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Huebner J, Rosé C, Geissler J, Gleiter CH, Prott FJ, Muenstedt K, Micke O, Muecke R, Buentzel J, Bottomley A, Hofheinz RD. Integrating cancer patients' perspectives into treatment decisions and treatment evaluation using patient-reported outcomes--a concept paper. Eur J Cancer Care (Engl) 2013; 23:173-9. [PMID: 23889081 DOI: 10.1111/ecc.12095] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2013] [Indexed: 11/27/2022]
Abstract
Patient-reported outcomes are an important tool in clinical research. In the setting of cancer treatments, benefit of therapy is essentially characterised by improvement of survival as well as quality of life (QoL). A standardised instrument to assess QoL is the standardised QoL questionnaire of the European Organisation for Research and Treatment (EORTC QLQ-C30 questionnaire). QoL instruments provide data on different aspects (domains) of the framework of QoL. Using these questionnaires in studies provides data on how a treatment affects QoL in a group of patients. The goal of our concept is to individualise QoL and to use validated instruments in order to integrate patients' perspectives and aims into treatment assessment, planning and control. We propose to use the domains of the EORTC QLQ-C30 and to ask the patient to determine which objectives besides survival are relevant for him and should be achieved by treatment. These individual goals can be used in a process of shared decision-making to choose and monitor treatment. In clinical studies, this approach would allow to recruit more patients who would most probably benefit from the therapy. In addition, supportive data could be gathered in correlation to treatment goals and actual benefits.
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Affiliation(s)
- J Huebner
- Dr. Senckenberg Chronomedical Institute, J. W. Goethe University Frankfurt/Main, Frankfurt
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De Aguiar SS, Bergmann A, Mattos IE. Quality of life as a predictor of overall survival after breast cancer treatment. Qual Life Res 2013; 23:627-37. [PMID: 23873516 DOI: 10.1007/s11136-013-0476-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To describe quality of life (QoL) in a cohort of surviving women 4 years after breast cancer treatment and to analyze its role as a predictor of mortality within 2 years. METHODS This is a prospective cohort study of 544 women who have undergone surgical treatment, from 2001 to 2002 and who answered a questionnaire about QoL in 2006. After, we conducted a survival study to evaluate the association between QoL and mortality within 2 years with the same population. We conducted factor analysis between the variables of the scales of function and symptoms. Survival analysis was conducted by Kaplan-Meier, and differences in survival curves were assessed with the log-rank test, assuming significant statistical level of 5 %. The Cox proportional hazards regression model was used to explore the relationship between QoL variables (functional scales) and prognostic value for survival. RESULTS The mean age of the women was 59.1 years (SD 11.66). The mean of overall QoL score was 75.16 (SD 20.93). Using factor analysis, we identified three conditions that made up the construct of QoL in this group of patients: social, psycho-emotional, and physical. Social condition was the most important factor. After assessment of QoL, the mean survival was 23 months (SD 3.90). Women who reported worse future perspective had higher chance of death compared with women better prospect of future (HR = 3.46; 95 % CI 1.36-8.79; p value = 0.009). CONCLUSION Future perspectives were predictors of mortality, which reinforce the relevance of social support and psychological aspects for these women.
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Affiliation(s)
- Suzana Sales De Aguiar
- National Cancer Institute and National School of Public Health, Rio de Janeiro, RJ, Brazil,
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Longitudinal health-related quality of life assessment implications for prognosis in stage IV pancreatic cancer. Pancreas 2013; 42:254-9. [PMID: 22850626 DOI: 10.1097/mpa.0b013e31825b9f56] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES We investigated whether changes in quality of life (QoL) during treatment could predict survival in stage IV pancreatic cancer. METHODS Quality of life was evaluated at baseline and after 3 months of treatment using European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) in 186 patients with stage IV pancreatic cancer. Cox regression evaluated the prognostic significance of baseline and changes in QoL scores after adjusting for age, sex, and treatment history. RESULTS One hundred twenty-one patients were males and 65 were females. One hundred twenty-seven patients' condition was newly diagnosed, whereas 59 were previously treated. The mean age at diagnosis was 55.1 years. Baseline QoL scale predictive of survival upon multivariate analysis was global health (hazard ratio, 0.88; 95% confidence interval, 0.81-0.95; P = 0.001). On multivariate analysis, QoL change variable that was significantly predictive of survival after 3 months of treatment was cognitive function (hazard ratio, 0.89; 95% confidence interval, 0.79-0.99; P = 0.04). CONCLUSIONS This study provides preliminary evidence to indicate that patients with stage IV pancreatic cancer who have a better global health at baseline as well as those whose cognitive function improves within 3 months of treatment have a significantly increased probability of survival.
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Assessment of general characteristics of patients with primary metastatic breast carcinoma: single center experience. Contemp Oncol (Pozn) 2013; 17:450-5. [PMID: 24596535 PMCID: PMC3934020 DOI: 10.5114/wo.2013.37543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Revised: 05/27/2013] [Accepted: 06/11/2013] [Indexed: 12/04/2022] Open
Abstract
Introduction Breast cancer (BC) is a heterogeneous disease. Several subgroups have been identified, according to the clinical presentation and radiographic, pathological, biological, and molecular characteristics of the tumor. Intrinsic genetic heterogeneity may be responsible for these differences. To date, little is known about the clinical features and outcome of patients with primary metastatic BC (PMBC) defined as those presenting with stage IV disease. Material and methods Between September 2007 and May 2011, BC patients who were admitted to a clinic were assessed. Patients with PMBC were included in this retrospective analysis. The patients’ demographic characteristics, treatment schedules, and survival data were recorded. Results Of 2478 BC patients, 102 (4.1%) with PMBC were included in the analysis. The median age of the patients was 50 (26–90) years. Only four patients (3.9%) had previously undergone mammography. The median progression-free survival (PFS) and overall survival (OS) were 30 and 66 months, respectively. The PFS and OS were unaffected by age, menopausal status, ECOG, histology, or tumor grade. Both PFS and OS were affected by HR status (log rank p = 0.006, log rank p = 0.04), HER2 status (p = 0.001, p = 0.005), site of metastasis (p = 0.01, p = 0.04), radiotherapy (p = 0.04, OS p = 0.03), and bisphosphonate treatment (p = 0.02, p = 0.006). PFS was greater in the hormone therapy group (43 months, p = 0.03) while OS was greater in the patients that received chemotherapy (76 months, p = 0.01). Conclusions Mammography should be given greater emphasis, considering its importance in the prevention of PMBC. As a treatment option for bone and soft tissue metastatic PMBC patients, hormone therapy should be effective as a first-line treatment.
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Gupta D, Lis CG, Grutsch JF. The European organization for research and treatment of cancer quality of life questionnaire: implications for prognosis in pancreatic cancer. ACTA ACUST UNITED AC 2012; 37:65-73. [PMID: 17827524 DOI: 10.1007/s12029-007-0001-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/1999] [Revised: 11/30/1999] [Accepted: 11/30/1999] [Indexed: 11/12/2022]
Abstract
BACKGROUND The goal of this study was to evaluate the association between patient quality of life (QoL) and survival in pancreatic cancer patients undergoing care in a community hospital comprehensive cancer center. PATIENTS AND METHODS A consecutive case series of 55 histologically confirmed pancreatic cancer treated at Cancer Treatment Centers of America® at Midwestern Regional Medical Center was studied between 04/01 and 11/04. The EORTC QLQ-C30 was utilized to assess patient QoL. Kaplan-Meier method was used to calculate survival. Log-rank test was used to study the equality of survival distributions. Multivariate Cox regression analyses were then performed to evaluate the joint prognostic significance of those QoL and clinical factors that were shown to be prognostic upon univariate analyses. RESULTS Of the 55 patients, 28 were newly diagnosed and 27 had prior treatment history. The median age was 55 years (range 33-74 years). Majority (34) had stage IV disease at diagnosis. The QLQ-C30 parameters to show statistically significant associations with survival were physical, role, and emotional functioning scales and fatigue, appetite loss, constipation, and diarrhea symptom scales. CONCLUSIONS We found that patient QoL, as measured by the QLQ-C30 physical functioning scale, provides useful prognostic information, independent of multiple cancer symptoms, in patients with pancreatic cancer. While these findings require further investigation in large patient cohorts, they may have important implications for patient stratification in clinical trials, as well as aid in clinical decision making.
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Affiliation(s)
- Digant Gupta
- Cancer Treatment Centers of America® (CTCA) at Midwestern Regional Medical Center, Zion, IL, USA.
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Efficace F, Cartoni C, Niscola P, Tendas A, Meloni E, Scaramucci L, Soldati S, Brunetti GA, Marini MG, Mandelli F. Predicting survival in advanced hematologic malignancies: do patient-reported symptoms matter? Eur J Haematol 2012; 89:410-6. [PMID: 22985353 DOI: 10.1111/ejh.12004] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate whether patient-reported symptoms provide independent prognostic information for survival in patients with hematological malignancies. STUDY DESIGN AND SETTING Overall 119 patients with various diagnoses were recruited in an observational study and symptoms were assessed with the M.D. Anderson Symptom Inventory (MDASI). Key potential socio-demographic, biomedical, and physician-reported prognostic candidates were also considered. The Cox proportional hazards regression model was used for both univariate and multivariate analyses of survival. Additional sensitivity analysis, based on 500 bootstrap-generated simulation datasets, was also performed to confirm the results obtained with the Cox regression model. RESULTS The median survival of the entire cohort was 4.8 months (range 0-28 months). The MDASI was completed at baseline by 91% of patients. The final multivariate model retained two parameters as independent prognostic factors for survival: clinical prognostic group and patient's self-reported severity of drowsiness. The following hazard ratios (HR) were found for curable vs. terminal: 0.055 (95% CI, 0.022-0.136; P < 0.001) and 0.193 (95% CI, 0.103-0.362: P < 0.001) for advanced vs. terminal. Patient's self-reported severity of drowsiness independently predicted survival with a HR of 1.801 (95% CI, 1.044-3.107; P = 0.033). Additional sensitivity analysis confirmed the independent prognostic value of variables identified in this study. CONCLUSION The results suggest that patients' self-reporting of symptoms provides independent prognostic information for survival in patients with hematologic malignancies. These findings underscore the value of collecting patient-reported symptom data in routine clinical practice.
