationwide breast carcinoma screening in Finland, 1987-1992. Cancer 1999; 86: 638 -46. Google Scholar 253 Norum J. Breast cancer screening by mammography in Norway. Is it cost-effective? Ann Oncol 1999 ; 10: 197 -203. Google Scholar 254 van der Pol MM, Cairns JA, Gilbert FJ, Hendry PJ. Economic analysis of outreach assessment clinics in breast screening programmes. Int J Health Plann Manage 1999; 14: 57 -67. Google Scholar 255 Kennedy H, Kennedy N, Barclay M, Horobin M. Cost efficiency of bone scans in breast cancer. Clin Oncol (R Coll Radiol) 1991 ; 3: 73 -7. Google Scholar 256 Mosconi P, Meyerowitz BE, Liberati MC, Liberati A. Disclosure of breast cancer diagnosis: patient and physician reports. GIVIO (Interdisciplinary Group for Cancer Care Evaluation, Italy). Ann Oncol 1991; 2: 273 -80. Google Scholar 257 McManus V, Desautels JE, Benediktsson H, Pasieka J, Lafreniere R. Enhancement of true-positive rates for nonpalpable carcinoma of the breast through mammographic selection. Surg Gynecol Obstet 1992 ; 175: 212 -8. Google Scholar 258 Layfield LJ, Chrischilles EA, Cohen MB, Bottles K. The palpable breast nodule. A cost-effectiveness analysis of alternate diagnostic approaches. Cancer 1993; 72: 1642 -51. Google Scholar 259 Velanovich V. Immediate biopsy versus observation for abnormal findings on mammograms: an analysis of potential outcomes and costs. Am J Surg 1995; 170: 327 -32. Google Scholar 260 Fajardo LL. Cost-effectiveness of stereotaxic breast core needle biopsy. Acad Radiol 1996; 3 Suppl 1: S21-S23. Google Scholar 261 Vetto JT, Pommier RF, Schmidt WA, Eppich H, Alexander PW. Diagnosis of palpable breast lesions in younger women by the modified triple test is accurate and cost-effective. Arch Surg 1996 ; 131: 967 -72. Google Scholar 262 Hillner BE. Decision analysis: MIBI imaging of nonpalpable breast abnormalities. J Nucl Med 1997 ; 38: 1772 -8. Google Scholar 263 Rubin M, Horiuchi K, Joy N, Haun W, Read R, Ratzer E, et al. Use of fine needle aspiration for solid breast lesions is accurate and cost-effective. Am J Surg 1997 ; 174: 694 -6. Google Scholar 264 Logan-Young W, Dawson AE, Wilbur DC, Avila EE, Tomkiewicz ZM, Sheils LA, et al. The cost-effectiveness of fine-needle aspiration cytology and 14-gauge core needle biopsy compared with open surgical biopsy in the diagnosis of breast carcinoma. Cancer 1998 ; 82: 1867 -73. Google Scholar 265 Velanovich V. Axillary lymph node dissection for breast cancer: a decision analysis of T1 lesions. Ann Surg Oncol 1998 ; 5: 131 -9. Google Scholar 266 Burkhardt JH, Sunshine JH. Core-needle and surgical breast biopsy: comparison of three methods of assessing cost. Radiology 1999 ; 212: 181 -8. Google Scholar 267 Heimdal K, Maehle L, Moller P. Costs and benefits of diagnosing familial breast cancer. Dis Markers 1999 ; 15: 167 -73. Google Scholar 268 Hrung JM, Langlotz CP, Orel SG, Fox KR, Schnall MD, Schwartz JS. Cost-effectiveness of MR imaging and core-needle biopsy in the pre-operative work-up of suspicious breast lesions. Radiology 1999 ; 213: 39 -49. Google Scholar 269 Leivo T, Salminen T, Sintonen H, Tuominen R, Auerma K, Partanen K, et al. Incremental cost-effectiveness of double-reading mammograms. Breast Cancer Res Treat 1999 ; 54: 261 -7. Google Scholar 270 Orr RK, Hoehn JL, Col NF. The learning curve for sentinel node biopsy in breast cancer: practical considerations. Arch Surg 1999 ; 134: 764 -7. Google Scholar 271 Verhoef LC, Stalpers LJ, Verbeek AL, Wobbes T, van Daal WA. Breast-conserving treatment or mastectomy in early breast cancer: a clinical decision analysis with special reference to the risk of local recurrence. Eur J Cancer 1991; 27: 1132 -7. Google