Study Highlights Importance of Progression-Related End Points in Cancer

This study examined the association of disease progression and the deterioration of health-related quality of life for patients with metastatic breast, pancreatic, lung, and colorectal cancer.

Patients with metastatic breast, pancreatic, lung, and colorectal cancer saw disease progression associated with deteriorating health-related quality of life, according to a recent study published in JAMA Network Open.

Global health-related quality of life was most associated with lung cancer (6.7 points [95% CI, 3.5-9.9 points]; P< .001) and pancreatic cancer (5.4 points [95% CI, 3.3-7.5 points]; P< .001). The association was least pronounced in colorectal cancer (3.5 points [95% CI, 1.3-5.7 points]; P= .002) and breast cancer (2.4 points [95% CI, 1.0-3.9 points]; P = .001).

“The objective of this analysis was to determine the association of disease progression with various health-related quality of life domains in patients with 1 of 4 frequent cancers in clinical routine practice,” wrote the researchers. “The findings suggest that disease progression is associated with a deterioration in health-related quality of life, irrespective of the cancer entity.”

The study also concluded that the first disease progression was associated with a statistically significant deterioration in 37 of the 45 health-related quality of life scales. Even more, 17 of those 37 saw results that were clinically meaningful. Appetite, physical functioning, and fatigue were impacted the most, regardless of cancer type. The second progression saw even further health-related quality of life deterioration.

The researchers used over 8000 questionnaires from 2314 patients with 2562 documented disease progressions. Of those patients, 464 had breast cancer, 807 had pancreatic cancer, 341 had lung cancer, and 702 had colorectal cancer.

The 4 validated questionnaires were the Functional Assessment of Cancer Therapy–General version 4, European Organization for Research and Treatment of Cancer QLQ-C30 version 3.0, European Organization for Research and Treatment of Cancer QLQ-C15-PAL version 1, and Hospital Anxiety and Depression Scale

“Regardless of whether the cancer was originating from breast, pancreas, lung, or colon, disease progression was adversely associated with health-related quality of life in this real-world setting,” the researchers explained. “Looking at the deterioration in global health-related quality of life upon the first disease progression, with 2.5 points in breast cancer and 3.5 points in colorectal cancer, the deterioration was markedly higher in pancreatic cancer (5.4 points) and lung cancer (6.7 points). This difference may well be associated with the differing prognoses and tumor biological profiles of these entities.”

As for some limitations to the study, the researchers start with the lack of “specifications as to the timing, frequency, or criteria of tumor assessment” due to observational nature of the study design. A second limitation frequently seen in these types of studies is missing data. Patients who find their health-related quality of life deteriorating are typically less likely to report their data, according to the researchers.

Moving forward, the researchers hope this study provides context on the importance of disease progression from the patient perspective. Therefore, progression-related end points should also be considered in these types of cancers when evaluating the benefit of novel treatment.

“This evidence highlights the importance of progression-related end points, such as time to progression and progression-free survival, as additional patient-relevant end points when evaluating the benefit of new treatments for patients with metastatic cancer,” wrote the researchers.


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 Network Open. doi:10.1001/jamanetworkopen.2020.0643.