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Quality of life and supportive care for patients with metastatic renal cell carcinoma

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Abstract

In recent years, a key issue in the management of patients with metastatic renal cell carcinoma (mRCC) has been the assessment of health-related quality of life (HRQoL), particularly following the introduction of targeted therapies that have brought significant improvements in progression-free survival and quality of life in these patients. HRQoL is becoming one of the main factors influencing choice of therapy, and HRQoL experienced during first-line treatment may affect the choice of the second-line therapy. Consequently, several trials have been conducted to evaluate the impact of approved targeted therapies for mRCC on HRQoL, and this measure is being introduced with increasing frequency in the trial design. With respect to agents used after progression on cytokines, sunitinib and temsirolimus have yielded better HRQoL scores, and sorafenib and pazopanib have shown stable HRQoL scores compared with placebo. Regarding targeted agents approved for patients who progress on a first-line tyrosine kinase inhibitor, everolimus has shown to delay and reduce the degree of Karnofsky performance status deterioration compared with placebo. Moreover, evidence obtained from these trials shows that tumor response and delay in disease progression affect HRQoL. In this article, we review the different HRQoL scales used to evaluate patients with mRCC along with the results obtained in clinical trials. Given that HRQoL is determined not only by treatment-related effects but also by mRCC symptoms and its clinical complications, the characteristics and appropriate treatment of the most commonly experienced symptoms, including anorexia, fatigue, pain, anemia, and venous thromboembolism, are also reviewed.

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References

  1. Cella, D. (2011). Beyond traditional outcomes: improving quality of life in patients with renal cell carcinoma. The Oncologist, 16(Suppl 2), 23–31.

    Article  PubMed  Google Scholar 

  2. Patil, S., Figlin, R. A., Hutson, T. E., Michaelson, M. D., Negrier, S., Kim, S. T., et al. (2009). Prognostic factors for overall survival with sunitinib as first-line therapy in patients with metastatic renal cell carcinoma (mRCC). ASCO Meeting Abstracts, 27(15S), 5042.

    Google Scholar 

  3. Cella, D. F., Tulsky, D. S., Gray, G., Sarafian, B., Linn, E., Bonomi, A., et al. (1993). The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. Journal of Clinical Oncology, 11(3), 570–579.

    PubMed  CAS  Google Scholar 

  4. Cella, D., Hahn, E. A., & Dineen, K. (2002). Meaningful change in cancer-specific quality of life scores: differences between improvement and worsening. Quality of Life Research, 11(3), 207–221.

    Article  PubMed  Google Scholar 

  5. Abel, E. J., Culp, S. H., Tannir, N. M., Tamboli, P., Matin, S. F., & Wood, C. G. (2011). Early primary tumor size reduction is an independent predictor of improved overall survival in metastatic renal cell carcinoma patients treated with sunitinib. European Urology., 60, 1273–1279.

    Article  PubMed  CAS  Google Scholar 

  6. Cella, D., Yount, S., Du, H., Dhanda, R., Gondek, K., Langefeld, K., et al. (2006). Development and validation of the Functional Assessment of Cancer Therapy-Kidney Symptom Index (FKSI). Journal of Supportive Oncology, 4(4), 191–199.

    PubMed  Google Scholar 

  7. Cella, D., Yount, S., Brucker, P. S., Du, H., Bukowski, R., Vogelzang, N., et al. (2007). Development and validation of a scale to measure disease-related symptoms of kidney cancer. Value in Health, 10(4), 285–293.

    Article  PubMed  Google Scholar 

  8. Rini, B. I., & Flaherty, K. (2008). Clinical effect and future considerations for molecularly-targeted therapy in renal cell carcinoma. Urologic Oncology, 26(5), 543–549.

    Article  PubMed  CAS  Google Scholar 

  9. Gelber, R. D., Goldhirsch, A., & Cole, B. F. (1993). Evaluation of effectiveness: Q-TWiST. The International Breast Cancer Study Group. Cancer Treatment Reviews, 19(Suppl A), 73–84.