Scholar 272 Ganz PA, Lee JJ, Sim MS, Polinsky ML, Schag CA. Exploring the influence of multiple variables on the relationship of age to quality of life in women with breast cancer. J Clin Epidemiol 1992 ; 45: 473 -85. Google Scholar 273 Ganz PA, Schag CA, Cheng HL. Assessing the quality of life—a study in newly-diagnosed breast cancer patients. J Clin Epidemiol 1990; 43: 75 -86. Google Scholar 274 Ganz PA, Hirji K, Sim MS, Schag CA, Fred C, Polinsky ML. Predicting psychosocial risk in patients with breast cancer. Med Care 1993 ; 31: 419 -31. Google Scholar 275 August DA, Ehrlich D, Carpenter LC. Patient evaluation of care within a multidisciplinary breast care center. Qual Manag Health Care 1995; 3: 1 -15. Google Scholar 276 Holcombe C, West N, Mansel RE, Horgan K. The satisfaction and savings of early discharge with drain in situ following axillary lymphadenectomy in the treatment of breast cancer. Eur J Surg Oncol 1995; 21: 604 -6. Google Scholar 277 Legorreta AP, Brooks RJ, Leibowitz AN, Solin LJ. Cost of breast cancer treatment. A 4-year longitudinal study. Arch Intern Med 1996 ; 156: 2197 -201. Google Scholar 278 Maunsell E, Brisson J, Deschenes L, Frasure-Smith N. Randomized trial of a psychologic distress screening program after breast cancer: effects on quality of life. J Clin Oncol 1996 ; 14: 2747 -55. Google Scholar 279 Berry MG, al Mufti RA, Jenkinson AD, Denton S, Sullivan M, Vaus A, et al. An audit of outcome including patient satisfaction with immediate breast reconstruction performed by breast surgeons. Ann R Coll Surg Engl 1998; 80: 173 -7. Google Scholar 280 Degner LF, Kristjanson LJ, Bowman D, Sloan JA, Carriere KC, O'Neil J, et al. Information needs and decisional preferences in women with breast cancer. JAMA 1997; 277: 1485 -92. Google Scholar 281 Hayman JA, Fairclough DL, Harris JR, Weeks JC. Patient preferences concerning the trade-off between the risks and benefits of routine radiation therapy after conservative surgery for early-stage breast cancer. J Clin Oncol 1997; 15: 1252 -60. Google Scholar 282 Liljegren G, Karlsson G, Bergh J, Holmberg L. The cost-effectiveness of routine postoperative radiotherapy after sector resection and axillary dissection for breast cancer stage I. Results from a randomized trial. Ann Oncol 1997 ; 8: 757 -63. Google Scholar 283 Andrykowski MA, Curran SL, Lightner R. Off-treatment fatigue in breast cancer survivors: a controlled comparison. J Behav Med 1998 ; 21: 1 -18. Google Scholar 284 Bonnema J, van Wersch AM, van Geel AN, Pruyn JF, Schmitz PI, Paul MA, et al. Medical and psychosocial effects of early discharge after surgery for breast cancer: randomised trial. BMJ 1998 ; 316: 1267 -71. Google Scholar 285 Bonnema J, van Wersch AM, van Geel AN, Pruyn JF, Schmitz PI, Uyl-de Groot CA, et al. Cost of care in a randomised trial of early hospital discharge after surgery for breast cancer. Eur J Cancer 1998 ; 34: 2015 -20. Google Scholar 286 Hayman JA, Hillner BE, Harris JR, Weeks JC. Cost-effectiveness of routine radiation therapy following conservative surgery for early-stage breast cancer. J Clin Oncol 1998 ; 16: 1022 -9. Google Scholar 287 Maslin AM, Baum M, Walker JS, A'Hern R, Prouse A. Using an interactive video disk in breast cancer patient support. Nurs Times 1998; 94: 52 -5. Google Scholar 288 Burstein HJ, Gelber S, Guadagnoli E, Weeks JC. Use of alternative medicine by women with early-stage breast cancer. N Engl J Med 1999 ; 340: 1733 -9. Google Scholar 289 Frost MH, Arvizu RD, Jayakumar S, Schoonover A, Novotny P, Zahasky K. A multidisciplinary healthcare delivery model for women with breast cancer: patient satisfaction and physical and psychosocial adjustment. Oncol