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Affiliation(s)
- Fabio Efficace
- Data Center and Health Outcomes Research Unit, Italian Group for Adult Hematologic Diseases, Rome, Italy.
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Li TC, Li CI, Tseng CH, Lin KS, Yang SY, Chen CY, Hsia TC, Lee YD, Lin CC. Quality of life predicts survival in patients with non-small cell lung cancer. BMC Public Health 2012; 12:790. [PMID: 22978682 PMCID: PMC3573998 DOI: 10.1186/1471-2458-12-790] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 07/13/2012] [Indexed: 01/21/2023] Open
Abstract
Background Patients with non-small cell lung cancer (NSCLC) have a poor prognosis. The objective of this study was to examine the relationship of EORTC QLQ-C30 and QLQ-LC13 and survival in patients with NSCLC undergoing different treatments. Methods Investigators conducted a health-related quality of life (HRQOL) survey of 488 patients with NSCLC: 162 patients undergoing surgery, 312 patients without surgery, and their survival status was prospectively followed up. EORTC QLQ-C30 and QLQ-LC13 scores and clinical variables at baseline were analyzed using Cox’s proportional hazard regression to identify factors that influenced survival. Results Median survival of these 474 patients was 9.82 months. After adjustment, emotional functioning scale, and symptom scales of pain and nausea/vomiting are associated with survival in NSCLC patients with surgery whereas social functioning scale, and symptom scales for fatigue, appetite loss, and financial problems had a significant impact on survival in NSCLC patients without surgery. The results of multivariate analysis showed that none of QLQ-LC13 scales are significant predictors of survival. After simultaneously considering these scales, we found significant independent predictors of survival were nausea/vomiting (HR = 0.11, 95% CI = 0.02-0.63 for score >0 compared with =0) in NSCLC patients with surgery and appetite loss (HR = 1.77, 95% CI = 1.26-2.49 for score >0 compared with =0) in NSCLC patients without surgery. Conclusions HRQOL provides additional predictive information that supplements traditional clinical factors, and is a new prognostic indicator for survival of NSCLC patients under different treatments.
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Affiliation(s)
- Tsai-Chung Li
- Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan
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REED E, KÖSSLER I, HAWTHORN J. Quality of life assessments in advanced breast cancer: should there be more consistency? Eur J Cancer Care (Engl) 2012; 21:565-80. [DOI: 10.1111/j.1365-2354.2012.01370.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Trajkovic-Vidakovic M, de Graeff A, Voest EE, Teunissen SCCM. Symptoms tell it all: a systematic review of the value of symptom assessment to predict survival in advanced cancer patients. Crit Rev Oncol Hematol 2012; 84:130-48. [PMID: 22465016 DOI: 10.1016/j.critrevonc.2012.02.011] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 02/14/2012] [Accepted: 02/29/2012] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To determine the prognostic meaning of symptoms in patients with advanced cancer. DESIGN Medline, Embase, Cochrane and Cinahl databases were systematically explored. The predicting symptoms were also evaluated in the three stages of palliative care: disease-directed palliation, symptom-oriented palliation and palliation in the terminal stage. RESULTS Out of 3167 papers, forty-four papers satisfied all criteria. Confusion, anorexia, fatigue, cachexia, weight loss, cognitive impairment, drowsiness, dyspnea, dysphagia, dry mouth and depressed mood were associated with survival in ≥ 50% of the studies evaluating these symptoms. Multivariate analysis showed confusion, anorexia, fatigue, cachexia, weight loss, dyspnea and dysphagia as independent prognostic factors in 30-56% of the studies. In the stage of disease-directed palliation anorexia, cachexia, weight loss, dysphagia and pain and in the stage of symptom-oriented palliation confusion, fatigue, cachexia, weight loss, dyspnea, dysphagia and nausea were shown to be independent predictors of survival in >30% of the studies. CONCLUSION Symptoms with independent predictive value are confusion, anorexia, fatigue, cachexia, weight loss, dyspnea and dysphagia. New insights are added by the variance between the three palliative stages.
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Affiliation(s)
- Marija Trajkovic-Vidakovic
- Department of Medical Oncology, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
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GUPTA D, BRAUN D, STAREN E. Association between changes in quality of life scores and survival in non-small cell lung cancer patients. Eur J Cancer Care (Engl) 2012; 21:614-22. [DOI: 10.1111/j.1365-2354.2012.01332.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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ZHANG LINGYUN, TENG YUEE, ZHANG YE, LIU JING, XU LING, QU JINGLEI, HOU KEZUO, YANG XIANGHONG, LIU YUNPENG, QU XIUJUAN. c-Src expression is predictive of poor prognosis in breast cancer patients with bone metastasis, but not in patients with visceral metastasis. APMIS 2012; 120:549-57. [DOI: 10.1111/j.1600-0463.2011.02864.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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La décision d’arrêt de la chimiothérapie chez les patientes atteintes de cancer du sein métastatique. ONCOLOGIE 2011. [DOI: 10.1007/s10269-011-2099-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Abstract
While the use of quality of life (QoL) assessments has been increasing in oncology, few studies have examined the prognostic significance of QoL in breast cancer. We investigated the association between QoL at presentation and survival in breast cancer. We examined 1,511 breast cancer patients treated at two single-system cancer centers between January 2001 and December 2008. QoL was evaluated using the validated survey instrument EORTC-QLQ-C30. Patient survival was defined as the time interval between the date of first patient visit and the date of death from any cause/date of last contact. Univariate and multivariate Cox regression analyses were performed to evaluate the prognostic significance of QoL after controlling for the effects of age, tumor stage, and prior treatment history. Mean age at presentation was 52.5 years. There were 590 analytic and 921 non-analytic patients. Patient stage of disease at diagnosis was I, 335; II, 591; III, 290; IV, 159; and 136 indeterminate. Median overall survival was 32.8 months (95% CI: 27.6-38.0). On univariate analysis, QoL function and symptom scales that were predictive of survival were physical (p < 0.001), role (p < 0.001), cognitive (p = 0.003), social (p < 0.001), fatigue (p < 0.001), nausea/vomiting (p < 0.001), pain (p < 0.001), dyspnea (p < 0.001), loss of appetite (p < 0.001), and constipation (p < 0.001). On multivariate analyses, only role function (degree of impairment of work and/or leisure/hobby related activities) was significantly associated with survival. This study suggests that baseline QoL (in particular, the role function) provides useful prognostic information in breast cancer.
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Affiliation(s)
- Edgar D Staren
- Office of Clinical Research, Cancer Treatment Centers of America® (CTCA) at Midwestern Regional Medical Center, Zion, Illinois, USA.
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Braun DP, Gupta D, Staren ED. Quality of life assessment as a predictor of survival in non-small cell lung cancer. BMC Cancer 2011; 11:353. [PMID: 21843358 PMCID: PMC3171386 DOI: 10.1186/1471-2407-11-353] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 08/15/2011] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There are conflicting and inconsistent results in the literature on the prognostic role of quality of life (QoL) in cancer. We investigated whether QoL at admission could predict survival in lung cancer patients. METHODS The study population consisted of 1194 non-small cell lung cancer patients treated at our institution between Jan 2001 and Dec 2008. QoL was evaluated using EORTC-QLQ-C30 prior to initiation of treatment. Patient survival was defined as the time interval between the date of first patient visit and the date of death from any cause/date of last contact. Univariate and multivariate Cox regression evaluated the prognostic significance of QoL. RESULTS Mean age at presentation was 58.3 years. There were 605 newly diagnosed and 589 previously treated patients; 601 males and 593 females. Stage of disease at diagnosis was I, 100; II, 63; III, 348; IV, 656; and 27 indeterminate. Upon multivariate analyses, global QoL as well as physical function predicted patient survival in the entire study population. Every 10-point increase in physical function was associated with a 10% increase in survival (95% CI = 6% to 14%, p < 0.001). Similarly, every 10-point increase in global QoL was associated with a 9% increase in survival (95% CI = 6% to 11%, p < 0.001). Furthermore, physical function, nausea/vomiting, insomnia, and diarrhea (p < 0.05 for all) in newly diagnosed patients, but only physical function (p < 0.001) in previously treated patients were predictive of survival. CONCLUSIONS Baseline global QoL and physical function provide useful prognostic information in non-small cell lung cancer patients.
