Randomized, controlled trial investigating short-term health-related quality of life with doxorubicin and paclitaxel versus doxorubicin and cyclophosphamide as first-line chemotherapy in patients with metastatic breast cancer: European Organization for Research and Treatment of Cancer Breast Cancer Group, Investigational Drug Branch for Breast Cancer and the New Drug Development Group Study.

PURPOSE: To compare health-related quality of life (HRQOL) in patients with metastatic breast cancer receiving the combination of doxorubicin and paclitaxel (AT) or doxorubicin and cyclophosphamide (AC) as first-line chemotherapy treatment. PATIENTS AND METHODS: Eligible patients (n = 275) with anthracycline-naive measurable metastatic breast cancer were randomly assigned to AT (doxorubicin 60 mg/m(2) as an intravenous bolus plus paclitaxel 175 mg/m(2) as a 3-hour infusion) or AC (doxorubicin 60 mg/m(2) plus cyclophosphamide 600 mg/m(2)) every 3 weeks for a maximum of six cycles. Dose escalation of paclitaxel (200 mg/m(2)) and cyclophosphamide (750 mg/m(2)) was planned at cycle 2 to reach equivalent myelosuppression in the two groups. HRQOL was assessed with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire C30 and the EORTC Breast Module at baseline and the start of cycles 2, 4, and 6, and 3 months after the last cycle. RESULTS: Seventy-nine percent of the patients (n = 219) completed a baseline measure. However, there were no statistically significant differences in HRQOL between the two treatment groups. In both groups, selected aspects of HRQOL were impaired over time, with increased fatigue, although some clinically significant improvements in emotional functioning were seen, as well as a reduction in pain over time. Overall, global quality of life was maintained in both treatment groups. CONCLUSION: This information is important when advising women patients of the expected HRQOL consequences of treatment regimens and should help clinicians and their patients make informed treatment decisions.

A comprehensive life cycle water analysis framework for residential buildings

Most studies on the environmental performance of buildings focus on energy demand and associated greenhouse gas emissions. They often neglect to consider the range of other resource demands and environmental impacts associated with buildings, including water. Studies that assess water use in buildings typically consider only operational water, which excludes the embodied water in building materials or the water associated with the mobility of building occupants. A new framework is presented that quantifies water requirements at the building scale (i.e. the embodied and operational water of the building as well as its maintenance and refurbishment) and at the city scale (i.e. the embodied water of nearby infrastructures such as roads, gas distribution and others) and the transport-related indirect water use of building occupants. A case study house located in Melbourne, Australia, is analysed using the new framework. The results show that each of the embodied, operational and transport requirements is nearly equally important. By integrating these three water requirements, the developed framework provides architects, building designers, planners and decision-makers with a powerful means to understand and effectively reduce the overall water use and associated environmental impacts of residential buildings.