Nurs Forum 1999; 26: 1673 -80. Google Scholar 290 Hack TF, Cohen L, Katz J, Robson LS, Goss P. Physical and psychological morbidity after axillary lymph node dissection for breast cancer. J Clin Oncol 1999 ; 17: 143 -9. Google Scholar 291 Wengstrom Y, Haggmark C, Strander H, Forsberg C. Effects of a nursing intervention on subjective distress, side effects and quality of life of breast cancer patients receiving curative radiation therapy—a randomized study. Acta Oncol 1999 ; 38: 763 -70. Google Scholar 292 Wenzel LB, Fairclough DL, Brady MJ, Cella D, Garrett KM, Kluhsman BC, et al. Age-related differences in the quality of life of breast carcinoma patients after treatment. Cancer 1999 ; 86: 1768 -74. Google Scholar 293 Hayman JA, Hillner BE, Harris JR, Pierce LJ, Weeks JC. Cost-effectiveness of adding an electron-beam boost to tangential radiation therapy in patients with negative margins after conservative surgery for early-stage breast cancer. J Clin Oncol 2000 ; 18: 287 -95. Google Scholar 294 Mille D, Roy T, Carrere MO, Ray I, Ferdjaoui N, Spath HM, et al. Economic impact of harmonizing medical practices: compliance with clinical practice guidelines in the follow-up of breast cancer in a French Comprehensive Cancer Center. J Clin Oncol 2000 ; 18: 1718 -24. Google Scholar 295 Palit TK, Miltenburg DM, Brunicardi FC. Cost analysis of breast conservation surgery compared with modified radical mastectomy with and without reconstruction. Am J Surg 2000 ; 179: 441 -5. Google Scholar 296 Whelan TJ, Levine M, Julian J, Kirkbride P, Skingley P. The effects of radiation therapy on quality of life of women with breast carcinoma: results of a randomized trial. Ontario Clinical Oncology Group. Cancer 2000; 88: 2260 -6. Google Scholar 297 Berglund G, Bolund C, Fornander T, Rutqvist LE, Sjoden PO. Late effects of adjuvant chemotherapy and postoperative radiotherapy on quality of life among breast cancer patients. Eur J Cancer 1991 ; 27: 1075 -81. Google Scholar 298 Gelber RD, Bonetti M, Cole BF, Gelber S, Goldhirsch A. Quality of life assessment in the adjuvant setting: is it relevant? International Breast Cancer Study Group. Recent Results Cancer Res 1998 ; 152: 373 -89. Google Scholar 299 Love RR, Cameron L, Connell BL, Leventhal H. Symptoms associated with tamoxifen treatment in postmenopausal women. Arch Intern Med 1991; 151: 1842 -7. Google Scholar 300 Campora E, Naso C, Vitullo MT, Giudici S, Camoirano A, Repetto L, et al. The impact of chemotherapy on the quality of life of breast cancer patients. J Chemother 1992 ; 4: 59 -63. Google Scholar 301 Hillner BE, Smith TJ. A model of chemotherapy in node-negative breast cancer. J Natl Cancer Inst Monogr 1992 ; 11: 143 -9. Google Scholar 302 Hillner BE, Smith TJ, Desch CE. Assessing the cost effectiveness of adjuvant therapies in early breast cancer using a decision analysis model. Breast Cancer Res Treat 1993 ; 25: 97 -105. Google Scholar 303 Smith TJ, Hillner BE. The efficacy and cost-effectiveness of adjuvant therapy of early breast cancer in premenopausal women. J Clin Oncol 1993; 11: 771 -6. Google Scholar 304 Hillner BE, Smith TJ. Should women with node-negative breast cancer receive adjuvant chemotherapy?