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Pleyer L, Heibl S, Tinchon C, Vallet S, Schreder M, Melchardt T, Stute N, Föhrenbach Quiroz KT, Leisch M, Egle A, Scagnetti L, Wolf D, Beswick R, Drost M, Larcher-Senn J, Grochtdreis T, Vaisband M, Hasenauer J, Zaborsky N, Greil R, Stauder R. Health-Related Quality of Life as Assessed by the EQ-5D-5L Predicts Outcomes of Patients Treated with Azacitidine-A Prospective Cohort Study by the AGMT. Cancers (Basel) 2023; 15:cancers15051388. [PMID: 36900181 PMCID: PMC10000211 DOI: 10.3390/cancers15051388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/10/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023] Open
Abstract
In this prospective study (NCT01595295), 272 patients treated with azacitidine completed 1456 EuroQol 5-Dimension (EQ-5D) questionnaires. Linear mixed-effect modelling was used to incorporate longitudinal data. When compared with a matched reference population, myeloid patients reported more pronounced restrictions in usual activities (+28%, p < 0.0001), anxiety/depression (+21%, p < 0.0001), selfcare (+18%, p < 0.0001) and mobility (+15%, p < 0.0001), as well as lower mean EQ-5D-5L indices (0.81 vs. 0.88, p < 0.0001), and lower self-rated health on the EuroQol Visual Analogue Scale (EQ-VAS) (64 vs. 72%, p < 0.0001). After multivariate-adjustment, (i) the EQ-5D-5L index assessed at azacitidine start the predicted time with clinical benefit (TCB) (9.6 vs. 6.6 months; p = 0.0258; HR = 1.43), time to next treatment (TTNT) (12.8 vs. 9.8 months; p = 0.0332; HR = 1.42) and overall survival (OS) (17.9 vs. 12.9 months; p = 0.0143; HR = 1.52); (ii) Level Sum Score (LSS) predicted azacitidine response (p = 0.0160; OR = 0.451) and the EQ-5D-5L index showed a trend (p = 0.0627; OR = 0.522); (iii) up to 1432 longitudinally assessed EQ-5D-5L response/clinical parameter pairs revealed significant associations of EQ-5D-5L response parameters with haemoglobin level, transfusion dependence and hematologic improvement. Significant increases of the likelihood ratios were observed after addition of LSS, EQ-VAS or EQ-5D-5L-index to the International Prognostic Scoring System (IPSS) or the revised IPSS (R-IPSS), indicating that they provide added value to these scores.
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Affiliation(s)
- Lisa Pleyer
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
- Salzburg Cancer Research Institute (SCRI), Center for Clinical Cancer and Immunology Trials (CCCIT), Austria and Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, 5020 Salzburg, Austria
- Correspondence: or ; Tel.: +43-(0)676-8997-58271
| | - Sonja Heibl
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
- 4th Medical Department of Internal Medicine, Hematology, Internistic Oncology and Palliative Medicine, Klinikum Wels-Grieskirchen GmbH, 4600 Wels, Austria
| | - Christoph Tinchon
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
- Department for Hemato-Oncology, LKH Hochsteiermark, 8700 Leoben, Austria
| | - Sonia Vallet
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
- Department of Internal Medicine 2, University Hospital Krems, Karl Landsteiner Private University of Health Sciences, 3500 Krems, Austria
| | - Martin Schreder
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
- 1st Department of Internal Medicine, Center for Oncology and Hematology, Klinik Ottakring, Wiener Gesundheitsverbund, 1030 Vienna, Austria
| | - Thomas Melchardt
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
- Salzburg Cancer Research Institute (SCRI), Center for Clinical Cancer and Immunology Trials (CCCIT), Austria and Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Norbert Stute
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
- Salzburg Cancer Research Institute (SCRI), Center for Clinical Cancer and Immunology Trials (CCCIT), Austria and Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Kim Tamara Föhrenbach Quiroz
- Salzburg Cancer Research Institute (SCRI), Center for Clinical Cancer and Immunology Trials (CCCIT), Austria and Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
| | - Michael Leisch
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
- Salzburg Cancer Research Institute (SCRI), Center for Clinical Cancer and Immunology Trials (CCCIT), Austria and Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Alexander Egle
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
- Salzburg Cancer Research Institute (SCRI), Center for Clinical Cancer and Immunology Trials (CCCIT), Austria and Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Lukas Scagnetti
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
- 4th Medical Department of Internal Medicine, Hematology, Internistic Oncology and Palliative Medicine, Klinikum Wels-Grieskirchen GmbH, 4600 Wels, Austria
| | - Dominik Wolf
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
- Department of Internal Medicine V, Innsbruck Medical University, 6020 Innsbruck, Austria
| | - Richard Beswick
- International Marketing, Swiss Business School, 8302 Zurich, Switzerland
| | - Manuel Drost
- Assign Data Management and Biostatistics GmbH, 6020 Innsbruck, Austria
| | | | - Thomas Grochtdreis