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Affiliation(s)
- Donald P Braun
- Cancer Treatment Centers of America® at Midwestern Regional Medical Center, Zion, IL 60099, USA
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Braun DP, Gupta D, Grutsch JF, Staren ED. Can changes in health related quality of life scores predict survival in stages III and IV colorectal cancer? Health Qual Life Outcomes 2011; 9:62. [PMID: 21812962 PMCID: PMC3162879 DOI: 10.1186/1477-7525-9-62] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2011] [Accepted: 08/03/2011] [Indexed: 01/12/2023] Open
Abstract
Background Several studies have demonstrated the predictive significance on survival of baseline quality of life (QoL) in colorectal cancer (CRC) with little information on the impact of changes in QoL scores on prognosis in CRC. We investigated whether changes in QoL during treatment could predict survival in CRC. Methods We evaluated 396 stages III-IV CRC patients available for a minimum follow-up of 3 months. QoL was evaluated at baseline and after 3 months of treatment using EORTC QLQ-C30. Cox regression evaluated the prognostic significance of baseline, 3-month and changes in QoL scores after adjusting for age, gender and stage at diagnosis. Results After adjusting for covariates, every 10-point increase in both baseline appetite loss and global QoL score was associated with a 7% increased risk of death with HR = 1.07 (95% CI, 1.01-1.14; P = 0.02) and (HR = 0.93 (95% CI, 0.87-0.98; P = 0.01) respectively. A lower risk of death was associated with a 10-point improvement in physical function at 3 months (HR, 0.86; 95% CI, 0.78-0.94; P = 0.001). Surprisingly, a higher risk of death was associated with a 10-point improvement in social function at 3 months (HR, 1.08; 95% CI, 1.02-1.13; P = 0.008). Conclusions This study provides preliminary evidence to indicate that CRC patients whose physical function improves within 3 months of treatment have a significantly increased probability of survival. These findings should be used in clinical practice to systematically address QoL-related problems of CRC patients throughout their treatment course.
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Affiliation(s)
- Donald P Braun
- Office of Clinical Research, Cancer Treatment Centers of America® (CTCA) at Midwestern Regional Medical Center, 2520 Elisha Ave,, Zion, IL 60099, USA
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Cella D, Cappelleri JC, Bushmakin A, Charbonneau C, Li JZ, Kim ST, Chen I, Michaelson MD, Motzer RJ. Quality of life predicts progression-free survival in patients with metastatic renal cell carcinoma treated with sunitinib versus interferon alfa. J Oncol Pract 2011; 5:66-70. [PMID: 20856722 DOI: 10.1200/jop.0922004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In a randomized phase III trial, sunitinib was associated with significantly superior progression-free survival when compared with interferon alfa as first-line therapy in patients with metastatic renal cell carcinoma. This article investigates whether baseline quality of life and demographic and clinical variables were predictive for progression-free survival.
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Affiliation(s)
- David Cella
- Center on Outcomes, Research and Education, Evanston Northwestern Healthcare, Evanston, IL; Pfizer Global Research and Development, Groton, CT, La Jolla, CA, and New York; Memorial Sloan-Kettering Cancer Center, New York, NY; and Massachusetts General Hospital Cancer Center, Boston, MA
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Braun DP, Gupta D, Staren ED. Predicting survival in prostate cancer: the role of quality of life assessment. Support Care Cancer 2011; 20:1267-74. [PMID: 21710307 PMCID: PMC3342489 DOI: 10.1007/s00520-011-1213-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 06/06/2011] [Indexed: 11/15/2022]
Abstract
Purpose While the use of quality of life (QoL) assessment has been increasing in clinical oncology, few studies have examined its prognostic significance in prostate cancer. We investigated the association between QoL at presentation and survival in prostate cancer. Methods We retrospectively reviewed 673 patients treated at two single-system cancer centers between January 2001 and December 2008. QoL was evaluated using EORTC-QLQ-C30. Patient survival was defined as the time interval between the date of first patient visit and the date of death/date of last contact. Univariate and multivariate Cox regression was performed to evaluate the prognostic significance of QoL. Results Mean age at presentation was 63.2 years. Patient stage of disease at diagnosis was I, 4; II, 464; III, 76; IV, 107; and 22 indeterminate. Median overall survival was 89.1 months (95% CI: 46.1–132.0). QoL scales predictive of survival upon univariate analysis were physical, role, emotional, social, fatigue, nausea/vomiting, pain, dyspnea, insomnia, loss of appetite, and constipation (p < 0.01 for all). Multivariate analyses found fatigue (p = 0.02) and constipation (p = 0.01) to be significantly associated with survival. Conclusions Baseline QoL provides useful prognostic information in prostate cancer. These findings have important implications for patient stratification in clinical trials and may aid decision making in clinical practice.
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Affiliation(s)
- Donald P Braun
- Office of Clinical Research, Cancer Treatment Centers of America® (CTCA), Midwestern Regional Medical Center, Zion, IL 60099, USA.
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Corey-Lisle PK, Peck R, Mukhopadhyay P, Orsini L, Safikhani S, Bell JA, Hortobagyi G, Roche H, Conte P, Revicki DA. Q-TWiST analysis of ixabepilone in combination with capecitabine on quality of life in patients with metastatic breast cancer. Cancer 2011; 118:461-8. [DOI: 10.1002/cncr.26213] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 03/30/2011] [Accepted: 04/01/2011] [Indexed: 11/08/2022]
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Foster TS, Miller JD, Boye ME, Blieden MB, Gidwani R, Russell MW. The economic burden of metastatic breast cancer: a systematic review of literature from developed countries. Cancer Treat Rev 2011; 37:405-15. [PMID: 21477928 DOI: 10.1016/j.ctrv.2010.12.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 12/21/2010] [Accepted: 12/23/2010] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Breast cancer, the most common malignant cancer among women in Western countries, has poor prognosis following metastasis. New therapies potentially extend survival, but their value is questioned when benefits are incremental and expensive. The objective of our study was to understand the economic impact of metastatic breast cancer (MBC) and its treatment, and to evaluate the designs of these studies. METHODS We systematically reviewed the MEDLINE-indexed, English-language literature, identifying 31 articles on the economic evaluation of MBC in 10 developed countries, including studies of per-patient costs, gross national costs, and cost-effectiveness models. We also included health technology assessments (HTAs) from government and regulatory agencies. RESULTS Total per-patient costs of MBC are only available for Sweden ($17,301-$48,169 annually, depending on patient age (2005 USD)). Most economic analyses of per-patient direct costs originate from the US; across all countries, data indicate that this burden is substantial. Gross national costs of MBC are available only for the UK (cost of incident MBC cases is estimated to be $22 million annually (2002 GBP)). Many cost-effectiveness analyses suggest that a number of new and established treatments are cost-effective compared to standard care in various countries, but many offer small increments in survival. The cost-effectiveness of trastuzumab, capecitabine, and nab-paclitaxel has been evaluated in many recent studies. CONCLUSION Most economic evaluations of MBC have utilized secondary rather than primary data, and have used scenarios and assumptions which may be inaccurate or outdated. The quality of evidence disseminated to decision-makers could be improved by adherence to best practices in cost-effectiveness analyses.
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Affiliation(s)
- Talia S Foster
- Health Economic Research & Quality of Life Evaluation Services (HERQuLES), Abt Bio-Pharma Solutions, Inc., Lexington, MA 02421, USA.
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Høyer BB, Toft GV, Debess J, Ramlau-Hansen CH. A nurse-led telephone session and quality of life after radiotherapy among women with breast cancer: a randomized trial. Open Nurs J 2011; 5:31-7. [PMID: 21660182 PMCID: PMC3109608 DOI: 10.2174/1874434601105010031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Revised: 02/18/2011] [Accepted: 02/21/2011] [Indexed: 11/29/2022] Open
Abstract
The purpose of this study was to investigate whether a nurse-led telephone session with patients suffering from breast cancer approximately ten days after final radiotherapy treatment affected their quality of life two to four weeks after radiotherapy. The study was conducted at the Radiotherapy ward at Vejle Hospital, Denmark between January and May 2010. The study population consisted of 100 patients, who were randomized with a 1:1 ratio to have either ordinary supportive conversations (control group), or ordinary supportive conversations and a supplementary nurse-led telephone session (intervention group). The quality of life was assessed using the questionnaires EORTC QLQ-C30 and EORTC QLQ-BR23. For statistical comparison of quality of life and for adjustment for covariates, multiple linear regression analysis was conducted. The mean [95 % CI] quality of life was 72.0 [66.4-77.6] in the control group and 69.9 [64.3-75.2] in the intervention group. Adjustment for covariates did not change the estimates. No statistically significant differences were found in the groups in either of the analyses. The nurse-led telephone session had no positive effect on the quality of life of patients with breast cancer two to four weeks after their final radiotherapy.
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Affiliation(s)
- Birgit Bjerre Høyer
- Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark.
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Abstract
The measurement of patient-reported outcomes, including health-related quality of life, is a new initiative which has emerged and grown over the past four decades. Following the development of reliable and valid self-report questionnaires, health-related quality of life has been assessed in tens of thousands of patients and a wide variety of cancers. This review is based on a selection of data published in the last decade and is intended primarily for healthcare professionals. The assessments in clinical trials have been particularly useful for elucidating the effects of various cancers and their treatments on patients' lives and have provided additional information that enhances the usual clinical endpoints used for determining the benefits and toxicity of treatment. With growing experience the quality of the health-related quality of studies has improved and, in general, recent studies are more likely to be methodologically robust than those that were performed in earlier decades. Health-related quality of life has become a more accurate predictor of survival than some other clinical parameters, such as performance status. The overall outlook for the routine assessment of patient-reported outcomes in clinical trials is assured and, eventually, it is likely to become a standard part of clinical practice. However, there is still a need for a clear method for determining the clinical meaningfulness of changes in scores. The answer will probably come from the greater use of patient-reported outcomes and the consequent growth of experience that is necessary to make such judgements.