—Insights from a decision analysis model. Breast Cancer Res Treat 1992 ; 23: 17 -27. Google Scholar 305 Hillner BE, Smith TJ. Efficacy and cost effectiveness of adjuvant chemotherapy in women with node-negative breast cancer. A decision-analysis model. N Engl J Med 1991 ; 324: 160 -8. Google Scholar 306 Clavel M, Soukop M, Greenstreet YL. Improved control of emesis and quality of life with ondansetron in breast cancer. Oncology 1993 ; 50: 180 -5. Google Scholar 307 Cox F, Hirsch J. Ondansetron: a cost-effective advance in anti-emetic therapy. Oncology 1993 ; 50: 186 -90. Google Scholar 308 Mapelli V, Graf vond der Schulenburg JM, Laaser U, Allhoff PG, Rossi F. Economic evaluation of lenograstim (glycosylated rHuG-CSF) in the treatment of inflammatory breast cancer for Germany and Italy. Pharmacoeconomics 1994; 6 Suppl 2: 27-35. Google Scholar 309 Barrenetxea G, Schneider J, Centeno MM, Romero H, de la Rica M, Rodriguez-Escudero FJ. Chemotherapy-induced emesis: management of early and delayed emesis in milder emetogenic regimens. Cancer Chemother Pharmacol 1996; 38: 471 -5. Google Scholar 310 Gelber RD, Cole BF, Goldhirsch A, Rose C, Fisher B, Osborne CK, et al. Adjuvant chemotherapy plus tamoxifen compared with tamoxifen alone for postmenopausal breast cancer: meta-analysis of quality-adjusted survival. Lancet 1996; 347: 1066 -71. Google Scholar 311 Lokich JJ, Moore CL, Anderson NR. Comparison of costs for infusion versus bolus chemotherapy administration: analysis of five standard chemotherapy regimens in three common tumors—Part one. Model projections for cost based on charges. Cancer 1996 ; 78: 294 -9. Google Scholar 312 Longman AJ, Braden CJ, Mishel MH. Side effects burden in women with breast cancer. Cancer Pract 1996 ; 4: 274 -20. Google Scholar 313 Messori A, Becagli P, Trippoli S, Tendi E. Cost-effectiveness of adjuvant chemotherapy with cyclophosphamide+methotrexate+fluorouracil in patients with node-positive breast cancer Eur J Clin Pharmacol 1996 ; 51: 111 -6. Google Scholar [published erratum appears in Eur J Clin Pharmacol 1997 ; 51: 427 ]. Google Scholar 314 Hann DM, Jacobsen PB, Martin SC, Kronish LE, Azzarello LM, Fields KK. Quality of life following bone marrow transplantation for breast cancer: a comparative study. Bone Marrow Transplant 1997 ; 19: 257 -64. Google Scholar 315 Carter KJ, Ritchey NP, Castro F, Caccamo LP, Kessler E, Erickson BA, et al. Treatment of early-stage breast cancer in the elderly: a health-outcome-based approach. Med Decis Making 1998 ; 18: 213 -9. Google Scholar 316 van Dam FS, Schagen SB, Muller MJ, Boogerd W, Wall E, Droogleever Fortuyn ME, et al. Impairment of cognitive function in women receiving adjuvant treatment for high-risk breast cancer: high-dose versus standard-dose chemotherapy. J Natl Cancer Inst 1998 ; 90: 210 -8. Google Scholar 317 Bernhard J, Castiglione-Gertsch M, Schmitz SF, Thurlimann B, Cavalli F, Morant R, et al. Quality of life in postmenopausal patients with breast cancer after failure of tamoxifen: formestane versus megestrol acetate as second-line hormonal treatment. Swiss Group for Clinical Cancer Research (SAKK). Eur J Cancer 1999 ; 35: 913 -20. Google Scholar 318 Day R, Ganz PA, Costantino JP, Cronin WM, Wickerham DL, Fisher B. Health-related quality of life and tamoxifen in breast cancer prevention: a report from the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Clin Oncol 1999; 17: 2659 -69. Google Scholar 319 Gaston-Johansson F, Fall-Dickson JM, Bakos AB, Kennedy MJ. Fatigue, pain, and depression in pre-autotransplant breast cancer patients. Cancer Pract 1999; 7: 240 -7. Google Scholar 320 Hoerger TJ, Downs KE, Lakshmanan MC, Lindrooth RC, Plouffe L Jr, Wendling B, et al. Healthcare use among U.S. women aged 45 and older: total costs and costs for selected postmenopausal health risks. J Women's Health Gend Based Med 1999; 8: 1077 -89. Google Scholar 321 Macquart-Moulin G, Viens P, Genre D, Bouscary ML, Resbeut M, Gravis G, et al. Concomitant chemoradiotherapy for patients with nonmetastatic breast carcinoma: side effects, quality of life, and organization. Cancer 1999; 85: 2190 -9. Google Scholar 322 McKinna