Disease Progression Tied to Reduced QoL in Adults With Cancer

Results from a multi-center study show that a link exists between disease progression and reduced quality of life in patients with metastatic breast, pancreatic, lung, and colorectal cancers (CRCs; JAMA Netw Open. 2020;3[3]:e200643).

“Mortality, morbidity, and health-related quality of life (HRQoL) are patient-relevant end points generally considered in the early benefit assessments of new cancer treatments,” according to Norbert Marschner, MD, Praxis für interdisziplinäre Onkologie und Hämatologie, Freiburg, Germany, and colleagues.

“Progression-related end points, such as time to progression or progression-free survival, are not included, although patients and physicians testify to the detrimental association of disease progression with HRQoL,” they continued.

Using data from 4 prospective, nonintervention, multi-center registries that were collected from 203 centers across Germany between 2011 and 2018, Dr Marschner et al evaluated the link between disease progression and HRQoL in 4 prevalent solid cancers in routine clinical practice.

A total of 2314 patients with 2562 documented disease progressions yielded >8000 questionnaires for analysis, including 464 patients with breast cancer (median age, 61.6 years), 807 with pancreatic cancer (median age, 70.0 years), 341 with lung cancer (median age, 65.9 years), and 702 with CRC (median age, 66.9 years).

The main end point was a decline in HRQoL associated with disease progression, determined via 4 validated questionnaires.

HRQoL was evaluated regularly for up to 5 years, with post-progression changes in HRQoL scores examined via linear mixed models adjusted for demographic and clinical covariates. Dr Marschner and colleagues performed data analysis between February 2019 and April 2019.

Overall, there were 2562 cases of disease progression documented, with a statistically significant deterioration observed in 37 of 45 HRQoL scales tied to the first instance of progression. Among 17 of these scales, the worsening was deemed clinically meaningful.

The most affected scale scores, regardless of cancer type, were for appetite loss (pancreatic cancer, 10.2 points; lung cancer, 10.8 points; CRC, 8.8 points), physical functioning (pancreatic cancer, 6.2 points; lung cancer, 8.4 points; CRC, 5.0 points), and fatigue (pancreatic cancer, 5.5 points; lung cancer, 7.7 points; CRC, 4.5 points).

Notably, the connection to global HRQoL was most prominent in 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) and less prevalent in CRC (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). Furthermore, the second instance of progression was tied to an even larger reduction in HRQoL.

“These findings suggest that disease progression is associated with a deterioration in HRQoL among patients with metastatic breast, pancreatic, lung, and colorectal cancer,” Dr Marschner and colleagues said.

“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,” they concluded.—Hina Porcelli