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Affiliation(s)
- David Osoba
- Professor (retired), Department of Medicine, University of British Columbia, Vancouver, BC, and Quality of Life Consulting, West Vancouver, BC, Canada; 4939 Edendale Court, West Vancouver, BC, Canada V7W 3H7
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Svensson H, Hatschek T, Johansson H, Einbeigi Z, Brandberg Y. Health-related quality of life as prognostic factor for response, progression-free survival, and survival in women with metastatic breast cancer. Med Oncol 2011; 29:432-8. [PMID: 21298494 DOI: 10.1007/s12032-011-9844-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Accepted: 01/21/2011] [Indexed: 12/18/2022]
Abstract
The purpose of this study was to, on an exploratory basis, investigate the role of health-related quality of life (HRQoL) at randomization as an independent prognostic factor for response to treatment, progression-free survival (PFS), and survival. In the TEX trial, 287 patients with locally advanced or distant metastatic breast cancer were randomized to either epirubicin and paclitaxel (ET) or epirubicin, paclitaxel, and capecitabine (TEX). Treatment was repeated every 3 weeks. The EORTC QLQ-C30 questionnaire was used to assess HRQoL before randomization. A total of 252 (88%) patients completed EORTC QLQ-C30 before randomization. Clinical conditions included in the multivariate model were age, number of metastases, ECOG performance status, time between diagnosis and randomization, and treatment arm. Univariate analysis revealed an association between prolonged survival and the HRQoL variables global health, physical functioning, role functioning, fatigue, and pain (P < 0.01). After controlling for clinical conditions, only fatigue remained statistically significant. No statistically significant relationships were found between HRQoL and PFS. In the analysis of the association between HRQoL and response to treatment, role functioning, social functioning, fatigue, nausea/vomiting, and appetite loss remained statistically significant. HRQoL variables could act as important predictors of response to treatment, progression-free survival, and overall survival in women with metastatic breast cancer.
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Affiliation(s)
- Helene Svensson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University, 413 45 Gothenburg, Sweden.
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Sezgin C, Gokmen E, Kapkac M, Zekioglu O, Esassolak M, Karabulut B, Sanli UA, Uslu R. p53 protein accumulation and presence of visceral metastasis are independent prognostic factors for survival in patients with metastatic inflammatory breast carcinoma. Med Princ Pract 2011; 20:159-64. [PMID: 21252573 DOI: 10.1159/000319916] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 05/19/2010] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the markers of prognosis in metastatic inflammatory breast cancer (IBC). SUBJECTS AND METHODS The prognostic value of patients' clinical characteristics and expression of c-erbB-2, p53, Ki-67, ER and PgR were assessed in the 45 patients with IBC who had developed distant metastasis. Immunohistochemical methods were used to detect the expression of c-erbB-2, p53, Ki-67, ER and PgR in surgical resection specimens of the patients' primary tumor. RESULTS The median overall survival (OS) measured from the diagnosis of metastatic disease was 23 months. In the univariate analysis, p53 protein accumulation and the presence of visceral metastasis were predictive of poor survival (p = 0.01 and 0.003, respectively). In the multivariate analysis, accumulation of p53 protein and the presence of visceral metastasis correlated with OS (p = 0.02 and 0.008, respectively). CONCLUSION In metastatic IBC, accumulation of p53 protein and presence of visceral metastasis are independent prognostic factors for OS. Established prognostic factors in non-IBC patients such as patient age, histologic grade, hormone receptor status and c-erbB-2 status did not have independent significance in IBC in this study.
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Affiliation(s)
- Canfeza Sezgin
- Department of Internal Medicine, Ege University Medical Faculty, Izmir, Turkey. canfeza.sezgin @ ege.edu.tr
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Epplein M, Zheng Y, Zheng W, Chen Z, Gu K, Penson D, Lu W, Shu XO. Quality of life after breast cancer diagnosis and survival. J Clin Oncol 2010; 29:406-12. [PMID: 21172892 DOI: 10.1200/jco.2010.30.6951] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To examine the association of quality of life (QOL) after diagnosis of breast cancer with mortality and recurrence. PATIENTS AND METHODS From 2002 to 2004, a total of 2,230 breast cancer survivors completed the General Quality of Life Inventory-74 6 months after diagnosis as part of the Shanghai Breast Cancer Survivor Study. Also collected at baseline was information on demographic and clinical characteristics. At 36 months postdiagnosis, 1,845 of these women were re-evaluated for QOL. Outcomes were ascertained by in-person interview and record linkage to the vital statistics registry. The association of QOL with total mortality and cancer recurrence was assessed by using Cox regression analysis. RESULTS During a median follow-up of 4.8 years after the 6-month postdiagnosis QOL assessment, 284 deaths were identified. Recurrence was documented in 267 patients after 108 patients with stage IV breast cancer or recurrence before study enrollment were excluded. Women with the highest tertile of social well-being QOL score, compared with those with the lowest score, had a 38% decreased risk of mortality (95% CI, 0.46 to 0.85; P for trend = .002) and a 48% decreased risk of breast cancer recurrence (95% CI, 0.38 to 0.71; P for trend < .001). QOL assessed at 36 months postdiagnosis was not significantly associated with subsequent risk of mortality or recurrence. CONCLUSION Social well-being in the first year after cancer diagnosis is a significant prognostic factor for breast cancer recurrence or mortality, suggesting a possible avenue of intervention by maintaining or enhancing social support for women soon after their breast cancer diagnosis to improve disease outcomes.
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Affiliation(s)
- Meira Epplein
- Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN 37203, USA.
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Giese-Davis J, Collie K, Rancourt KMS, Neri E, Kraemer HC, Spiegel D. Decrease in depression symptoms is associated with longer survival in patients with metastatic breast cancer: a secondary analysis. J Clin Oncol 2010; 29:413-20. [PMID: 21149651 DOI: 10.1200/jco.2010.28.4455] [Citation(s) in RCA: 314] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Numerous studies have examined the comorbidity of depression with cancer, and some have indicated that depression may be associated with cancer progression or survival. However, few studies have assessed whether changes in depression symptoms are associated with survival. METHODS In a secondary analysis of a randomized trial of supportive-expressive group therapy, 125 women with metastatic breast cancer (MBC) completed a depression symptom measure (Center for Epidemiologic Studies-Depression Scale [CES-D]) at baseline and were randomly assigned to a treatment group or to a control group that received educational materials. At baseline and three follow-up points, 101 of 125 women completed a depression symptom measure. We used these data in a Cox proportional hazards analysis to examine whether decreasing depression symptoms over the first year of the study (the length of the intervention) would be associated with longer survival. RESULTS Median survival time was 53.6 months for women with decreasing CES-D scores over 1 year and 25.1 months for women with increasing CES-D scores. There was a significant effect of change in CES-D over the first year on survival out to 14 years (P = .007) but no significant interaction between treatment condition and CES-D change on survival. Neither demographic nor medical variables explained this association. CONCLUSION Decreasing depression symptoms over the first year were associated with longer subsequent survival for women with MBC in this sample. Further research is necessary to confirm this hypothesis in other samples, and causation cannot be assumed based on this analysis.
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Chae YR, Seo K. Health-related quality of life in women with breast cancer in Korea: do sociodemographic characteristics and time since diagnosis make a difference? Oncol Nurs Forum 2010; 37:E295-303. [PMID: 20591793 DOI: 10.1188/10.onf.e295-e303] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To describe whether levels of health-related quality of life (HRQOL) differ by sociodemographic characteristics and time since breast cancer diagnosis in women in Korea. DESIGN A descriptive, cross-sectional study of women with breast cancer. SETTING An outpatient clinic of one large hospital in Seoul, Republic of Korea. SAMPLE A convenience sample of 244 women with breast cancer after mastectomy. METHODS Study participants completed sociodemographic characteristics and HRQOL questionnaires. Medical charts were reviewed to determine time since breast cancer diagnosis. MAIN RESEARCH VARIABLES Sociodemographic characteristics (age, marital status, employment status, education, monthly household income, and religion), time since diagnosis, and HRQOL. FINDINGS The psychological well-being domain scored the lowest among domains of HRQOL. Women who are younger, married, unemployed, highly educated, or religious, with higher monthly household income or with greater than one year elapsed time since diagnosis, had higher HRQOL. CONCLUSIONS Study findings will be useful to establish priorities in planning nursing interventions to enhance HRQOL in care of women with breast cancer. IMPLICATIONS FOR NURSING Nursing interventions can be provided to Korean women with breast cancer who are not religious, who are older, single or widowed, or employed, with lower education level, with lower monthly household income, or with one year or less elapsed time since breast cancer diagnosis.
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Affiliation(s)
- Young Ran Chae
- Department of Nursing, Kangwon National University, Chuncheon, Republic of Korea
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Bredal IS, Sandvik L, Karesen R, Ekeberg O. Prognostic value of health-related quality-of-life parameters in early-stage breast cancer: an 8-year follow-up study. Psychooncology 2010; 20:1102-7. [DOI: 10.1002/pon.1822] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 05/19/2010] [Accepted: 06/22/2010] [Indexed: 11/12/2022]
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Svensson H, Einbeigi Z, Johansson H, Hatschek T, Brandberg Y. Quality of life in women with metastatic breast cancer during 9 months after randomization in the TEX trial (epirubicin and paclitaxel w/o capecitabine). Breast Cancer Res Treat 2010; 123:785-93. [PMID: 20680680 DOI: 10.1007/s10549-010-1084-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2010] [Accepted: 07/20/2010] [Indexed: 10/19/2022]
Abstract
The aim of this study was to compare the effects on health-related quality of life (HRQOL) of two treatment regimens in the TEX trial during 9 month from random assignment, with emphasis on the 2- and 9-months assessments. A total of 287 patients were randomized to treatment in 3-week cycles with either epirubicin plus paclitaxel (ET, 143 patients), or epirubicin, paclitaxel and capecitabine (TEX, 144 patients). HRQOL was assessed by the EORTC-QLQ C30 and EORTC QLQ-BR23 questionnaires at five points during 9 months. A total of 252 (88%) completed questionnaires before randomization. Response rate for the following assessments was >75%. There were no statistically significant differences between the TEX group and the ET group on any of the subscales 2 months after randomization. Small clinical differences (5-10 points) in favor of the ET group were found for global quality of life, role functioning, social functioning, and insomnia. At the 9-months assessment, the TEX group scored statistically significantly higher on global quality of life and physical functioning. Small clinically significant differences were found for global quality of life, physical functioning, role functioning, emotional functioning, dyspnoea, and insomnia, all in favour of the TEX group. At the 2-months assessment, when side-effects of chemotherapy were present, patients in the TEX group appeared to fare a bit worse than those receiving ET. However, after 9 months, when the patients had adapted to treatment, the TEX group seemed to have a slightly better quality of life.
