Baseline quality of life predicts survival in patients with advanced colorectal cancer

https://doi.org/10.1016/S0959-8049(02)00098-9Get rights and content

Abstract

The aim of this study was to investigate the influence of baseline quality of life (QoL) on survival in patients with advanced colorectal cancer. From 1992 to 1998, four randomised clinical trials in advanced colorectal cancer were conducted at this institution. The European Organization for Research and Treatment of Cancer-Quality of Life Core 30 (EORTC-QLQ-C30) questionnaire was completed prior to the commencement of chemotherapy. Analyses were performed on median-dichotomised baseline Quality of Life (QoL) and clinical prognostic factors. Baseline QoL questionnaires were completed by 501 patients. One-year survival was 38.3 and 72.5% (P<0.0001) for patients with global QoL scores below and above the median (67), respectively. Other than cognitive functioning, fatigue, appetite, constipation, diarrhoea and financial domains, all QoL scales were significant independent predictors of survival (P<0.035). In the final model, the global QoL score remained highly significant as an independent predictor of survival (P<0.0001). Baseline QoL is a strong independent predictor of survival in patients with advanced colorectal cancer. Measurements should be routinely recorded in clinical trials to stratify cohorts and aid in trial comparison.

Introduction

Previous perceived lack of scientific value and practical difficulties contributed to skepticism surrounding the use of quality of life (QoL) data in oncology trials. However, it is now clear that high completion rates of QoL questionnaires are possible 1, 2, 3 and that QoL is a useful endpoint when measuring the impact of therapeutic manoeuvres. Its use in patients with colorectal cancer is no exception. Chemotherapy has been found to improve the QoL of patients as well as to prolong survival 4, 5. QoL measurements are of particular value in cancers with poor prognosis, as well as in the comparison of chemotherapy regimens that are unlikely to produce large differences in survival 6, 7, 8.

In addition to quantifying the impact of treatments, there is evidence to suggest that QoL data may also have a prognostic role. Baseline QoL has been demonstrated to predict survival in a number of cancer types including breast cancer 9, 10, lung cancer [11], melanoma [12] and in large cohorts of patients with varied malignancies 13, 14. A similar finding in patients with colorectal cancer would be of great value. Several poor prognostic factors in colorectal cancer have been identified, such as performance status, tumour burden, liver function and haematological parameters 15, 16, 17, 18, 19, but a simple prognostic model for these patients does not exist. Such a model may allow the stratification of trial patients, as well as the comparison of outcomes between studies.

The aim of this study was to examine the prognostic value of baseline QoL measurements in patients with locally advanced and metastatic colorectal cancer treated with systemic chemotherapy within the context of clinical trials.

Section snippets

Patients

Between 1992 and 1998, four randomised clinical trials in advanced colorectal cancer were conducted at this institution. Details of these clinical trials have been presented elsewhere, but results are summarised in Table 1. Briefly, the COLO1 study randomised patients between protracted venous infusion (PVI) 5-fluorouracil (5-FU) with or without interferon [20]. The COLO2 study compared raltitrexed (Tomudex) with 5-FU, administered according to the Mayo schedule [21]. Patients in the Chromatic

Patient demographics

A total of 631 patients were recruited into the four studies from our centre. Of these, 501 patients completed the baseline QoL questionnaire (see Table 1). These form the cohort of the present study. Almost all patients (98%) received 5-FU-based chemotherapy, with only 2% receiving raltitrexed. The median age was 62 years (range 33–82), 63% of patients were male, 82% had metastatic disease and 98% of patients were of PS 0–2. The site of the primary was as follows: 28% in the right colon (up to

Discussion

We have found that baseline QoL measurements are significant independent prognostic indicators in patients with inoperable colorectal cancer receiving chemotherapy within the context of randomised phase III clinical trials. Patients with a high baseline global QoL have a 1-year survival that is almost double that of patients with a score below the median value (72.5% versus 38.3%, P<0.00001). The relationship between QoL and survival has been documented in other cancer types 9, 10, 11, 12, 13,

References (40)

  • D Spiegel et al.

    Effect of psychosocial treatment on survival of patients with metastatic breast cancer

    Lancet

    (1989)
  • H.J Andreyev et al.

    Why do patients with weight loss have a worse outcome when undergoing chemotherapy for gastrointestinal malignancies?

    Eur. J. Cancer

    (1998)
  • S Kaasa et al.

    Compliance in quality of life dataa Norwegian experience

    Stat. Med.

    (1998)
  • J Bernhard et al.

    Practical issues in quality of life assessment in multicentre trials conducted by the Swiss Group for Clinical Cancer Research

    Stat. Med.

    (1998)
  • C.M Moinpour et al.

    Ensuring the quality of quality of life datathe Southwest Oncology Group experience

    Stat. Med.

    (1998)
  • H.A Burris III et al.

    Improvements in survival and clinical benefit with gemcitabine as first-line therapy for patients with advanced pancreas cancera randomized trial

    J. Clin. Oncol.

    (1997)
  • A.S Coates et al.

    Quality-of-life scores predict outcome in metastatic but not early breast cancer. International Breast Cancer Study Group

    J. Clin. Oncol.

    (2000)
  • A Coates et al.

    Prognostic value of quality-of-life scores during chemotherapy for advanced breast cancer. Australian New Zealand Breast Cancer Trials Group

    J. Clin. Oncol.

    (1992)
  • J Dancey et al.

    Quality of life scoresan independent prognostic variable in a general population of cancer patients receiving chemotherapy. The National Cancer Institute of Canada Clinical Trials Group

    Qual. Life Res.

    (1997)
  • N Kemeny et al.

    Prognostic variables in patients with hepatic metastases from colorectal cancer. Importance of medical assessment of liver involvement

    Cancer

    (1989)
  • Cited by (0)

    View full text