Hsu Tina, Speers Caroline H, Kennecke Hagen F, Cheung Winson Y
Department of Medical Oncology, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, British Columbia, Canada.
Cancer. 2017 May 15;123(10):1839-1847. doi: 10.1002/cncr.30511. Epub 2017 Jan 12.
Patient-reported outcomes (PROs) are increasingly used in clinical settings. Prior research suggests that PROs collected at baseline may be associated with cancer survival, but most of those studies were conducted in patients with breast or lung cancer. The objective of this study was to determine the correlation between prospectively collected PROs and cancer-specific outcomes in patients with early stage colorectal cancer.
Patients who had newly diagnosed stage II or III colorectal cancer from 2009 to 2010 and had a consultation at the British Columbia Cancer Agency completed the brief Psychosocial Screen for Cancer (PSSCAN) questionnaire, which collects data on patients' perceived social supports, quality of life (QOL), anxiety and depression, and general health. PROs from the PSSCAN were linked with the Gastrointestinal Cancers Outcomes Database, which contains information on patient and tumor characteristics, treatment details, and cancer outcomes. Cox regression models were constructed for overall survival (OS), and Fine and Gray regression models were developed for disease-specific survival (DSS).
In total, 692 patients were included. The median patient age was 67 years (range, 26-95 years), and the majority had colon cancer (61%), were diagnosed with stage III disease (54%), and received chemotherapy (58%). In general, patients felt well supported and reported good overall health and QOL. On multivariate analysis, increased fatigue was associated with worse OS (hazard ratio [HR], 1.99; P = .00007) and DSS (HR, 1.63; P = .03), as was lack of emotional support (OS: HR, 4.36; P = .0003; DSS: HR, 1.92; P = .02).
Although most patients described good overall health and QOL and indicated that they were generally well supported, patients who experienced more pronounced fatigue or lacked emotional support had a higher likelihood of worse OS and DSS. These findings suggest that abbreviated PROs can inform and assist clinicians to identify patients who have a worse prognosis and may need more vigilant follow-up. Cancer 2017;123:1839-1847. © 2017 American Cancer Society.
患者报告结局（PROs）在临床环境中的应用日益广泛。先前的研究表明，基线时收集的PROs可能与癌症生存率相关，但这些研究大多是在乳腺癌或肺癌患者中进行的。本研究的目的是确定前瞻性收集的PROs与早期结直肠癌患者癌症特异性结局之间的相关性。
2009年至2010年新诊断为II期或III期结直肠癌且在不列颠哥伦比亚癌症机构接受会诊的患者完成了简明癌症心理社会筛查（PSSCAN）问卷，该问卷收集患者感知的社会支持、生活质量（QOL）、焦虑和抑郁以及总体健康状况的数据。PSSCAN中的PROs与胃肠道癌症结局数据库相关联，该数据库包含患者和肿瘤特征、治疗细节以及癌症结局的信息。构建Cox回归模型用于总生存（OS）分析，并开发Fine和Gray回归模型用于疾病特异性生存（DSS）分析。
总共纳入了692例患者。患者的中位年龄为67岁（范围26 - 95岁），大多数患者患有结肠癌（61%），被诊断为III期疾病（54%），并接受了化疗（58%）。总体而言，患者感觉得到良好的支持，并报告总体健康状况和QOL良好。多因素分析显示，疲劳加剧与较差的OS（风险比[HR]，1.99；P = .00007）和DSS（HR，1.63；P = .03）相关，缺乏情感支持也是如此（OS：HR，4.36；P = .0003；DSS：HR，1.92；P = .02）。
尽管大多数患者描述总体健康状况和QOL良好，并表示他们总体上得到了良好的支持，但经历更明显疲劳或缺乏情感支持的患者OS和DSS较差可能性更高。这些发现表明，简短的PROs可为临床医生提供信息并帮助其识别预后较差且可能需要更密切随访的患者。《癌症》2017年；123：1839 - 1847。© 2017美国癌症协会。