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Affiliation(s)
- Helene Svensson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
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Serpentini S, Del Bianco P, Alducci E, Toppan P, Ferretti F, Folin M, De Salvo GL, Nitti D, Pucciarelli S. Psychological well-being outcomes in disease-free survivors of mid-low rectal cancer following curative surgery. Psychooncology 2010; 20:706-14. [DOI: 10.1002/pon.1763] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2009] [Revised: 03/26/2010] [Accepted: 04/01/2010] [Indexed: 01/11/2023]
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Chen RC, Mamon HJ, Chen YH, Gelman RS, Suh WW, Talcott JA, Clark JW, Hong TS. Patient-reported acute gastrointestinal symptoms during concurrent chemoradiation treatment for rectal cancer. Cancer 2010; 116:1879-86. [DOI: 10.1002/cncr.24963] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Self-reported health-related quality of life is an independent predictor of chemotherapy treatment benefit and toxicity in women with advanced breast cancer. Br J Cancer 2010; 102:1341-7. [PMID: 20389302 PMCID: PMC2865758 DOI: 10.1038/sj.bjc.6605649] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background: Baseline health-related quality of life (QL) is associated with survival in advanced breast cancer. We sought to identify patients who were less likely to respond to chemotherapy and at greater risk of toxicity on the basis of their QL. Methods: We used data from three advanced breast cancer trials in which patients (n=378) were treated with cyclophosphamide, methotrexate and 5-fluouracil. Patients self-rated their QL using LASA scales for physical well-being (PWB), mood, pain, nausea/vomiting, appetite and overall QL. Multivariable regression models were constructed to compare overall survival (OS), objective tumour response (OTR), adverse events (AEs) and weight loss according to grouped QL scores. Results: Physical well-being, mood, appetite and overall QL were significant univariable predictors of OS. Physical well-being and appetite remained significant after adjustment for baseline biomedical factors. Poor PWB was associated with lower OTR (odds ratio (OR)=0.21, 95% confidence interval (CI) 0.09–0.51), higher risk of non-haematological AEs (OR=3.26, 95% CI 1.49–7.15) and greater risk of weight loss (OR 2.37, 95% CI 1.12–5.01) compared with good PWB. Conclusion: In women with advanced breast cancer, PWB and appetite are predictors of chemotherapy response and toxicity as well as survival. Quality of life should be a routine clinical assessment to guide patient selection for chemotherapy and for stratification of patients in clinical trials.
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Surviving cervical cancer: does health-related quality of life influence survival? Gynecol Oncol 2010; 118:35-42. [PMID: 20382414 DOI: 10.1016/j.ygyno.2010.02.027] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 02/24/2010] [Accepted: 02/27/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVE This study investigates the association between health-related quality of life (HRQOL) outcomes and survival status among a population-based cohort diagnosed with invasive cancer of the cervix uteri. METHODS This study is based on data from 353 multiethnic cervical cancer survivors (CCS) recruited through the California Cancer Surveillance Program. The independent variable is HRQOL measured by the FACT-CX (FACT-G plus additional items) and the SF-12. The dependent variable is survival from date of the HRQOL survey. Kaplan-Meier estimates and univariate and multivariate Cox Proportional Hazards Regression models were used to examine the relationship between HRQOL and survival. RESULTS In the Kaplan-Meier analyses, the FACT-CX functional well-being score equal to or above the median score was significantly associated with improved overall survival (X(2)=7.19; p=0.007). Significant differences in survival were observed for the SF-12 physical and mental health component scores. In the multivariate Cox regression analyses, the final model indicated that the FACT-CX total scores, functional well-being, and additional cervical cancer concerns subscales, and the SF-12 physical and mental component summary scores significantly influenced survival, after controlling for medical characteristics. However, the FACT components that do not include cervical cancer specific items including mean standardized FACT-G and physical, emotional, and social/family well-being subscales were not predictors of survival before and after adjustment for covariates. CONCLUSIONS The results of this study advance the current scientific knowledge by confirming that HRQOL outcomes, in particular the physical, function and mental health dimensions are associated with survival for CCS. These findings highlight the utility of cancer site specific HRQOL data to inform the psychosocial and symptom management aspects, as well as the medical follow-up care practice and research that may extend life.
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Ashing-Giwa KT, Lim JW. Predicting physical quality of life among a multiethnic sample of breast cancer survivors. Qual Life Res 2010; 19:789-802. [DOI: 10.1007/s11136-010-9642-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2010] [Indexed: 12/24/2022]
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Montazeri A. Quality of life data as prognostic indicators of survival in cancer patients: an overview of the literature from 1982 to 2008. Health Qual Life Outcomes 2009; 7:102. [PMID: 20030832 PMCID: PMC2805623 DOI: 10.1186/1477-7525-7-102] [Citation(s) in RCA: 372] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Accepted: 12/23/2009] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Health-related quality of life and survival are two important outcome measures in cancer research and practice. The aim of this paper is to examine the relationship between quality of life data and survival time in cancer patients. METHODS A review was undertaken of all the full publications in the English language biomedical journals between 1982 and 2008. The search was limited to cancer, and included the combination of keywords 'quality of life', 'patient reported-outcomes' 'prognostic', 'predictor', 'predictive' and 'survival' that appeared in the titles of the publications. In addition, each study was examined to ensure that it used multivariate analysis. Purely psychological studies were excluded. A manual search was also performed to include additional papers of potential interest. RESULTS A total of 451 citations were identified in this rapid and systematic review of the literature. Of these, 104 citations on the relationship between quality of life and survival were found to be relevant and were further examined. The findings are summarized under different headings: heterogeneous samples of cancer patients, lung cancer, breast cancer, gastro-oesophageal cancers, colorectal cancer, head and neck cancer, melanoma and other cancers. With few exceptions, the findings showed that quality of life data or some aspects of quality of life measures were significant independent predictors of survival duration. Global quality of life, functioning domains and symptom scores - such as appetite loss, fatigue and pain - were the most important indicators, individually or in combination, for predicting survival times in cancer patients after adjusting for one or more demographic and known clinical prognostic factors. CONCLUSION This review provides evidence for a positive relationship between quality of life data or some quality of life measures and the survival duration of cancer patients. Pre-treatment (baseline) quality of life data appeared to provide the most reliable information for helping clinicians to establish prognostic criteria for treating their cancer patients. It is recommended that future studies should use valid instruments, apply sound methodological approaches and adequate multivariate statistical analyses adjusted for socio-demographic characteristics and known clinical prognostic factors with a satisfactory validation strategy. This strategy is likely to yield more accurate and specific quality of life-related prognostic variables for specific cancers.
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Affiliation(s)
- Ali Montazeri
- Iranian Institute for Health Sciences Research, ACECR, Tehran, Iran.
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Predictive value of serial measurements of quality of life on all-cause mortality in prostate cancer patients: data from CaPSURE (cancer of the prostate strategic urologic research endeavor) database. Qual Life Res 2009; 18:1019-27. [PMID: 19697155 PMCID: PMC2744792 DOI: 10.1007/s11136-009-9526-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Accepted: 08/03/2009] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Health-related quality of life (HRQOL) is a legitimate construct for evaluating treatment and its side effects. Recently, predictive value of HRQOL on survival also has been of interest. In light of the longer survival in patients with prostate cancer and importance of quality of life, we seek to evaluate the association between HRQOL and survival using traditional and novel techniques. METHODS Patients from CaPSURE (Cancer of the Prostate Strategic Urologic Research Endeavor) who were treated within 6 months of diagnosis and had pre-treatment and sufficient post-treatment follow-up information constituted the study population. A sample consisting of 2,899 patients met the study criteria. SF-36 domains were used to measure HRQOL outcomes. Categorical variables were created for HRQOL based on the baseline distribution of the lower 10th percentile and the remainder of the patients. Association between HRQOL and survival (defined by all-cause mortality) in patients with prostate cancer was evaluated using Cox proportional hazards models controlling for age at diagnosis, type of treatment received, clinical risk classification, and number of comorbidities. Sequential bootstrap resampling was implemented to evaluate stability of the model. Univariate and multivariate Cox proportional hazards models were fit using various time points over the course of follow-up. RESULTS In the analysis looking at association of HRQOL baseline measurements, higher levels of physical function and general health were significantly associated with better survival (HR 0.49 95% CI 0.32-0.78 and HR 0.51 95% CI 0.35-0.75, respectively). Post-treatment analysis demonstrated similar results. In time-dependent analysis, higher levels of physical function, role physical, and general health were significantly associated with better survival (HR ranged from 0.57 to 0.65). In addition, analysis looking at change in HRQOL scores demonstrated an association between higher scores on physical function, role physical, vitality, social function, and general health and longer survival (HR ranged from 0.56 to 0.63). CONCLUSION This study demonstrated that several domains of HRQOL were significantly associated with survival in a large group of patients with localized prostate cancer. This association was maintained over the course of disease regardless of the time of the assessment. Results from our study have both research and clinical relevance. They could provide information that enable us to not only improve communication with patients and families, but also to develop interventions and treatments best suited for the patient.
