NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
Australia New Zealand Gynaecological Oncology Group (ANZGOG), New South Wales, Australia.
Oncologist. 2017 Sep;22(9):1117-1124. doi: 10.1634/theoncologist.2017-0047. Epub 2017 Jun 8.
Clinicians and patients often overestimate the benefits of chemotherapy, and overall survival (OS), in platinum resistant/refractory ovarian cancer (PRROC). This study sought to determine aspects of health-related quality of life and clinicopathological characteristics before starting chemotherapy that were associated with stopping chemotherapy early, shortened survival, and death within 30 days of chemotherapy.
This study enrolled women with PRROC before starting palliative chemotherapy. Health-related quality of life was measured with EORTC QLQ-C30/QLQ-OV28. Chemotherapy stopped within 8 weeks of starting was defined as stopping early. Logistic regression was used to assess univariable and multivariable associations with stopping chemotherapy early and death within 30 days of chemotherapy; Cox proportional hazards regression was used to assess associations with progression-free and OS.
Low baseline global health status (GHS), role function (RF), physical function (PF), and high abdominal/gastrointestinal symptom (AGIS) were associated with stopping chemotherapy early (all < .007); low PF and RF remained significant after adjusting for clinicopathological factors (both < .0401). Most who stopped chemotherapy early had Eastern Cooperative Oncology Group Performance Score 0-1 at baseline (79%); PF, RF, and GHS remained independently significant predictors of stopping chemotherapy early in this subgroup. Death within 30 days of chemotherapy occurred in 14%. Low GHS, RF, and PF remained significantly associated with death within 30 days of chemotherapy after adjusting for clinicopathological factors (all < .012).
Women with low GHS, RF, or PF before starting chemotherapy were more likely to stop chemotherapy early, with short OS. Self-ratings of GHS, RF, and PF could improve patient-clinician communication regarding prognosis and help decision-making in women considering chemotherapy for PRROC.
Measuring aspects of health-related quality of life when considering further chemotherapy in platinum resistant/refractory ovarian cancer (PRROC) could help identify women with a particularly poor prognosis who are unlikely to benefit from chemotherapy and could therefore be spared unnecessary treatment and toxicity in their last months of life. Self-ratings of global health status, role function, and physical function could improve patient-clinician communication regarding prognosis and help decision-making in women considering chemotherapy for PRROC.
临床医生和患者常常高估了化疗在铂耐药/难治性卵巢癌（PRROC）中的益处和总生存期（OS）。本研究旨在确定在开始化疗前与提前停止化疗、缩短生存时间以及化疗后 30 天内死亡相关的健康相关生活质量和临床病理特征方面。
本研究纳入了 PRROC 女性患者，在开始姑息性化疗前进行了健康相关生活质量评估，采用 EORTC QLQ-C30/QLQ-OV28 进行评估。化疗开始后 8 周内停止化疗定义为提前停止。采用逻辑回归分析评估与提前停止化疗和化疗后 30 天内死亡相关的单变量和多变量关联；采用 Cox 比例风险回归分析评估与无进展生存期和 OS 的关联。
基线时全球健康状况（GHS）、角色功能（RF）、身体功能（PF）和腹部/胃肠道症状（AGIS）较低与提前停止化疗相关（均<0.007）；调整临床病理因素后，PF 和 RF 仍具有统计学意义（均<0.0401）。大多数提前停止化疗的患者基线时东部肿瘤协作组表现状态为 0-1（79%）；PF、RF 和 GHS 仍然是该亚组中提前停止化疗的独立预测因素。化疗后 30 天内死亡 14%。调整临床病理因素后，低 GHS、RF 和 PF 与化疗后 30 天内死亡仍显著相关（均<0.012）。
在开始化疗前 GHS、RF 或 PF 较低的女性更有可能提前停止化疗，OS 较短。在考虑对 PRROC 进行进一步化疗时，自我评估 GHS、RF 和 PF 可以改善医患沟通，帮助决策制定，让患者受益。
在考虑对铂耐药/难治性卵巢癌（PRROC）进行进一步化疗时，测量健康相关生活质量的各个方面可以帮助确定预后特别差的女性，这些女性可能无法从化疗中获益，因此可以避免在生命的最后几个月接受不必要的治疗和毒性。自我评估全球健康状况、角色功能和身体功能可以改善医患沟通，帮助决策制定，让患者受益。
