Determining Quality of Life in Patients with Advanced Cancer

April 20, 2020

Identifying early predictors of poor quality of life could allow for the identification of patients who may benefit from early referral to palliative and supportive care according to the researchers.

A study published in Cancer indicated that quality of life is determined, at least in part, by weight loss, Eastern Cooperative Oncology Group performance status (ECOG-PS), and the systemic inflammatory response in patients with advanced cancer. 

By identifying early predictors of poor quality of life, researchers may allow for the identification of patients who may benefit from early referral to palliative and supportive care, which has previously been found to improve quality of life. 

“For the first time to our knowledge, the current study reports a comprehensive analysis of tumor and host factors and their effect on [quality of life] in a large cohort of patients with incurable disease,” the authors wrote. 

In this multicenter study of adult patients with advanced cancer conducted in Ireland and the UK between 2011 and 2016, researchers collected data from patients at study entry. The data included patient demographics, ECOG-PS, nutritional parameters (the percentage weight loss), muscle parameters assessed using computed tomography images (skeletal muscle index and skeletal muscle attenuation), inflammatory markers (modified Glasgow Prognostic score [mGPS]), and quality of life data (the European Organization for Research and Treatment Quality-of-Life Questionnaire C-30).

Overall, data was available for 1,027 patients. Gastrointestinal cancer was most prevalent cancer type (40%), followed by lung cancer (26%) and breast cancer (9%). Distant metastatic disease was also present in 87% of patients.

The percentage weight loss, ECOG-PS, and mGPS were found to be significantly correlated with deteriorating QoL functional and symptom scales (all < 0.001). On the multivariate regression analysis, >10% weight loss (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 found to be independently associated with poorer summary QoL scores. 

Additionally, these parameters were independently associated with poorer physical function, fatigue, and appetite loss (all < 0.05). Low skeletal muscle attenuation was also 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 quality of life summary scores.

“Our findings suggest that interventions to mitigate the systemic inflammatory response and WL in patients with incurable cancer might have a positive effect on patients’ [quality of life],” the authors wrote. “Research is warranted to determine whether attenuating the systemic inflammatory response is capable of producing clinically relevant improvements in symptoms that may represent a new therapeutic approach to symptom management in patients with advanced cancer.” 

However, given the convenient recruitment strategy in this study, the researchers indicated that patients might have been at different time points in their disease trajectory when quality of life was assessed; in total, 81% had received chemotherapy in the previous 4 weeks. Additionally, patients could have received prior treatments, and this may have impacted quality of life scores. 

“Our findings indicate potential targets for interventions aimed at safe-guarding the [quality of life] of patients with advanced cancer,” the authors wrote. “Future work should focus on targeting the systemic inflammatory response, attenuating [weight loss], and improving performance status in patients with incurable cancer as a means of improving [patient reported outcomes; PROMs] and reducing symptom burden.”

Reference:

Daly LE, Dolan RD, Power DG, et al. Determinants of Quality of Life in Patients With Incurable Cancer. Cancer. doi:10.1002/cncr.32824.