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Kenne Sarenmalm E, Odén A, Ohlén J, Gaston-Johansson F, Holmberg SB. Changes in health-related quality of life may predict recurrent breast cancer. Eur J Oncol Nurs 2009; 13:323-9. [PMID: 19596212 DOI: 10.1016/j.ejon.2009.05.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Revised: 05/18/2009] [Accepted: 05/23/2009] [Indexed: 01/22/2023]
Abstract
BACKGROUND Patient-reported outcomes incorporated in cancer clinical trials, are increasingly hypothesized to be predictors of disease-free survival. Previous research supports health-related quality of life (HRQoL) as an independent predictor of survival in patients with advanced or metastatic breast cancer. In contrast, recent studies provide evidence that baseline HRQoL scores are not associated with increased risk of relapse or survival in women with early-stage breast cancer. One plausible assumption might be that baseline HRQoL scores are limited as predictors of a recurrence of breast cancer several years after the initial diagnosis. In this explorative study, we examined whether changes in HRQoL over time may predict breast cancer recurrence. As a supplement, we investigated whether baseline HRQoL predicted recurrence. METHODS The study sample consisted of 141 participants in the International Breast Cancer Study Group adjuvant Trial 12-93 and Trial 14-93, from the Western region of Sweden. HRQoL was assessed, during a 5-year follow up. Poisson regression analysis was used to estimate the hazard function of recurrence depending on time since primary diagnosis and on HRQoL variables. RESULTS According to the Poisson multivariable regression analysis changes in physical well-being (beta=0.00439, p-value=0.0470), and nausea/vomiting (beta=-0.00612, p-value=0.0136) significantly predicted recurrence. Baseline HRQoL outcomes were not predictors of recurrence. CONCLUSIONS Changes of HRQoL during adjuvant therapy may be associated with recurrence. This explorative finding needs prospective investigation.
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A longitudinal study of the role of patient-reported outcomes on survival prediction of palliative cancer inpatients in Taiwan. Support Care Cancer 2009; 17:1285-94. [PMID: 19214595 DOI: 10.1007/s00520-009-0583-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2008] [Accepted: 01/12/2009] [Indexed: 11/12/2022]
Abstract
GOALS OF WORK This study explores the significance of patient-reported outcomes for predicting length of survival of palliative cancer patients. PATIENTS AND METHODS Patients were recruited upon admission to the inpatient palliative care unit. Weekly assessment of 180 terminal cancer patients was carried out throughout their survival time using the Medical Outcome Study 36-Item Short-Form Health Survey, the Taiwanese version of the M.D. Anderson Symptom Inventory (MDASI-T), the Karnofsky Performance Status (KPS), the Brief Pain Inventory, and the Brief Fatigue Inventory. Generalized estimating equations (GEE) were utilized to analyze whether the patient-reported outcomes predicted survival time. MAIN RESULTS Of all patients, 64 had one assessment, 51 had two, 25 had three, and 40 had four or more assessments, up to a maximum of eight. The univariate analysis showed that gender (P < 0.01), KPS (P < 0.01), the physical component summary score (P = 0.02), the MDASI-T total score (P < 0.01), composite fatigue severity (P < 0.01), and composite pain severity (P < 0.01) were significantly associated with length of survival. The multivariate analysis showed that gender (P < 0.01), KPS (P < 0.01), and the MDASI-T total score (P = 0.01) were significant predictors of survival time. CONCLUSIONS This is the first study to explore the significance of patient-related outcomes for predicting length of survival of palliative cancer patients using the GEE method. This study confirms that overall symptom severity is a significant factor in assessing the length of survival of palliative cancer patients.
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Mills ME, Murray LJ, Johnston BT, Donnelly M. Feasibility of a standardised quality of life questionnaire in a weekly diary format for inoperable lung cancer patients. Eur J Oncol Nurs 2008; 12:457-63. [DOI: 10.1016/j.ejon.2008.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2008] [Revised: 06/16/2008] [Accepted: 06/20/2008] [Indexed: 11/28/2022]
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Serin D, Brédart A, Debled M, Fumoleau P. Chimiothérapie et qualité de vie dans le cancer du sein métastatique: état des lieux. ONCOLOGIE 2008. [DOI: 10.1007/s10269-008-0932-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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90
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Awad MA, Denic S, El Taji H. Validation of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires for Arabic-speaking Populations. Ann N Y Acad Sci 2008; 1138:146-54. [DOI: 10.1196/annals.1414.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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91
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Health-related quality of life in breast cancer patients: a bibliographic review of the literature from 1974 to 2007. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2008; 27:32. [PMID: 18759983 PMCID: PMC2543010 DOI: 10.1186/1756-9966-27-32] [Citation(s) in RCA: 456] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Accepted: 08/29/2008] [Indexed: 02/06/2023]
Abstract
Background Quality of life in patients with breast cancer is an important outcome. This paper presents an extensive overview on the topic ranging from descriptive findings to clinical trials. Methods This was a bibliographic review of the literature covering all full publications that appeared in English language biomedical journals between 1974 and 2007. The search strategy included a combination of key words 'quality of life' and 'breast cancer' or 'breast carcinoma' in titles. A total of 971 citations were identified and after exclusion of duplicates, the abstracts of 606 citations were reviewed. Of these, meetings abstracts, editorials, brief commentaries, letters, errata and dissertation abstracts and papers that appeared online and were indexed ahead of publication were also excluded. The remaining 477 papers were examined. The major findings are summarized and presented under several headings: instruments used, validation studies, measurement issues, surgical treatment, systemic therapies, quality of life as predictor of survival, psychological distress, supportive care, symptoms and sexual functioning. Results Instruments-Several valid instruments were used to measure quality of life in breast cancer patients. The European Organization for Research and Treatment of Cancer Core Cancer Quality of Life Questionnaire (EORTC QLQ-C30) and its breast cancer specific complementary measure (EORTC QLQ-BR23) and the Functional Assessment Chronic Illness Therapy General questionnaire (FACIT-G) and its breast cancer module (FACIT-B) were found to be the most common and well developed instruments to measure quality of life in breast cancer patients. Surgery-different surgical procedures led to relatively similar results in terms of quality of life assessments, although mastectomy patients compared to conserving surgery patients usually reported a lower body image and sexual functioning. Systemic therapies-almost all studies indicated that breast cancer patients receiving chemotherapy might experience several side-effects and symptoms that negatively affect their quality of life. Adjuvant hormonal therapies also were found to have similar negative impact on quality of life, although in general they were associated with improved survival. Quality of life as predictor of survival-similar to known medical factors, quality of life data in metastatic breast cancer patients was found to be prognostic and predictive of survival time. Psychological distress-anxiety and depression were found to be common among breast cancer patients even years after the disease diagnosis and treatment. Psychological factors also were found to predict subsequent quality of life or even overall survival in breast cancer patients. Supportive care-clinical treatments to control emesis, or interventions such as counseling, providing social support and exercise could improve quality of life. Symptoms-Pain, fatigue, arm morbidity and postmenopausal symptoms were among the most common symptoms reported by breast cancer patients. As recommended, recognition and management of these symptoms is an important issue since such symptoms impair health-related quality of life. Sexual functioning-breast cancer patients especially younger patients suffer from poor sexual functioning that negatively affect quality of life. Conclusion There was quite an extensive body of the literature on quality of life in breast cancer patients. These papers have made a considerable contribution to improving breast cancer care, although their exact benefit was hard to define. However, quality of life data provided scientific evidence for clinical decision-making and conveyed helpful information concerning breast cancer patients' experiences during the course of the disease diagnosis, treatment, disease-free survival time, and recurrences; otherwise finding patient-centered solutions for evidence-based selection of optimal treatments, psychosocial interventions, patient-physician communications, allocation of resources, and indicating research priorities were impossible. It seems that more qualitative research is needed for a better understanding of the topic. In addition, issues related to the disease, its treatment side effects and symptoms, and sexual functioning should receive more attention when studying quality of life in breast cancer patients.
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Bonnetain F, Paoletti X, Collette S, Doffoel M, Bouché O, Raoul JL, Rougier P, Masskouri F, Barbare JC, Bedenne L. Quality of life as a prognostic factor of overall survival in patients with advanced hepatocellular carcinoma: results from two French clinical trials. Qual Life Res 2008; 17:831-43. [PMID: 18618292 DOI: 10.1007/s11136-008-9365-y] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2007] [Accepted: 05/28/2008] [Indexed: 12/14/2022]
Abstract
AIM The aims of our study were to assess quality of life (QoL) as a prognostic factor of overall survival (OS) and to determine whether QoL data improved three prognostic classifications among French patients with advanced hepatocellular carcinoma (HCC). METHODS We pooled two randomized clinical trials conducted by the Fédération Francophone de Cancérologie Digestive in a palliative setting. In each trial QoL was assessed at baseline using the Spitzer QoL Index (0-10). Three prognostic classifications were calculated: Okuda, Cancer of the Liver Italian Program (CLIP), and Barcelona Clinic Liver Cancer group (BCLC) scores. To explore whether the scores could be improved by including QoL, univariate Cox analyses of all potential baseline predictors were performed. A final multivariate Cox model was constructed including only significant multivariate baseline variables likely to result in improvement of each scoring system. In order to retain the best prognostic variable to add for each score, we compared Akaike information criterion, likelihood ratio, and Harrell's C-index. Cox analyses were stratified for each trial. RESULTS Among 538 included patients, QoL at baseline was available for 489 patients (90%). Longer median OS was significantly associated with higher Spitzer scores at baseline, ranging from 2.17 months (Spitzer=3) to 8.93 months (Spitzer=10). Variables retained in the multivariate Cox model were: jaundice, hepatomegaly, hepatalgia, portal thrombosis, alphafetoprotein, bilirubin, albumin, small HCC, and Spitzer QoL Index (hazard ratio=0.84 95% CI [0.79-0.90]). According to Harrell's C-index, QoL was the best prognostic variable to add. CLIP plus the Spitzer QoL Index had the most discriminating value (C=0.71). CONCLUSIONS Our results suggest that QoL is an independent prognostic factor for survival in HCC patients with mainly alcoholic cirrhosis. The prognostic value of CLIP score could be improved by adding Spitzer QOL Index scores.