F, Gothard L, Ashley S, Ebbs S, Yarnold J. Selective avoidance of lymphatic radiotherapy in the conservative management of women with early breast cancer. Radiother Oncol 1999 ; 52: 219 -23. Google Scholar 323 Silber JH, Fridman M, Shpilsky A, Even-Shoshan O, Smink DS, Jayaraman J, et al. Modeling the cost-effectiveness of granulocyte colony-stimulating factor use in early-stage breast cancer. J Clin Oncol 1998; 16: 2435 -44. Google Scholar 324 Van Tiggelen O, Storme G, Torfs K, Van den Berge D. Using appropriate comparisons in economic evaluations. An exercise in Belgium. Int J Technol Assess Health Care 1999 ; 15: 243 -53. Google Scholar 325 van Enckevort PJ, TenVergert EM, Schrantee S, Rutten FF, de Vries EG. Economic evaluations of systemic adjuvant breast cancer treatments: methodological issues and a critical review. Crit Rev Oncol Hematol 1999; 32: 113 -24. Google Scholar 326 Kramer JA, Curran D, Piccart M, de Haes JC, Bruning P, Klijn J, et al. Identification and interpretation of clinical and quality of life prognostic factors for survival and response to treatment in first-line chemotherapy in advanced breast cancer. Eur J Cancer 2000 ; 36: 1498 -506. Google Scholar 327 Norum J. Adjuvant cyclophosphamide, methotrexate, fluorouracil (CMF) in breast cancer—is it cost-effective? Acta Oncol 2000 ; 39: 33 -9. Google Scholar 328 Pandya KJ, Raubertas RF, Flynn PJ, Hynes HE, Rosenbluth RJ, Kirshner JJ, et al. Oral clonidine in postmenopausal patients with breast cancer experiencing tamoxifen-induced hot flashes: a University of Rochester Cancer Center Community Clinical Oncology Program Study. Ann Intern Med 2000; 132: 788 -93. Google Scholar 329 Vrieling C, Collette L, Fourquet A, Hoogenraad WJ, Horiot JH, Jager JJ, et al. The influence of patient, tumor and treatment factors on the cosmetic results after breast-conserving therapy in the EORTC `boost vs. no boost' trial. EORTC Radiotherapy and Breast Cancer Cooperative Groups. Radiother Oncol 2000; 55: 219 -32. Google Scholar 330 Biermann WA, Cantor RI, Fellin FM, Jakobowski J, Hopkins L, Newbold RC III. An evaluation of the potential cost reductions resulting from the use of clodronate in the treatment of metastatic carcinoma of the breast to bone. Bone 1991; 12 Suppl 1: S37 -S42. Google Scholar 331 Hillner BE, Smith TJ, Desch CE. Efficacy and cost-effectiveness of autologous bone marrow transplantation in metastatic breast cancer. Estimates using decision analysis while awaiting clinical trial results. JAMA 1992; 267: 2055 -61. Google Scholar 332 Koopmanschap MA, van Ineveld BM, Miltenburg TE. Costs of home care for advanced breast and cervical cancer in relation to cost-effectiveness of screening. Soc Sci Med 1992 ; 35: 979 -85. Google Scholar 333 Kornblith AB, Hollis DR, Zuckerman E, Lyss AP, Canellos GP, Cooper MR, et al. Effect of megestrol acetate on quality of life in a dose-response trial in women with advanced breast cancer. The Cancer and Leukemia Group B. J Clin Oncol 1993; 11: 2081 -9. Google Scholar 334 Peters WP, Ross M, Vredenburgh JJ, Hussein A, Rubin P, Dukelow K, et al. The use of intensive clinic support to permit outpatient autologous bone marrow transplantation for breast cancer. Semin Oncol 1994 ; 21(4 Suppl 7): 25 -31. Google Scholar 335 Hayes DF, Van Zyl JA, Hacking A, Goedhals L, Bezwoda WR, Mailliard JA, et al. Randomized comparison of tamoxifen and two separate doses of toremifene in postmenopausal patients with metastatic breast cancer. J Clin Oncol 1995; 13: 2556 -66. Google Scholar 336 McQuellon RP, Muss HB, Hoffman SL, Russell G, Craven B, Yellen SB. Patient preferences for treatment of metastatic breast cancer: a study of women with