Determinants of quality of life in patients with incurable cancer

Abstract

BACKGROUND: Optimizing quality of life (QoL) remains the central tenet of care in patients with incurable cancer; however, determinants of QoL are not clear. The objective of the current study was to examine which factors influence QoL in patients with incurable cancer. METHODS: A multicenter study of adult patients with advanced cancer was conducted in Ireland and the United Kingdom between 2011 and 2016. Data were collected from patients at study entry and included patient demographics, Eastern Cooperative Oncology Group performance status (ECOG-PS), nutritional parameters (the percentage weight loss [%WL]), muscle parameters assessed using computed tomography images (skeletal muscle index and skeletal muscle attenuation), inflammatory markers (modified Glasgow Prognostic score [mGPS]), and QoL data (the European Organization for Research and Treatment Quality-of-Life Questionnaire C-30). The relation between clinical, nutritional, and inflammatory parameters with QoL was assessed using the Spearman rank correlation coefficient and multivariate binary logistic regression. Components of the European Organization for Research and Treatment Quality-of-Life Questionnaire C-30 (physical function, fatigue, and appetite loss) and summary QoL scores were mean-dichotomized for the logistic regression analyses. RESULTS: Data were available for 1027 patients (51% men; median age, 66 years). Gastrointestinal cancer was most prevalent (40%), followed by lung cancer (26%) and breast cancer (9%). Distant metastatic disease was present in 87% of patients. The %WL, ECOG-PS, and mGPS were significantly correlated with deteriorating QoL functional and symptom scales (all P < .001). On multivariate regression analysis, >10% WL (odds ratio [OR], 2.69; 95% CI, 1.63-4.42), an ECOG-PS of 3 or 4 (OR, 14.33; 95% CI, 6.76-30.37), and an mGPS of 2 (OR, 1.58; 95% CI, 1.09-2.29) were independently associated with poorer summary QoL scores. These parameters were also independently associated with poorer physical function, fatigue, and appetite loss (all P < .05). Low skeletal muscle attenuation was independently associated with poorer physical functioning (OR, 1.67; 95% CI, 1.09-2.56), but muscle parameters were not independently associated with fatigue, appetite loss, or QoL summary scores. CONCLUSIONS: The current findings indicate that QoL is determined (at least in part) by WL, ECOG-PS, and the systemic inflammatory response in patients with advanced cancer. Identifying early predictors of poor QoL may allow the identification of patients who may benefit from early referral to palliative and supportive care, which has been shown to improve QoL. Cancer 2020;126:2872-2882.

Impact of musculoskeletal degradation on cancer outcomes and strategies for management in clinical practice

“…Individual proinflammatory cytokines have been associated with clinical symptoms, e.g., IL-6 and C-reactive protein with anorexia (129) , IL-1ra with fatigue (129) and IL-6 with major depression (130,131) . Our group recently reported that systemic inflammation has a negative impact on QoL that is independent of Eastern Cooperative Oncology Group performance status (14) which is consistent with previous reports indicating that the systemic inflammatory response is associated with poorer QoL, even in those with a good performance score (132) .…”

“…The negative impact on QoL is unsurprising, considering cancer-related malnutrition is a major cause of fatigue (117,118) , reduced functional ability (116) and a source of emotional distress (117,119) . Our group recently reported on a cohort of 1027 patients with advanced cancer and showed that WL >10 % was associated with poorer QoL in almost all functional and symptom domains (14) . In particular, WL in excess of 10 % in the preceding 3 months was independently associated with poorer physical function, fatigue and appetite loss and overall poorer QoL summary scores.…”

“…A recent large international cohort of 8160 patients with cancer suggesting that WL of as little as 2⋅4 % predicts survival independent of disease, site, stage or performance score (6) . In addition to the adverse impact on survival, WL has historically been associated with severe chemotherapy-related toxicity (8–12) ; and leads to a significant deterioration in a patients' performance status, psychological well-being and overall quality of life (QoL) (13,14) .…”

The Relationship between ECOG-PS, mGPS, BMI/WL Grade and Body Composition and Physical Function in Patients with Advanced Cancer

“…A biobank of data from patients with advanced cancer was analysed. All data were collected prospectively across 9 sites in the UK and Ireland (cancer centres, hospitals, and specialist palliative care units) over a five-year period (2011-2016) [9,11,12]. Eligible patients provided written informed consent, were adults, had advanced cancer including all cancer subtypes (defined as metastatic cancer with histological, cytological or radiological evidence, that was locally advanced, or receiving anti-cancer therapy with palliative intent) and had the ability to comply with study procedures including provision of a venous blood sample (taken on the day of consent).…”

The Relationship Between Social Support From Family and Quality of Life Among Cancer Patients: A Cross-Sectional Study

“…Nayak et al reported that 82.3% of cancer patients had low QoL scores [3]. Moreover, the rate of patients with low QoL scores is higher regarding advanced cancer [4]. Numerous factors have been reported as the predictors of QoL; these factors include radiotherapy treatments, the feeling of loneliness, marital status, education status, comorbidity, and weight loss.…”