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Affiliation(s)
- Franck Bonnetain
- Methodological and Biostatistical unit, Fédération Francophone de Cancérologie Digestive, INSERM U866, Dijon, France.
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Efficace F, Innominato PF, Bjarnason G, Coens C, Humblet Y, Tumolo S, Genet D, Tampellini M, Bottomley A, Garufi C, Focan C, Giacchetti S, Lévi F. Validation of Patient's Self-Reported Social Functioning As an Independent Prognostic Factor for Survival in Metastatic Colorectal Cancer Patients: Results of an International Study by the Chronotherapy Group of the European Organisation for Research and Treatment of Cancer. J Clin Oncol 2008; 26:2020-6. [DOI: 10.1200/jco.2007.12.3117] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Purpose A recent study identified a prognostic model for survival in metastatic colorectal cancer patients which included WBC count, alkaline phosphatase (AP), number of metastatic sites, and patients’ self-reported social functioning. The aim of this research is to validate this model on data from an independent sample. Patients and Methods This validation study is based on a prospective randomized controlled trial in patients with metastatic colorectal cancer conducted by the European Organisation for Research and Treatment of Cancer (EORTC) Chronotherapy Group. Overall, 564 patients in 10 countries were enrolled. For the purpose of this independent validation, patients with health-related quality of life (HRQOL) baseline data were analyzed. HRQOL was assessed using the EORTC Quality of Life Questionnaire C30 (QLQ-C30). The Cox proportional hazards regression model was used for both univariate and multivariate analyses of survival. Results The previous model with an additional adjustment, by stratification for sex, was replicated and its parameters were confirmed to independently predict survival: WBC count with an hazard ratio (HR) of 1.31 (95% CI, 1.021 to 1.698; P = .034); AP with an HR of 1.53 (95% CI, 1.188 to 1.979; P = .001); number of sites involved with an HR of 1.90 (95% CI, 1.531 to 2.364; P < .0001); and patients’ self-reported social functioning with an HR of 0.94 (95% CI, 0.905 to 0.976; P = .001). The latter translates into a 6% increase in the likelihood of an earlier death for every 10-point decrease in the social functioning scale of the EORTC QLQ-C30. Conclusion This study provides confirmatory evidence of the independent prognostic value of patients’ self-reported social functioning in patients with advanced colorectal cancer.
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Affiliation(s)
- Fabio Efficace
- From the European Organisation for Research and Treatment of Cancer Data Center, Quality of Life Unit; Hôpital Universitaire St-Luc, Université Catholique de Louvain, Brussels; Centre Hospitalier Chrétien-Clinique Saint-Joseph, Departement d'Oncologie Medicale, Liege, Belgium; Institut National de la Santé et de la Recherche Médicale, U776, Rythmes Biologiques et Cancers; Assistance Publique-Hôpitaux de Paris, Unité de Chronothérapie, Département de Cancérologie, Hôpital Paul Brousse, Villejuif
| | - Pasquale F. Innominato
- From the European Organisation for Research and Treatment of Cancer Data Center, Quality of Life Unit; Hôpital Universitaire St-Luc, Université Catholique de Louvain, Brussels; Centre Hospitalier Chrétien-Clinique Saint-Joseph, Departement d'Oncologie Medicale, Liege, Belgium; Institut National de la Santé et de la Recherche Médicale, U776, Rythmes Biologiques et Cancers; Assistance Publique-Hôpitaux de Paris, Unité de Chronothérapie, Département de Cancérologie, Hôpital Paul Brousse, Villejuif
| | - Georg Bjarnason
- From the European Organisation for Research and Treatment of Cancer Data Center, Quality of Life Unit; Hôpital Universitaire St-Luc, Université Catholique de Louvain, Brussels; Centre Hospitalier Chrétien-Clinique Saint-Joseph, Departement d'Oncologie Medicale, Liege, Belgium; Institut National de la Santé et de la Recherche Médicale, U776, Rythmes Biologiques et Cancers; Assistance Publique-Hôpitaux de Paris, Unité de Chronothérapie, Département de Cancérologie, Hôpital Paul Brousse, Villejuif
| | - Corneel Coens
- From the European Organisation for Research and Treatment of Cancer Data Center, Quality of Life Unit; Hôpital Universitaire St-Luc, Université Catholique de Louvain, Brussels; Centre Hospitalier Chrétien-Clinique Saint-Joseph, Departement d'Oncologie Medicale, Liege, Belgium; Institut National de la Santé et de la Recherche Médicale, U776, Rythmes Biologiques et Cancers; Assistance Publique-Hôpitaux de Paris, Unité de Chronothérapie, Département de Cancérologie, Hôpital Paul Brousse, Villejuif
| | - Yves Humblet
- From the European Organisation for Research and Treatment of Cancer Data Center, Quality of Life Unit; Hôpital Universitaire St-Luc, Université Catholique de Louvain, Brussels; Centre Hospitalier Chrétien-Clinique Saint-Joseph, Departement d'Oncologie Medicale, Liege, Belgium; Institut National de la Santé et de la Recherche Médicale, U776, Rythmes Biologiques et Cancers; Assistance Publique-Hôpitaux de Paris, Unité de Chronothérapie, Département de Cancérologie, Hôpital Paul Brousse, Villejuif
| | - Salvatore Tumolo
- From the European Organisation for Research and Treatment of Cancer Data Center, Quality of Life Unit; Hôpital Universitaire St-Luc, Université Catholique de Louvain, Brussels; Centre Hospitalier Chrétien-Clinique Saint-Joseph, Departement d'Oncologie Medicale, Liege, Belgium; Institut National de la Santé et de la Recherche Médicale, U776, Rythmes Biologiques et Cancers; Assistance Publique-Hôpitaux de Paris, Unité de Chronothérapie, Département de Cancérologie, Hôpital Paul Brousse, Villejuif
| | - Dominique Genet
- From the European Organisation for Research and Treatment of Cancer Data Center, Quality of Life Unit; Hôpital Universitaire St-Luc, Université Catholique de Louvain, Brussels; Centre Hospitalier Chrétien-Clinique Saint-Joseph, Departement d'Oncologie Medicale, Liege, Belgium; Institut National de la Santé et de la Recherche Médicale, U776, Rythmes Biologiques et Cancers; Assistance Publique-Hôpitaux de Paris, Unité de Chronothérapie, Département de Cancérologie, Hôpital Paul Brousse, Villejuif
| | - Marco Tampellini
- From the European Organisation for Research and Treatment of Cancer Data Center, Quality of Life Unit; Hôpital Universitaire St-Luc, Université Catholique de Louvain, Brussels; Centre Hospitalier Chrétien-Clinique Saint-Joseph, Departement d'Oncologie Medicale, Liege, Belgium; Institut National de la Santé et de la Recherche Médicale, U776, Rythmes Biologiques et Cancers; Assistance Publique-Hôpitaux de Paris, Unité de Chronothérapie, Département de Cancérologie, Hôpital Paul Brousse, Villejuif
| | - Andrew Bottomley
- From the European Organisation for Research and Treatment of Cancer Data Center, Quality of Life Unit; Hôpital Universitaire St-Luc, Université Catholique de Louvain, Brussels; Centre Hospitalier Chrétien-Clinique Saint-Joseph, Departement d'Oncologie Medicale, Liege, Belgium; Institut National de la Santé et de la Recherche Médicale, U776, Rythmes Biologiques et Cancers; Assistance Publique-Hôpitaux de Paris, Unité de Chronothérapie, Département de Cancérologie, Hôpital Paul Brousse, Villejuif
| | - Carlo Garufi
- From the European Organisation for Research and Treatment of Cancer Data Center, Quality of Life Unit; Hôpital Universitaire St-Luc, Université Catholique de Louvain, Brussels; Centre Hospitalier Chrétien-Clinique Saint-Joseph, Departement d'Oncologie Medicale, Liege, Belgium; Institut National de la Santé et de la Recherche Médicale, U776, Rythmes Biologiques et Cancers; Assistance Publique-Hôpitaux de Paris, Unité de Chronothérapie, Département de Cancérologie, Hôpital Paul Brousse, Villejuif
| | - Christian Focan
- From the European Organisation for Research and Treatment of Cancer Data Center, Quality of Life Unit; Hôpital Universitaire St-Luc, Université Catholique de Louvain, Brussels; Centre Hospitalier Chrétien-Clinique Saint-Joseph, Departement d'Oncologie Medicale, Liege, Belgium; Institut National de la Santé et de la Recherche Médicale, U776, Rythmes Biologiques et Cancers; Assistance Publique-Hôpitaux de Paris, Unité de Chronothérapie, Département de Cancérologie, Hôpital Paul Brousse, Villejuif
| | - Sylvie Giacchetti
- From the European Organisation for Research and Treatment of Cancer Data Center, Quality of Life Unit; Hôpital Universitaire St-Luc, Université Catholique de Louvain, Brussels; Centre Hospitalier Chrétien-Clinique Saint-Joseph, Departement d'Oncologie Medicale, Liege, Belgium; Institut National de la Santé et de la Recherche Médicale, U776, Rythmes Biologiques et Cancers; Assistance Publique-Hôpitaux de Paris, Unité de Chronothérapie, Département de Cancérologie, Hôpital Paul Brousse, Villejuif
| | - Francis Lévi
- From the European Organisation for Research and Treatment of Cancer Data Center, Quality of Life Unit; Hôpital Universitaire St-Luc, Université Catholique de Louvain, Brussels; Centre Hospitalier Chrétien-Clinique Saint-Joseph, Departement d'Oncologie Medicale, Liege, Belgium; Institut National de la Santé et de la Recherche Médicale, U776, Rythmes Biologiques et Cancers; Assistance Publique-Hôpitaux de Paris, Unité de Chronothérapie, Département de Cancérologie, Hôpital Paul Brousse, Villejuif
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Karamouzis MV, Ioannidis G, Rigatos G. Quality of life in metastatic breast cancer patients under chemotherapy or supportive care: a single-institution comparative study. Eur J Cancer Care (Engl) 2008; 16:433-8. [PMID: 17760930 DOI: 10.1111/j.1365-2354.2006.00771.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of the present study was to evaluate quality of life (QoL) parameters in patients with metastatic breast cancer (MBC) and assess the potential differences between patients receiving chemotherapy and those undergoing supportive care interventions. In total, 210 women with MBC were enrolled in this prospective, randomized, single-institution study. The primary outcome of the trial was QoL assessment, using the self-administered European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30, version 3) and Quality of Life Questionnaire Breast 23 (QLQ-BR23) questionnaires. Quality of life was found to be statistically better (P = 0.008) in MBC patients receiving chemotherapy than those under only supportive care. Statistically significant differences in favour of chemotherapy were also found in functioning subscales, symptom single-item questions and sexual functioning. Our findings suggest that chemotherapy in MBC patients with good performance status is the more rational therapeutic approach in terms of QoL improvement.