early-stage breast cancer. J Clin Oncol 1995 ; 13: 858 -68. Google Scholar 337 Hultborn R, Johansson-Terje I, Bergh J, Glas U, Hallsten L, Hatschek T, et al. Second-line endocrine treatment of advanced breast cancer—a randomized cross-over study of medroxy-progesterone acetate and amino-glutethimide. Acta Oncol 1996 ; 35 Suppl 5: 75 . Google Scholar 338 Hultborn R, Gundersen S, Ryden S, Holmberg E, Carstensen J, Wallgren UB, et al. Efficacy of pamidronate in breast cancer with bone metastases: a randomized double-blind placebo controlled multicenter study. Acta Oncol 1996; 35 Suppl 5: 73 -4. Google Scholar 339 Jonat W, Howell A, Blomqvist C, Eiermann W, Winblad G, Tyrrell C, et al. A randomised trial comparing two doses of the new selective aromatase inhibitor anastrozole (Arimidex) with megestrol acetate in postmenopausal patients with advanced breast cancer. Eur J Cancer 1996 ; 32A: 404 -12. Google Scholar 340 Launois R, Reboul-Marty J, Henry B, Bonneterre J. A cost-utility analysis of second-line chemotherapy in metastatic breast cancer. Docetaxel versus paclitaxel versus vinorelbine. Pharmacoeconomics 1996 ; 10: 504 -21. Google Scholar 341 van Holten-Verzantvoort AT, Hermans J, Beex LV, Blijham G, Cleton FJ, Eck-Smit BC, et al. Does supportive pamidronate treatment prevent or delay the first manifestation of bone metastases in breast cancer patients? Eur J Cancer 1996; 32A: 450 -4. Google Scholar 342 Bates M, Lieu D, Zagari M, Spiers A, Williamson T. A pharmacoeconomic evaluation of the use of dexrazoxane in preventing anthracycline-induced cardiotoxicity in patients with stage IIIB or IV metastatic breast cancer. Clin Ther 1997 ; 19: 167 -84. Google Scholar 343 Joensuu H, Holli K, Heikkinen M, Suonio E, Aro AR, Hietanen P, et al. Combination chemotherapy versus single-agent therapy as first- and second-line treatment in metastatic breast cancer: a prospective randomized trial. J Clin Oncol 1998 ; 16: 3720 -30. Google Scholar 344 Brown RE, Hutton J. Cost-utility model comparing docetaxel and paclitaxel in advanced breast cancer patients. Anticancer Drugs 1998 ; 9: 899 -907. Google Scholar 345 Cobleigh MA, Vogel CL, Tripathy D, Robert NJ, Scholl S, Fehrenbacher L, et al. Multinational study of the efficacy and safety of humanized anti-HER2 monoclonal antibody in women who have HER2-overexpressing metastatic breast cancer that has progressed after chemotherapy for metastatic disease. J Clin Oncol 1999 ; 17: 2639 -48. Google Scholar 346 Cotton SP, Levine EG, Fitzpatrick CM, Dold KH, Targ E. Exploring the relationships among spiritual well-being, quality of life, and psychological adjustment in women with breast cancer Psychooncology 1999; 8: 429 -38. Google Scholar [published erratum appears in Psychooncology 2000 ; 9: 89 ]. Google Scholar 347 Hultborn R, Gundersen S, Ryden S, Holmberg E, Carstensen J, Wallgren UB, et al. Efficacy of pamidronate in breast cancer with bone metastases: a randomized, double-blind placebo-controlled multicenter study. Anticancer Res 1999; 19: 3383 -92. Google Scholar 348 Kristensen B, Ejlertsen B, Groenvold M, Hein S, Loft H, Mouridsen HT. Oral clodronate in breast cancer patients with bone metastases: a randomized study. J Intern Med 1999 ; 246: 67 -74. Google Scholar 349 Leung PP, Tannock IF, Oza AM, Puodziunas A, Dranitsaris G. Cost-utility analysis of chemotherapy using paclitaxel, docetaxel, or vinorelbine for patients with anthracycline-resistant breast cancer. J Clin Oncol 1999; 17: 3082 -90. Google Scholar 350 Nabholtz JM, Senn HJ, Bezwoda WR, Melnychuk D, Deschenes L, Douma J, et al. Prospective randomized trial of docetaxel versus mitomycin plus vinblastine in patients with metastatic breast cancer progressing despite previous anthracycline-containing chemotherapy. 