    Article  PubMed  Google Scholar 

  10. Glasziou, P. P., Simes, R. J., & Gelber, R. D. (1990). Quality adjusted survival analysis. Statistics in Medicine, 9(11), 1259–1276.

    Article  PubMed  CAS  Google Scholar 

  11. Bosaeus, I., Daneryd, P., Svanberg, E., & Lundholm, K. (2001). Dietary intake and resting energy expenditure in relation to weight loss in unselected cancer patients. International Journal of Cancer, 93(3), 380–383.

    Article  CAS  Google Scholar 

  12. Argiles, J. M., Almendro, V., Busquets, S., & Lopez-Soriano, F. J. (2004). The pharmacological treatment of cachexia. Current Drug Targets, 5(3), 265–277.

    Article  PubMed  CAS  Google Scholar 

  13. Jatoi, A., Windschitl, H. E., Loprinzi, C. L., Sloan, J. A., Dakhil, S. R., Mailliard, J. A., et al. (2002). Dronabinol versus megestrol acetate versus combination therapy for cancer-associated anorexia: a North Central Cancer Treatment Group study. Journal of Clinical Oncology, 20(2), 567–573.

    Article  PubMed  CAS  Google Scholar 

  14. Jho, D., Babcock, T. A., Helton, W. S., & Espat, N. J. (2003). Omega-3 fatty acids: implications for the treatment of tumor-associated inflammation. American Surgeon, 69(1), 32–36.

    PubMed  Google Scholar 

  15. Tisdale, M. J. (2003). The ‘cancer cachectic factor’. Supportive Care in Cancer, 11(2), 73–78.

    PubMed  Google Scholar 

  16. Bruera, E., Strasser, F., Palmer, J. L., Willey, J., Calder, K., Amyotte, G., et al. (2003). Effect of fish oil on appetite and other symptoms in patients with advanced cancer and anorexia/cachexia: a double-blind, placebo-controlled study. Journal of Clinical Oncology, 21(1), 129–134.

    Article  PubMed  CAS  Google Scholar 

  17. Grobbelaar, E. J., Owen, S., Torrance, A. D., & Wilson, J. A. (2004). Nutritional challenges in head and neck cancer. Clinical Otolaryngology and Allied Sciences, 29(4), 307–313.

    Article  PubMed  CAS  Google Scholar 

  18. Jatoi, A., Rowland, K., Loprinzi, C. L., Sloan, J. A., Dakhil, S. R., MacDonald, N., et al. (2004). An eicosapentaenoic acid supplement versus megestrol acetate versus both for patients with cancer-associated wasting: a North Central Cancer Treatment Group and National Cancer Institute of Canada collaborative effort. Journal of Clinical Oncology, 22(12), 2469–2476.

    Article  PubMed  CAS  Google Scholar 

  19. Afari, N., & Buchwald, D. (2003). Chronic fatigue syndrome: a review. The American Journal of Psychiatry, 160(2), 221–236.

    Article  PubMed  Google Scholar 

  20. Wyller, V. B. (2007). The chronic fatigue syndrome—an update. Acta Neurologica Scandinavica. Supplementum, 187, 7–14.

    Article  PubMed  Google Scholar 

  21. Bruera, E., & Neumann, C. M. (1998). Management of specific symptom complexes in patients receiving palliative care. Canadian Medical Association Journal, 158(13), 1717–1726.

    PubMed  CAS  Google Scholar 

  22. Di Lorenzo, G., Buonerba, C., Federico, P., Rescigno, P., Milella, M., Ortega, C., et al. (2010). Third-line sorafenib after sequential therapy with sunitinib and mTOR inhibitors in metastatic renal cell carcinoma. European Urology, 58(6), 906–911.