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Affiliation(s)
- M V Karamouzis
- First Department of Medical Oncology, St. Savvas Anticancer-Oncologic Hospital, Athens, Greece.
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Bergquist H, Johnsson A, Hammerlid E, Wenger U, Lundell L, Ruth M. Factors predicting survival in patients with advanced oesophageal cancer: a prospective multicentre evaluation. Aliment Pharmacol Ther 2008; 27:385-95. [PMID: 18081735 DOI: 10.1111/j.1365-2036.2007.03589.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Oesophageal cancer is often diagnosed at an advanced stage, with poor prognosis and severe morbidity. In majority of cases, palliative treatment is the only option available. AIM To find factors that can predict survival for patients with incurable cancer of the oesophagus or gastro-oesophageal junction and hence aid in the choice of treatment. METHODS Ninety-six patients were included. Health-related quality of life questionnaires (EORTC QLQ C-30 and QLQ OES18) were administered and computerized tomography-derived size assessment of the primary tumours was performed. Univariate and multivariate Cox-regression analyses were used to determine potential predictors of survival. RESULTS Karnofsky Index, occurrence of metastases (M-stage), Union International Contre le Cancer-stage, computerized tomography-derived tumour size assessment and 10 of 25 scales and single items from the health-related quality of life questionnaires were found to be related to survival. In the multivariate analysis, three of the health-related quality of life questionnaire scales (physical functioning, fatigue and reflux) were found to add prognostic information to M-stage, the single strongest predictor (HR 1.9, P < 0.01). CONCLUSION In addition to M-stage, the outcome of health-related quality of life questionnaires can sharpen the prediction of survival in patients with advanced cancer of the oesophagus or gastro-oesophageal junction and thus aid in the choice of palliative treatment strategy.
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Affiliation(s)
- H Bergquist
- Department of Otorhinolaryngology, Sahlgrenska University Hospital, Göteborg, Sweden.
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96
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Lifting symptom burden--how far off the ground are we? Support Care Cancer 2008; 16:757-61. [PMID: 18256858 DOI: 10.1007/s00520-007-0401-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Accepted: 12/19/2007] [Indexed: 10/22/2022]
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Gotay CC, Kawamoto CT, Bottomley A, Efficace F. The prognostic significance of patient-reported outcomes in cancer clinical trials. J Clin Oncol 2008; 26:1355-63. [PMID: 18227528 DOI: 10.1200/jco.2007.13.3439] [Citation(s) in RCA: 474] [Impact Index Per Article: 29.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
PURPOSE Patient-reported outcomes (PROs), routinely collected as a part of cancer clinical trials, have been linked with survival in numerous clinical studies, but a comprehensive critical review has not been reported. This study systematically assessed the impact of PROs on patient survival after a cancer diagnosis within the context of clinical trials. DESIGN Cancer clinical trials that assessed baseline PROs and mortality were identified through MEDLINE (through December 2006) supplemented by the Cochrane database, American Society of Clinical Oncology/European Society for Medical Oncology abstracts and hand searches. Inclusion criteria were publication in English language and use of multivariate analyses of PROs that controlled for one or more clinical factors. Two raters reviewed each study, abstracted data, and assessed study quality; two additional raters verified abstractions. RESULTS In 36 of 39 studies (N = 13,874), at least one PRO was significantly associated with survival (P < .05) in multivariate analysis, with varying effect sizes. Studies of lung (n = 12) and breast cancer (n = 8) were most prevalent. The most commonly assessed PRO was quality of life, measured by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 in 56% of studies. Clinical variables adjusted for included performance status (PS), treatment arm, stage, weight loss, and serum markers. Results indicated that PROs provide distinct prognostic information beyond standard clinical measures in cancer clinical trials. CONCLUSION PROs might be considered for stratification purposes in future trials, as they were often better predictors of survival than PS. Studies are needed to determine whether interventions that improve PROs also increase survival and to identify explanatory mechanisms through which PROs relate to survival.
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Affiliation(s)
- Carolyn C Gotay
- Department of Health Care and Epidemiology, University of British Columbia, 5804 Fairview Ave, Vancouver, British Columbia, V6E 1R7 Canada.
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Bottomley A, Coens C, Efficace F, Gaafar R, Manegold C, Burgers S, Vincent M, Legrand C, van Meerbeeck JP. Symptoms and patient-reported well-being: do they predict survival in malignant pleural mesothelioma? A prognostic factor analysis of EORTC-NCIC 08983: randomized phase III study of cisplatin with or without raltitrexed in patients with malignant pleural mesothelioma. J Clin Oncol 2007; 25:5770-6. [PMID: 18089874 DOI: 10.1200/jco.2007.12.5294] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Malignant pleural mesothelioma (MPM) is a rare disease. Unlike other advanced cancer types, little is known about patient-reported symptoms or health-related quality of life (HRQOL) and their possible prognostic value. This study reports an evaluation of the prognostic value of these factors using data gathered from a recent randomized controlled trial. PATIENTS AND METHODS Patients were entered onto this trial if they had a histologically proven unresectable MPM, not pretreated with chemotherapy, WHO performance status < or = 2, and adequate hematologic, renal, and hepatic function. Patients were randomly assigned to receive cisplatin 80 mg/m2 intravenously on day 1, without or with preceding infusion of raltitrexed 3 mg/m2. HRQOL was assessed using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30/Lung Cancer 13 tool. The Cox proportional hazards regression model was used for the univariate and multivariate analyses of survival, along with a bootstrap validation technique. Included were the EORTC prognostic index (PI) composed of stage of disease, histology type, time since diagnosis, and WBC, and, in addition, 10 selected key symptoms and HRQOL scales. RESULTS Two hundred fifty patients were randomly assigned (80% male; median age, 58 years; WHO performance status 0, 1, 2 in 25%, 62%, and 13% of cases, respectively). Two hundred twenty-nine patients (91.6%) had a valid HRQOL assessment. The final multivariate model retained the PI, pain (P < .0001), and appetite loss (P = .0100) as independent prognostic indicators of survival. CONCLUSION Results suggest that the PI, pain, and appetite loss may be independent prognostic factors in patients with advanced MPM.
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Affiliation(s)
- Andrew Bottomley
- EORTC Data Center, Quality of Life Unit, Avenue E. Mounier, 83, 1200 Brussels, Belgium.
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Mauer MEL, Taphoorn MJB, Bottomley A, Coens C, Efficace F, Sanson M, Brandes AA, van der Rijt CCD, Bernsen HJJA, Frénay M, Tijssen CC, Lacombe D, van den Bent MJ. Prognostic value of health-related quality-of-life data in predicting survival in patients with anaplastic oligodendrogliomas, from a phase III EORTC brain cancer group study. J Clin Oncol 2007; 25:5731-7. [PMID: 18089867 DOI: 10.1200/jco.2007.11.1476] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This is one of a few studies that have explored the value of baseline symptoms and health-related quality of life (HRQOL) in predicting survival in patients with brain cancer. PATIENTS AND METHODS Baseline HRQOL scores (from the European Organisation for Research and Treatment of Cancer [EORTC] Quality of Life Questionnaire C30 and the EORTC Brain Cancer Module) were examined in 247 patients with anaplastic oligodendrogliomas to determine the relationship with overall survival by using Cox proportional hazards regression models. Refined techniques as the bootstrap resampling procedure and the computation of C indexes and R2 coefficients were used to explore the stability of the models as well as better assess the potential benefit of using HRQOL to predict survival in clinical practice and research. RESULTS Classical analysis controlled for major clinical prognostic factors selected emotional functioning (P = .0016), communication deficit (P = .0261), future uncertainty (P = .0481), and weakness of legs (P = .0001) as statistically significant prognostic factors of survival. However, several issues question the validity of these findings and no single model was found to be preferable over all others. C indexes, which estimate the probability of a model to correctly predict which patient among a randomly chosen pair of patients will survive longer, and R2 coefficients, which measure the proportion of variability explained by the model, did not exhibit major improvement when adding selected or all HRQOL scores to clinical factors. CONCLUSION While classical techniques lead to positive results, more refined analyses suggest that baseline HRQOL scores add relatively little to clinical factors to predict survival. These results may have implications for future use of HRQOL as a prognostic factor for patients with cancer.
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Affiliation(s)
- Murielle E L Mauer
- European Organisation for Research and Treatment of Cancer Data Center, Quality of Life Unit, Ave Mounier 83/11, Brussels, Belgium 1200.
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Bruner DW. Should Patient-Reported Outcomes Be Mandatory for Toxicity Reporting in Cancer Clinical Trials? J Clin Oncol 2007; 25:5345-7. [DOI: 10.1200/jco.2007.13.3330] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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