304 Study Group. J Clin Oncol 1999; 17: 1413 -24. Google Scholar 351 Nabholtz JM, Thuerlimann B, Bezwoda WR, Melnychuk D, Deschenes L, Douma J, et al. Docetaxel vs mitomycin plus vinblastine in anthracycline-resistant metastatic breast cancer. Oncology (Huntingt) 1997; 11(8 Suppl 8): 25 -30. Google Scholar 352 Nuijten M, Meester L, Waibel F, Wait S. Cost effectiveness of letrozole in the treatment of advanced breast cancer in postmenopausal women in the UK. Pharmacoeconomics 1999 ; 16: 379 -97. Google Scholar 353 Osoba D, Burchmore M. Health-related quality of life in women with metastatic breast cancer treated with trastuzumab (herceptin). Semin Oncol 1999; 26(4 Suppl 12): 84 -8. Google Scholar 354 Burgess CC, Ramirez AJ, Smith P, Richards MA. Do adverse life events and mood disorders influence delayed presentation of breast cancer? J Psychosom Res 2000; 48: 171 -5. Google Scholar 355 Geels P, Eisenhauer E, Bezjak A, Zee B, Day A. Palliative effect of chemotherapy: objective tumor response is associated with symptom improvement in patients with metastatic breast cancer. J Clin Oncol 2000 ; 18: 2395 -405. Google Scholar 356 Hakamies-Blomqvist L, Luoma M, Sjostrom J, Pluzanska A, Sjodin M, Mouridsen H, et al. Quality of life in patients with metastatic breast cancer receiving either docetaxel or sequential methotrexate and 5-fluorouracil. A multicentre randomised phase III trial by the Scandinavian breast group. Eur J Cancer 2000; 36: 1411 -7. Google Scholar 357 Hillner BE, Weeks JC, Desch CE, Smith TJ. Pamidronate in prevention of bone complications in metastatic breast cancer: a cost-effectiveness analysis. J Clin Oncol 2000 ; 18: 72 -9. Google Scholar 358 Kaufmann M, Bajetta E, Dirix LY, Fein LE, Jones SE, Zilembo N, et al. Exemestane is superior to megestrol acetate after tamoxifen failure in postmenopausal women with advanced breast cancer: results of a phase III randomized double-blind trial. The Exemestane Study Group. J Clin Oncol 2000; 18: 1399 -411. Google Scholar 359 Kramer JA, Curran D, Piccart M, de Haes JC, Bruning PF, Klijn JG, et al. Randomised trial of paclitaxel versus doxorubicin as first-line chemotherapy for advanced breast cancer: quality of life evaluation using the EORTC QLQ-C30 and the Rotterdam symptom checklist. Eur J Cancer 2000 ; 36: 1488 -97. Google Scholar 360 Lipton A, Theriault RL, Hortobagyi GN, Simeone J, Knight RD, Mellars K, et al. Pamidronate prevents skeletal complications and is effective palliative treatment in women with breast carcinoma and osteolytic bone metastases: long term follow-up of two randomized, placebo-controlled trials. Cancer 2000; 88: 1082 -90. Google Scholar 361 Norris B, Pritchard KI, James K, Myles J, Bennett K, Marlin S, et al. Phase III comparative study of vinorelbine combined with doxorubicin versus doxorubicin alone in disseminated metastatic/recurrent breast cancer: National Cancer Institute of Canada Clinical Trials Group Study MA8. J Clin Oncol 2000; 18: 2385 -94. Google Scholar 362 Hannisdal E, Gundersen S, Kvaloy S, Lindegaard MW, Aas M, Finnanger AM, et al. Follow-up of breast cancer patients stage I-II: a baseline strategy. Eur J Cancer 1993 ; 29A: 992 -7. Google Scholar 363 Holli K, Hakama M. Biological, physical, mental and social dimensions of breast cancer: information based on routine case notes. Eur J Cancer 1993; 29A: 2152 -5. Google Scholar 364 The GIVIO Investigators. Impact of follow-up testing on survival and health-related quality of life in breast cancer patients. A multicenter randomized controlled trial. JAMA 1994 ; 271: 1587 -92. Google Scholar 365 Mor