    Article  PubMed  Google Scholar 

  23. Bruera, E., Brenneis, C., Michaud, M., & MacDonald, R. N. (1989). Influence of the pain and symptom control team (PSCT) on the patterns of treatment of pain and other symptoms in a cancer center. Journal of Pain and Symptom Management, 4(3), 112–116.

    Article  PubMed  CAS  Google Scholar 

  24. Cleeland, C. S., Gonin, R., Hatfield, A. K., Edmonson, J. H., Blum, R. H., Stewart, J. A., et al. (1994). Pain and its treatment in outpatients with metastatic cancer. The New England Journal of Medicine, 330(9), 592–596.

    Article  PubMed  CAS  Google Scholar 

  25. Leppert, W. (2011). Pain management in patients with cancer: focus on opioid analgesics. Current Pain and Headache Reports, 15(4), 271–279.

    Article  PubMed  Google Scholar 

  26. Henry, D. H. (2010). Parenteral iron therapy in cancer-associated anemia. Hematology American Society for Hematology Education Program, 2010, 351–356.

    Article  Google Scholar 

  27. Beguin, Y. (1996). Erythropoietin and the anemia of cancer. Acta Clinica Belgica, 51(1), 36–52.

    PubMed  CAS  Google Scholar 

  28. Escudier, B., & Kataja, V. (2010). Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of Oncology, 21(Suppl 5), v137–v139.

    Article  PubMed  Google Scholar 

  29. Blom, J. W., Doggen, C. J., Osanto, S., & Rosendaal, F. R. (2005). Malignancies, prothrombotic mutations, and the risk of venous thrombosis. Journal of the American Medical Association, 293(6), 715–722.

    Article  PubMed  CAS  Google Scholar 

  30. Khorana, A. A., Francis, C. W., Culakova, E., Kuderer, N. M., & Lyman, G. H. (2007). Frequency, risk factors, and trends for venous thromboembolism among hospitalized cancer patients. Cancer, 110(10), 2339–2346.

    Article  PubMed  Google Scholar 

  31. Khorana, A. A., Francis, C. W., Culakova, E., & Lyman, G. H. (2005). Risk factors for chemotherapy-associated venous thromboembolism in a prospective observational study. Cancer, 104(12), 2822–2829.

    Article  PubMed  Google Scholar 

  32. Sallah, S., Wan, J. Y., & Nguyen, N. P. (2002). Venous thrombosis in patients with solid tumors: determination of frequency and characteristics. Thrombosis and Haemostasis, 87(4), 575–579.

    PubMed  CAS  Google Scholar 

  33. Dvorak, H. F., Quay, S. C., Orenstein, N. S., Dvorak, A. M., Hahn, P., Bitzer, A. M., et al. (1981). Tumor shedding and coagulation. Science, 212(4497), 923–924.

    Article  PubMed  CAS  Google Scholar 

  34. Khorana, A. A., Ahrendt, S. A., Ryan, C. K., Francis, C. W., Hruban, R. H., Hu, Y. C., et al. (2007). Tissue factor expression, angiogenesis, and thrombosis in pancreatic cancer. Clinical Cancer Research, 13(10), 2870–2875.

    Article  PubMed  CAS  Google Scholar 

  35. Tesselaar, M. E., Romijn, F. P., Van Der Linden, I. K., Prins, F. A., Bertina, R. M., & Osanto, S. (2007). Microparticle-associated tissue factor activity: a link between cancer and thrombosis? Journal of Thrombosis and Haemostasis, 5(3), 520–527.

    Article  PubMed  CAS  Google Scholar 

  36. Wahrenbrock, M., Borsig, L., Le, D., Varki, N., & Varki, A. (2003). Selectin-mucin interactions as a probable molecular explanation for the association of Trousseau syndrome with mucinous adenocarcinomas. The Journal of Clinical Investigation, 112(6), 853–862.

