Department of Palliative Medicine, Tohoku University School of Medicine, Sendai, Japan; Department of Palliative Medicine, Takeda General Hospital, Aizuwakamatsu, Japan.
Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
Ann Palliat Med. 2022 Jul;11(7):2338-2348. doi: 10.21037/apm-22-33. Epub 2022 Apr 24.
Several prognostic tools have been developed to aid clinicians in survival prediction. However, changes in symptoms are rarely included in established prognostic systems. We aimed to investigate the influence of changes in symptoms and quality of life (QOL) on survival time in outpatients with advanced cancer.
Study subjects included a subgroup of those with longitudinal symptom and QOL data within a larger, single-site parent study. We assessed patients' symptoms and QOL at enrollment and follow-up at an approximately 3-month interval. Patients' symptoms were evaluated by the Korean version of the Edmonton Symptom Assessment System (K-ESAS). QOL was checked by the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). Participants were categorized into three groups by changes in symptoms or QOL. These groups were: improved (having at least a one level of improvement in the response scale), stable (no change), or worsened (at least a one level of worsening in the scale). We compared survival time in the improved plus stable vs. worsened groups, using a log-rank test.
We analyzed 60 patients, with a median survival time of 346 days. In the Worsened group, depression (P<0.01) and sleep disturbance (P<0.01) by K-ESAS, and dyspnea (P<0.03) per the EORTC QLQ-C30, were statistically significantly related to shorter survival time compared to 'improved and stable' group. There was no relationship between changes in other symptoms, overall QOL, and survival.
Longitudinal assessment of depression, sleep disturbance and dyspnea may be useful in prognostication of patients with advanced cancer. Further studies are needed to confirm our findings with more consecutive assessments in diverse populations.
已经开发了几种预后工具来帮助临床医生进行生存预测。然而，在既定的预后系统中很少包括症状的变化。我们旨在研究门诊晚期癌症患者症状和生活质量（QOL）变化对生存时间的影响。
研究对象包括一项更大的单站点母研究中具有纵向症状和 QOL 数据的亚组。我们在大约 3 个月的间隔内评估患者的症状和 QOL。患者的症状由韩国版埃德蒙顿症状评估系统（K-ESAS）评估。通过欧洲癌症研究与治疗组织生活质量问卷核心 30 项（EORTC QLQ-C30）检查 QOL。通过症状或 QOL 的变化，将患者分为三组。这些组是：改善（在反应量表上至少有一个级别的改善），稳定（无变化）或恶化（在量表上至少有一个级别的恶化）。我们使用对数秩检验比较改善加稳定组与恶化组的生存时间。
我们分析了 60 名患者，中位生存时间为 346 天。在恶化组中，K-ESAS 的抑郁（P<0.01）和睡眠障碍（P<0.01）以及 EORTC QLQ-C30 的呼吸困难（P<0.03）与“改善和稳定”组相比，与较短的生存时间相关。其他症状，总体 QOL 与生存之间没有关系。
对抑郁，睡眠障碍和呼吸困难的纵向评估可能对预测晚期癌症患者的预后有用。需要进一步的研究来确认我们的发现，并在不同人群中进行更多连续评估。