V, Malin M, Allen S. Age differences in the psychosocial problems encountered by breast cancer patients. J Natl Cancer Inst Monogr 1994; 16: 191 -7. Google Scholar 366 Coleman EA, Coon SK, Thompson PJ, Lemon SJ, Depuy RS. Impact of silicone implants on the lives of women with breast cancer. Oncol Nurs Forum 1995; 22: 1493 -500. Google Scholar 367 German Breast Cancer Study Group. Therapy of small breast cancer—four-year results of a prospective non-randomized study. German Breast Cancer Study Group (GBSG). Breast Cancer Res Treat 1995 ; 34: 1 -13. Google Scholar 368 Paradiso A, Nitti P, Frezza P, Scorpiglione N. A survey in Puglia: the attitudes and opinions of specialists, general physicians and patients on follow-up practice. G.S.Bio.Ca.M. Ann Oncol 1995 ; 6 Suppl 2: 53 -6. Google Scholar 369 Tasmuth T, von Smitten K, Hietanen P, Kataja M, Kalso E. Pain and other symptoms after different treatment modalities of breast cancer. Ann Oncol 1995; 6: 453 -9. Google Scholar 370 Grunfeld E, Mant D, Yudkin P, Adewuyi-Dalton R, Cole D, Stewart J, et al. Routine follow up of breast cancer in primary care: randomised trial. BMJ 1996; 313: 665 -9. Google Scholar 371 Adewuyi-Dalton R, Ziebland S, Grunfeld E, Hall A. Patients' views of routine hospital follow-up: a qualitative study of women with breast cancer in remission. Psychooncology 1998 ; 7: 436 -9. Google Scholar 372 Gulliford T, Opomu M, Wilson E, Hanham I, Epstein R. Popularity of less frequent follow up for breast cancer in randomised study: initial findings from the hotline study. BMJ 1997 ; 314: 174 -7. Google Scholar 373 Poulsen B, Graversen HP, Beckmann J, Blichert-Toft M. A comparative study of post-operative psychosocial function in women with primary operable breast cancer randomized to breast conservation therapy or mastectomy. Eur J Surg Oncol 1997; 23: 327 -34. Google Scholar 374 Tate DG, Riley BB, Perna R, Roller S. Quality of life issues among women with physical disabilities or breast cancer. Arch Phys Med Rehabil 1997; 78(12 Suppl 5): S18 -S25. Google Scholar 375 Carpenter JS, Andrykowski MA, Sloan P, Cunningham L, Cordova MJ, Studts JL, et al. Postmastectomy/postlumpectomy pain in breast cancer survivors. J Clin Epidemiol 1998 ; 51: 1285 -92. Google Scholar 376 Carpenter JS, Andrykowski MA, Cordova M, Cunningham L, Studts J, McGrath P, et al. Hot flashes in postmenopausal women treated for breast carcinoma: prevalence, severity, correlates, management, and relation to quality of life. Cancer 1998 ; 82: 1682 -91. Google Scholar 377 Jahkola T. Self-perceptions of women after early breast cancer surgery. Eur J Surg Oncol 1998 ; 24: 9 -14. Google Scholar 378 Velanovich V, Szymanski W. Quality of life of breast cancer patients with lymphedema. Am J Surg 1999 ; 177: 184 -7. Google Scholar 379 Andersen MR, Urban N. Involvement in decision-making and breast cancer survivor quality of life. Ann Behav Med 1999 ; 21: 201 -9. Google Scholar 380 Carpenter JS, Andrykowski MA. Menopausal symptoms in breast cancer survivors. Oncol Nurs Forum 1999 ; 26: 1311 -7. Google Scholar 381 Bower JE, Ganz PA, Desmond KA, Rowland JH, Meyerowitz BE, Belin TR. Fatigue in breast cancer survivors: occurrence, correlates, and impact on quality of life. J Clin Oncol 2000 ; 18: 743 -53. Google Scholar 382 Demark-Wahnefried W, Peterson B, McBride C, Lipkus I, Clipp E. Current health behaviors and readiness to pursue life-style changes among men and women diagnosed with early stage prostate and breast carcinomas. Cancer 2000; 88: 674 -84. Google Scholar © Oxford University Press
JNCI Monographs – Oxford University Press
Published: Oct 1, 2004
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