    PubMed  CAS  Google Scholar 

  37. Mismetti, P., Laporte-Simitsidis, S., Tardy, B., Cucherat, M., Buchmuller, A., Juillard-Delsart, D., et al. (2000). Prevention of venous thromboembolism in internal medicine with unfractionated or low-molecular-weight heparins: a meta-analysis of randomised clinical trials. Thrombosis and Haemostasis, 83(1), 14–19.

    PubMed  CAS  Google Scholar 

  38. Lyman, G. H., Khorana, A. A., Falanga, A., Clarke-Pearson, D., Flowers, C., Jahanzeb, M., et al. (2007). American Society of Clinical Oncology guideline: recommendations for venous thromboembolism prophylaxis and treatment in patients with cancer. Journal of Clinical Oncology, 25(34), 5490–5505.

    Article  PubMed  CAS  Google Scholar 

  39. Wagman, L. D., Baird, M. F., Bennett, C. L., Bockenstedt, P. L., Cataland, S. R., Fanikos, J., et al. (2006). Venous thromboembolic disease. Clinical practice guidelines in oncology. Journal of the National Comprehensive Cancer Network, 4(9), 838–869.

    PubMed  CAS  Google Scholar 

  40. Bianchi, M., Sun, M., Jeldres, C., Shariat, S. F., Trinh, Q. D., Briganti, A., et al. (2012). Distribution of metastatic sites in renal cell carcinoma: a population-based analysis. Annals of Oncology., 23, 973–980.

    Article  PubMed  CAS  Google Scholar 

  41. Coleman, R. E. (2001). Metastatic bone disease: clinical features, pathophysiology and treatment strategies. Cancer Treatment Reviews, 27(3), 165–176.

    Article  PubMed  CAS  Google Scholar 

  42. Aapro, M., Abrahamsson, P. A., Body, J. J., Coleman, R. E., Colomer, R., Costa, L., et al. (2008). Guidance on the use of bisphosphonates in solid tumours: recommendations of an international expert panel. Annals of Oncology, 19(3), 420–432.

    Article  PubMed  CAS  Google Scholar 

  43. Rosen, L. S., Gordon, D., Tchekmedyian, N. S., Yanagihara, R., Hirsh, V., Krzakowski, M., et al. (2004). Long-term efficacy and safety of zoledronic acid in the treatment of skeletal metastases in patients with nonsmall cell lung carcinoma and other solid tumors: a randomized, Phase III, double-blind, placebo-controlled trial. Cancer, 100(12), 2613–2621.

    Article  PubMed  CAS  Google Scholar 

  44. Cella, D., Li, J. Z., Cappelleri, J. C., Bushmakin, A., Charbonneau, C., Kim, S. T., et al. (2008). Quality of life in patients with metastatic renal cell carcinoma treated with sunitinib or interferon alfa: results from a phase III randomized trial. Journal of Clinical Oncology, 26(22), 3763–3769.

    Article  PubMed  CAS  Google Scholar 

  45. Patil, S., Figlin, RA., Hutson, TE., Michaelson, D., Negrier, S., Kim, S.T., et al. TWiST analysis to estimate overall benefit for metastatic renal cell carcinoma (mRCC) patients (pts) treated in a phase III trial of sunitinib versus interferon-alfa (IFN-{alpha}). ASCO Meeting Abstracts. 28(15_suppl): 4594.

  46. Bukowski, R., Cella, D., Gondek, K., & Escudier, B. (2007). Effects of Sorafenib on Symptoms and Quality of Life: Results From a Large Randomized Placebo-Controlled Study in Renal Cancer. American Journal of Clinical Oncology, 30(3), 220–227. doi:10.1097/01.coc.0000258732.80710.05.

    Article  PubMed  CAS  Google Scholar 

  47. Miyake, H., Kurahashi, T., Yamanaka, K., Kondo, Y., Takenaka, A., Inoue, T. A., et al. (2010). Impact of sorafenib on health-related quality of life in Japanese patients with metastatic renal cell carcinoma: a prospective evaluation. BJU International, 106(11), 1643–1647.

