Association of Disease Progression With Health-Related Quality of Life Among Adults With Breast, Lung, Pancreatic, and Colorectal Cancer

Abstract

IMPORTANCE Mortality, morbidity, and health-related quality of life (HRQoL) are patient-relevant end points generally considered in the early benefit assessments of new cancer treatments. Progression-related end points, such as time to progression or progression-free survival, are not included, although patients and physicians testify to the detrimental association of disease progression with HRQoL. OBJECTIVE To examine the association of disease progression and HRQoL in 4 prevalent solidcancer entities in routine clinical practice. DESIGN, SETTING, AND PARTICIPANTS This cohort study evaluated data from 4 prospective, nonintervention, multicenter registries collected between 2011 and 2018 in 203 centers in Germany. Patients' HRQoL was assessed regularly for up to 5 years. The change in HRQoL scores after disease progression was examined with linear mixed models, adjusting for demographic and clinical covariates. Patients with metastatic breast, pancreatic, lung, and colorectal cancer were recruited at the start of systemic first-line treatment. Data analysis was performed from February 2019 to April 2019. EXPOSURES All patients received systemic, palliative first-line treatment according to their physician's choice. MAIN OUTCOMES AND MEASURES The primary outcome was deterioration of HRQoL associated with disease progression, as measured by 4 validated questionnaires: Functional Assessment of Cancer Therapy-General version 4, European Organization for Research and Treatment of Cancer QLQ-C30 version 3.0, European Organization for Research and Treatment of Cancer QLQ-C15-PAL version 1, and Hospital Anxiety and Depression Scale. RESULTS More than 8000 questionnaires from 2314 patients with 2562 documented disease progressions were analyzed. In total, 464 patients had breast cancer (464 [100.0%] female; median [range] age, 61.6 [26.4-90.1] years), 807 patients had pancreatic cancer (352 [43.6%] female; median [range] age, 70.0 [39.0-93.0] years), 341 patients had lung cancer (118 [34.6%] female; median [range] age, 65.9 [28.4-88.2] years), and 702 patients had colorectal cancer (248 [35.3%] female; median [range] age, 66.9 [26.9-92.1] years). The first disease progression was associated with a statistically significant worsening of 37 of 45 HRQoL scales; for 17 of these scales, the worsening was clinically meaningful.

Exercise Medicine in the Management of Pancreatic Cancer

“…Evidence indicates that disease progression is associated with a deterioration of QoL in this patient group. 85 There are also a number of other factors identified that may contribute to a worsening in QoL, such as treatments, comorbidities, and various demographic factors (including ethnicity, age, and educational level). 16 Although the benefits of exercise in QoL for various patients with cancer (including advanced disease) have been well established, 22 , 24 , 86 , 87 its effect for patients with PanCa requires further work and clarification.…”

TELO2 induced progression of colorectal cancer by binding with RICTOR through mTORC2

“…The staining sections were then reviewed and scored as follows by a pathologist with over 15 years of experience: Cells with <10% staining were scored as negative staining (−, 1); cells with 10-49% staining were scored as (+, 2); cells with 50-74% staining were scored as (++, 3); and cells with 75-100% staining were scored as (+++, 4). The staining color was scored as light-yellow particle ( 1 ), brown-yellow particle ( 2 ), and brown particle ( 3 ). The final score was defined as staining number score multiplied by staining color score ( 20 ).…”

“…CRC progression, from adenoma to adenocarcinoma, is a multistep process ( 2 ). CRC results from a series of genetic and epigenetic alterations in key growth regulatory genes, which endow the colorectal cells with proliferative, survival, and metastatic advantages ( 3 ). The median overall survival (OS) of metastatic CRC (mCRC) is less than 3 years.…”

Cost-effectiveness Analysis of Genetic Testing and Tailored First-Line Therapy for Patients With Metastatic Gastrointestinal Stromal Tumors

“…The importance of progression-free survival has been shown across a variety of cancer types and is associated with a clinically relevant deterioration in quality of life. 36 For these reasons, the cost-effectiveness of withholding futile therapy for patients with KIT exon 9 variation is not surprising.…”