Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, Massachusetts.
Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
Cancer. 2021 Feb 15;127(4):619-627. doi: 10.1002/cncr.33315. Epub 2020 Nov 10.
Patient-reported outcomes (PROs) assessing quality of life (QOL) and symptom burden correlate with clinical outcomes in patients with cancer. However, to the authors' knowledge, data regarding associations between PROs and treatment response are lacking.
The authors prospectively approached consecutive patients with advanced gastrointestinal cancer who were initiating a new treatment. Prior to treatment, patients reported their QOL (Functional Assessment of Cancer Therapy-General [FACT-G], 4 subscales: Functional, Physical, Emotional, Social; higher scores indicate better QOL) and symptom burden (Edmonton Symptom Assessment System [ESAS], Patient Health Questionnaire-4 [PHQ-4]; higher scores represent greater symptoms). Regression models were used to examine associations of baseline PROs with treatment response (clinical benefit or progressive disease [PD] at time of first scan), healthcare utilization, and survival.
From May 2019 to April 2020, a total of 112 patients with advanced gastrointestinal cancer were enrolled. For treatment response, 64.3% had CB and 35.7% had PD. Higher baseline ESAS-Physical (odds ratio, 1.04; P = .027) and lower FACT-G Functional (odds ratio, 0.92; P = .038) scores were associated with PD. Higher ESAS-Physical (hazard ratio [HR], 1.03; P = .044) and lower FACT-G Total (HR, 0.96; P = .005), FACT-G Physical (HR, 0.89; P < .001), and FACT-G Functional (HR, 0.87; P < .001) scores were associated with a greater hospitalization risk. Lower FACT-G Total (HR, 0.96; P = .009) and FACT-G Emotional (HR, 0.86; P = .012) scores as well as higher ESAS-Total (HR, 1.03; P = .014) and ESAS-Physical (HR, 1.04; P = .032) scores were associated with worse survival.
Baseline PROs are associated with treatment response in patients with advanced gastrointestinal cancer, namely physical symptoms and functional QOL, in addition to health care use and survival. The findings of the current study support the association between PROs and important clinical outcomes, including the novel finding of treatment response.
评估生活质量（QOL）和症状负担的患者报告结局（PROs）与癌症患者的临床结局相关。然而，据作者所知，缺乏关于 PROs 与治疗反应之间关联的数据。
作者前瞻性地接触了开始新治疗的晚期胃肠道癌症的连续患者。在治疗之前，患者报告了他们的 QOL（癌症治疗功能评估-一般量表 [FACT-G]，4 个分量表：功能、身体、情感、社会；得分越高表示 QOL 越好）和症状负担（埃德蒙顿症状评估系统 [ESAS]，患者健康问卷-4 [PHQ-4]；得分越高表示症状越严重）。回归模型用于检查基线 PROs 与治疗反应（首次扫描时的临床获益或进展性疾病 [PD]）、医疗保健利用和生存之间的关联。
2019 年 5 月至 2020 年 4 月，共纳入 112 例晚期胃肠道癌症患者。在治疗反应方面，64.3%有 CB，35.7%有 PD。较高的基线 ESAS-Physical（优势比，1.04；P =.027）和较低的 FACT-G 功能（优势比，0.92；P =.038）得分与 PD 相关。较高的 ESAS-Physical（风险比 [HR]，1.03；P =.044）和较低的 FACT-G 总分（HR，0.96；P =.005）、FACT-G 身体（HR，0.89；P <.001）和 FACT-G 功能（HR，0.87；P <.001）得分与更高的住院风险相关。较低的 FACT-G 总分（HR，0.96；P =.009）和 FACT-G 情绪（HR，0.86；P =.012）得分以及较高的 ESAS-总分（HR，1.03；P =.014）和 ESAS-Physical（HR，1.04；P =.032）得分与较差的生存相关。
基线 PROs 与晚期胃肠道癌症患者的治疗反应相关，除了与医疗保健使用和生存相关外，还与身体症状和功能 QOL 相关。本研究的结果支持 PROs 与重要临床结局之间的关联，包括治疗反应这一新颖发现。