    Article  PubMed  Google Scholar 

  48. Sternberg, C. N., Davis, I. D., Mardiak, J., Szczylik, C., Lee, E., Wagstaff, J., et al. (2010). Pazopanib in locally advanced or metastatic renal cell carcinoma: results of a randomized phase III trial. Journal of Clinical Oncology, 28(6), 1061–1068.

    Article  PubMed  CAS  Google Scholar 

  49. Parasuraman, S., Hudes, G., Levy, D., Strahs, A., Moore, L., DeMarinis, R., et al. (2007). Comparison of quality-adjusted survival in patients with advanced renal cell carcinoma receiving first-line treatment with temsirolimus (TEMSR) or interferon-{alpha} (IFN) or the combination of IFN+TEMSR. ASCO Meeting Abstracts, 25(18_suppl), 5049.

    Google Scholar 

  50. Yang, S., de Souza, P., Alemao, E., & Purvis, J. (2010). Quality of life in patients with advanced renal cell carcinoma treated with temsirolimus or interferon-alpha. British Journal of Cancer, 102(10), 1456–1460.

    Article  PubMed  CAS  Google Scholar 

  51. Motzer, R. J., Escudier, B., Oudard, S., Hutson, T. E., Porta, C., Bracarda, S., et al. (2008). Efficacy of everolimus in advanced renal cell carcinoma: a double-blind, randomised, placebo-controlled phase III trial. Lancet, 372(9637), 449–456.

    Article  PubMed  CAS  Google Scholar 

  52. Motzer, R. J., Escudier, B., Oudard, S., Hutson, T. E., Porta, C., Bracarda, S., et al. (2010). Phase 3 trial of everolimus for metastatic renal cell carcinoma: final results and analysis of prognostic factors. Cancer, 116(18), 4256–4265.

    Article  PubMed  CAS  Google Scholar 

  53. Porta, C., Escudier, B., Hutson, T. E., Figlin, R. A., Calvo, E., Grunwald, V., et al. (2011). Analysis of the relationship between Karnofsky performance status (KPS) and tumor response in the RECORD-1 phase III trial of everolimus in patients with advanced renal cell carcinoma (RCC). ASCO Meeting Abstracts, 29(15_suppl), 4610.

    Google Scholar 

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Acknowledgments

The authors acknowledge the support of Novartis Oncology, Spain, which has facilitated the necessary meetings to evaluate and discuss all the data presented in this review, and Ana Martín from HealthCo SL (Madrid, Spain) for assistance in the preparation of this manuscript.

Conflicts of interest

The authors declare that they do not have any conflict of interest that may inappropriately influence this work.

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Authors and Affiliations

  1. Hospital Clínico Universitario de Zaragoza, Zaragoza, Spain

    Julio Lambea

  2. Hospital de Basurto, Bilbao, Spain

    Carmen Hinojo

  3. Complejo Hospitalario de Navarra, Pamplona, Spain

    Nuria Lainez

  4. Hospital Xeral Cíes, Vigo, Spain

    Martín Lázaro

  5. Hospital Universitario Santiago de Compostela, Santiago de Compostela, Spain

    Luís León

  6. Centro Hospitalario de León, León, Spain

    Ángel Rodríguez

  7. Hospital Clínico Universitario de Valladolid, Valladolid, Spain

    Diego Soto de Prado

  8. Hospital Central de Asturias, Oviedo, Spain

    Emilio Esteban

  9. Medical Oncology Service, Hospital Universitario Central de Asturias, Oviedo, Spain

    Emilio Esteban

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  1. Julio Lambea
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Correspondence to Emilio Esteban.

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Lambea, J., Hinojo, C., Lainez, N. et al. Quality of life and supportive care for patients with metastatic renal cell carcinoma. Cancer Metastasis Rev 31 (Suppl 1), 33–39 (2012). https://doi.org/10.1007/s10555-012-9357-9

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