Metastases progression linked to deteriorating HRQoL
medwireNews: Disease progression among patients with metastatic lung, pancreatic, colorectal, and breast cancer is associated with statistically significant and clinically relevant reductions in health-related quality of life (HRQoL), real-world study data show.
The strongest associations seen among the 2314 patients with 2562 documented disease progressions were for appetite loss, physical functioning, and fatigue, irrespective of cancer type, report Norbert Marschner (Praxis für interdisziplinäre Onkologie und Hämatologie, Freiburg, Germany) and co-authors in JAMA Network Open.
The study included data from more than 8000 validated HRQoL questionnaires collected via four multicenter, prospective, nonintervention registries of patients with metastatic pancreatic (34.9%), colorectal (30.3%), breast (20.1%), and lung (14.7%) cancer who were recruited at the start of first-line systemic, palliative treatment.
After adjusting for demographic and clinical covariates, the researchers found that first disease progression was associated with a statistically significant worsening of 37 of the 45 HRQoL scales of the EORTC QLQ-C15 PAL (pancreatic cancer), EORTC QLQ-C30 (lung and colorectal cancer), Functional Assessment of Cancer Therapy–General (breast cancer), and Hospital Anxiety and Depression Scale (breast cancer) questionnaires.
Of these affected scales, 17 showed changes of moderate-to-large clinical significance, defined as a decline of 5% or more.
For example, all EORTC QLQ-C30 subscales for lung cancer except insomnia, constipation, and diarrhea showed statistically significant worsening after disease progression, with the highest reductions observed for appetite loss (10.8 points), physical functioning (8.4 points), fatigue (7.7 points), social functioning (7.6 points), and pain (7.4 points).
Significant deterioration in global HRQoL scores was associated with first disease progression in all four cancer cohorts but was most pronounced in lung cancer (6.7 points), followed by pancreatic cancer (5.4 points), colorectal cancer (3.5 points), and breast cancer (2.4 points).
Marschner et al say: “Public authorities often disregard disease progression as a patient-relevant end point because radiologically assessed progression might not necessarily be associated with morbidity and because longer [progression-free survival] is often not statistically significantly associated with longer survival.
“Here, we show that disease progression is accompanied by a distinct deterioration in HRQoL in 4 common metastatic cancer entities.”
They conclude that their data highlight “the importance of disease progression from a patient perspective,” and therefore propose “that progression-related end points in metastatic breast, colorectal, lung, or pancreatic cancer should be considered when evaluating the benefit of novel treatments, in addition to survival, morbidity, and HRQoL outcomes.”
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