Progressing Metastases Linked To HRQoL Deterioration

Author: By Lynda Williams, Senior medwireNews Reporter 

medwireNews: Disease progression is accompanied by a deterioration in health-related quality of life (HRQoL), demonstrates a cohort study of patients undergoing first-line systemic palliative treatment for breast, pancreatic, lung or colorectal cancer. 

“This evidence highlights the importance of progression-related end points, such as time to progression and progression-free survival [PFS], as additional patient-relevant end points when evaluating the benefit of new treatments for patients with metastatic cancer”, the study authors write in JAMA Network Open. 

The team collated responses from 2314 patients who completed more than 8000 questionnaires measuring HRQoL while attending one of 203 German centres between 2011 and 2018.  

This included data from 464 breast cancer patients who completed the Functional Assessment of Cancer Therapy-General (FACT-G) and Hospital Anxiety and Depression Scale; 807 pancreatic patients who completed the EORTC QLQ-C15-PAL scale; and 341 lung cancer and 702 colorectal cancer patients, all of whom completed the EORTC QLQ-C30 questionnaire. 

Overall, 2562 incidences of disease progression were recorded among the participants and at the time of first disease progression the patients experienced a statistically significant decrease in their scores for 37 of the 45 HRQoL measures completed, including “clinically meaningful” decreases in 17 scales. 

Analysis showed that appetite loss, physical functioning and fatigue were the most affected by initial disease progression, occurring in all four patient populations, report Norbert Marschner, from Praxis für interdisziplinäre Onkologie und Hämatologie in Freiburg, Germany, and co-authors. 

The greatest decreases in global HRQoL at first progression were found for patients with lung and pancreatic cancer, which the researchers say reflects previously published data indicating shorter median overall survival durations for these patients compared with their breast and colorectal cancer counterparts. 

And second progression was associated with greater worsening of 38 of the 45 HRQoL scales than the initial progression; at the time of second progression, 32 of the scales had a statistically significant worsening and 32 scales showed a clinically significant decline. 

Indeed, global HRQoL showed a “severe” deterioration at time of second progression for pancreatic, lung and colorectal cancer patients, and a “moderate” decline for the breast cancer cohort, the researchers 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 PFS is often not statistically significantly associated with longer survival”, observe Norbert Marschner et al.

Believing their findings “emphasize the importance of disease progression from a patient perspective”, the team recommends 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.” 

Reference 

Marschner N, Zacharias S, Lordick F, et al. Association of disease progression with health-related quality of life among adults with breast, lung, pancreatic, and colorectal cancer. JAMA Netw Open 2020; 3:e200643. doi:10.1001/jamanetworkopen.2020.0643