Department of Epidemiology and Data Science, Amsterdam UMC, VU University, Amsterdam, The Netherlands.
Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
Int J Cancer. 2021 Jun 1;148(11):2702-2711. doi: 10.1002/ijc.33472. Epub 2021 Jan 25.
Patient's quality of life should be included in clinical decision making regarding the administration of adjuvant chemotherapy (ACT) in stage II/III colon cancer. Therefore, quality of life, summarized as health utility (HU), was evaluated for patients treated with and without ACT. Furthermore, the role of chemotherapy-induced peripheral neuropathy (CIPN) on HU was evaluated. Patients diagnosed with stage II/III colon cancer between 2011 and 2019 and participating in the Prospective Dutch ColoRectal Cancer cohort were included (n = 914). HU scores were assessed with the EQ-5D-5L at baseline, 3, 6, 12, 18, and 24 months. Patients treated with ACT received mainly capecitabine and oxaliplatin (57%) or capecitabine monotherapy (40%) (average duration: 3.5 months). HU 3 to 18 months after diagnosis (potential ACT period + 12 months follow-up) was compared between patients treated with and without ACT using a mixed model adjusted for age, sex and education level. Subsequently, the CIPN sensory, motor and autonomy scales, measured using the EORTC QLQ-CIPN20, were independently included in the model to evaluate the impact of neuropathy. Using a mixed model, a significant difference of -0.039 (95% confidence interval: -0.062; -0.015) in HU was found between patients treated with and without ACT. Including the CIPN sensory, motor and autonomy scales decreased the difference with 0.019, 0.015 and 0.02, respectively. HU 3 to 18 months after diagnosis is significantly lower in patients treated with ACT vs without ACT. This difference is on the boundary of clinical relevance and appears to be partly related to the sensory and motor neuropathy-related side effects of ACT.
患者的生活质量应纳入 II/III 期结肠癌辅助化疗（ACT）管理的临床决策中。因此，评估了接受和未接受 ACT 治疗的患者的生活质量，总结为健康效用（HU）。此外，还评估了化疗引起的周围神经病变（CIPN）对 HU 的影响。纳入了 2011 年至 2019 年间诊断为 II/III 期结肠癌并参加前瞻性荷兰结直肠癌队列的患者（n=914）。在基线、3、6、12、18 和 24 个月时使用 EQ-5D-5L 评估 HU 评分。接受 ACT 治疗的患者主要接受卡培他滨和奥沙利铂（57%）或卡培他滨单药治疗（40%）（平均持续时间：3.5 个月）。使用混合模型，根据年龄、性别和教育水平调整，比较了接受和未接受 ACT 治疗的患者在诊断后 3 至 18 个月（潜在 ACT 期+12 个月随访）的 HU。随后，独立纳入 EORTC QLQ-CIPN20 测量的 CIPN 感觉、运动和自主量表，以评估神经病变的影响。使用混合模型，发现接受和未接受 ACT 治疗的患者之间的 HU 存在显著差异，差异为-0.039（95%置信区间：-0.062；-0.015）。纳入 CIPN 感觉、运动和自主量表后，差异分别降低了 0.019、0.015 和 0.02。与未接受 ACT 治疗的患者相比，接受 ACT 治疗的患者在诊断后 3 至 18 个月时的 HU 显著降低。这种差异处于临床相关的边界，似乎部分与 ACT 相关的感觉和运动神经病变相关的副作用有关。