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Marc Vaisband
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
- Salzburg Cancer Research Institute (SCRI), Center for Clinical Cancer and Immunology Trials (CCCIT), Austria and Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- Life and Medical Sciences Institute, University of Bonn, 53115 Bonn, Germany
| | - Jan Hasenauer
- Life and Medical Sciences Institute, University of Bonn, 53115 Bonn, Germany
| | - Nadja Zaborsky
- Salzburg Cancer Research Institute (SCRI), Center for Clinical Cancer and Immunology Trials (CCCIT), Austria and Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, 5020 Salzburg, Austria
- Laboratory of Immunological and Molecular Cancer Research (LIMCR), 5020 Salzburg, Austria
| | - Richard Greil
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
- Salzburg Cancer Research Institute (SCRI), Center for Clinical Cancer and Immunology Trials (CCCIT), Austria and Cancer Cluster Salzburg (CCS), 5020 Salzburg, Austria
- 3rd Medical Department with Hematology, Medical Oncology, Hemostaseology, Rheumatology and Infectiology, Oncologic Center, Paracelsus Medical University, 5020 Salzburg, Austria
| | - Reinhard Stauder
- Austrian Group for Medical Tumor Therapy (AGMT) Study Group, 1180 Vienna, Austria
- Department of Internal Medicine V, Innsbruck Medical University, 6020 Innsbruck, Austria
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Salas M, Henderson M, Wientzek-Fleischmann A, Islam Z, Tu N, Bilitou A, Elsharkawy M, Stellmacher U. Validated Instruments of Quality of Life (QOL) in Patients With Acute Myeloid Leukemia (AML) and Other Cancers. Front Pharmacol 2020; 11:1109. [PMID: 32792948 PMCID: PMC7394002 DOI: 10.3389/fphar.2020.01109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/08/2020] [Indexed: 11/26/2022] Open
Abstract
Introduction Acute myeloid leukemia (AML) can negatively impact quality of life (QOL). Few QOL instruments are specific to and have been validated in AML. This review aims to identify QOL instruments that have been validated in patients with AML and other cancers and summarize their psychometric properties reported in published literature. A literature review search was performed using PubMed and OVID (Biosis, Embase, MEDLINE) databases through June 25, 2020. Search terms included: QOL, health-related QOL, patient-reported outcomes and validity, reliability, validated, tools, instruments, test-retest, and leukemia myeloid acute, leukemia, myeloid, acute, acute myeloid leukemia. Articles were included if they focused on cancer and reported psychometric properties that could be extracted. Abstracts and their references were reviewed for inclusion. Results Twelve evaluating ten instruments were included. Functional Assessment of Cancer Therapy Leukemia (FACT-Leu) showed internal consistency (IC) of α = 0.86 to >0.9, correlation with EQ-5D-3L of r > 0.50, correlation with European Organisation for Research and Treatment of Cancer (EORTC) QLQ-Leu of ρ = 0.29–0.63, test-retest reliability of κ = 0.861. FACT-F showed correlations with EORTC QLQ-C30 of r = 0.40–0.83. Hematological Malignancy Patient-Reported Outcome (HM-PRO) showed intraclass correlation coefficient (ICC) of 0.94–0.98. EORTC-8D and EQ-5D-3L showed ICC = 0.595, correlations with each other of ρ = 0.137–0.634 and with EORTC QLQ-C30 of r = 0.651–0.917. EORTC QLQ-C30 showed person separation reliability of 0.47 to 0.90 and patient-observer agreement of 0.85. Life Ingredient Profile (LIP) showed IC of α = 0.29–0.77 and test-retest reliability of κ = 0.42–1.0. QOL-E showed correlation with FACT-general of R = 0.71, internal validity of α = 0.7, and test-retest reliability of standardized Cronbach’s α = 0.7–0.92. EORTC QLQ-Leu showed IC of α = 0.6–0.79. The Acute Myeloid Leukemia–Quality of Life (AML-QOL) instrument showed IC of α = 0.72, correlations with EORTC QLQ-30 of magnitudes ρ = 0.59–0.72, and test-retest reliability of ICC = 0.52–0.91. Conclusion Although several QOL instruments have been validated, more research is needed to determine the most clinically useful instruments in patients with AML.
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Affiliation(s)
- Maribel Salas
- Epidemiology and Clinical Safety and Pharmacovigilance, Daiichi Sankyo, Inc., Basking Ridge, NJ, USA.,Centers for Clinical Epidemiology and Biostatistics and Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Mackenzie Henderson
- Epidemiology and Clinical Safety and Pharmacovigilance, Daiichi Sankyo, Inc., Basking Ridge, NJ, USA.,Rutgers Institute for Pharmaceutical Industry Fellowships, Rutgers University, Piscataway, NJ, United States
| | | | - Zahidul Islam
- Epidemiology and Clinical Safety and Pharmacovigilance, Daiichi Sankyo, Inc., Basking Ridge, NJ, USA
| | - Nora Tu
- Epidemiology and Clinical Safety and Pharmacovigilance, Daiichi Sankyo, Inc., Basking Ridge, NJ, USA
| | - Aikaterini Bilitou
- HEOR/RWE: Health Economics and Outcomes Research (HEOR)/Real-World Evidence (RWE), Market Access, DSE, Munich, Germany
| | - Maggie Elsharkawy
- Epidemiology and Clinical Safety and Pharmacovigilance, Daiichi Sankyo, Inc., Basking Ridge, NJ, USA
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