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Patient-reported outcomes as predictors of survival in patients with bowel cancer: a systematic review

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Abstract

Introduction

The prognostic value of patient-reported outcomes (PROs) has been determined in some cancers, but a focussed review in colorectal cancer (CRC) has not yet been conducted. We systematically reviewed PRO predictors of CRC patient survival.

Methods

We searched four electronic databases (from inception to May 2018), reference lists and professional organisations to identify studies reporting pre-treatment PRO predictors of overall survival (OS) or progression-free survival (PFS) in CRC identified through univariate or multivariate models. Two reviewers independently applied inclusion criteria and extracted data on study characteristics, median and 1-year survival rates, PROs assessed and model results.

Results

In 25 of 27 studies (n = 12,544), at least one PRO was significantly associated with survival. Physical functioning, fatigue, pain and appetite loss predicted OS more often than other PROs in metastatic disease (19/27 studies). One study explored PRO predictors in early-stage CRC, finding emotional well-being and mood predicted OS. In mixed-stage samples (7/27 studies), physical functioning predicted OS more often than other PROs. Few studies modelled PFS, for which few PROs had predictive value.

Conclusions

Physical and psychological functioning, pain, fatigue and appetite loss had prognostic significance above and beyond clinical predictors in CRC. Routine monitoring of these PROs may allow earlier detection and amelioration of problems, which may improve quality of life and perhaps extend survival. More research is needed to determine prognostic value of PROs in early-stage CRC, and prognostic significance of changes in PRO scores.

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References

  1. Wildiers, H., Mauer, M., Pallis, A., Hurria, A., Mohile, S. G., Luciani, A., et al. (2013). End points and trial design in geriatric oncology research: A joint European organisation for research and treatment of cancer–Alliance for Clinical Trials in Oncology-International Society of Geriatric Oncology position article. Journal of Clinical Oncology, 31(29), 3711–3718. https://doi.org/10.1200/jco.2013.49.6125.

    Article  PubMed  Google Scholar 

  2. United States Food and Drug Administration. (2009). Patient reported outcome measures: Use in medical product development to support labelling claims. MD: US Department of Health & Human Support Food & Drug Administration. https://www.fda.gov/downloads/drugs/guidances/ucm193282.pdf. Accessed 23/01/2019.

  3. Osoba, D. (1994). Lessons learned from measuring health-related quality of life in oncology. Journal of Clinical Oncology, 12(3), 608–616. https://doi.org/10.1200/jco.1994.12.3.608.

    Article  CAS  PubMed  Google Scholar 

  4. Revicki, D. A., Osoba, D., Fairclough, D., Barofsky, I., Berzon, R., Leidy, N. K., et al. (2000). Recommendations on health-related quality of life research to support labeling and promotional claims in the United States. Quality of Life Research, 9(8), 887–900.

    Article  CAS  PubMed  Google Scholar 

  5. Chen, J., Ou, L., & Hollis, S. J. (2013). A systematic review of the impact of routine collection of patient reported outcome measures on patients, providers and health organisations in an oncologic setting. BMC Health Services Research, 13, 211. https://doi.org/10.1186/1472-6963-13-211.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Montazeri, A. (2009). Quality of life data as prognostic indicators of survival in cancer patients: An overview of the literature from 1982 to 2008. Health and Quality Life Outcomes, 7, 102. https://doi.org/10.1186/1477-7525-7-102.

    Article  Google Scholar 

  7. Zikos, E., Coens, C., Quinten, C., Ediebah, D. E., Martinelli, F., Ghislain, I., et al. (2016). The added value of analyzing pooled health-related quality of life data: A review of the EORTC PROBE initiative. Journal of the National Cancer Institute, 108(5), djv391. https://doi.org/10.1093/jnci/djv391.

    Article  PubMed  Google Scholar 

  8. Gotay, C. C., Kawamoto, C. T., Bottomley, A., & Efficace, F. (2008). The prognostic significance of patient-reported outcomes in cancer clinical trials. Journal of Clinical Oncology, 26(8), 1355–1363. https://doi.org/10.1200/jco.2007.13.3439.

    Article  PubMed  Google Scholar 

  9. Quinten, C., Martinelli, F., Coens, C., Sprangers, M. A., Ringash, J., Gotay, C., et al. (2014). A global analysis of multitrial data investigating quality of life and symptoms as prognostic factors for survival in different tumor sites. Cancer, 120(2), 302–311. https://doi.org/10.1002/cncr.28382.

    Article  PubMed  Google Scholar 

  10. Ansa, B. E., Coughlin, S. S., Alema-Mensah, E., & Smith, S. A. (2018). Evaluation of colorectal cancer incidence trends in the United States (2000–2014). Journal of Clinical Medicine, 7(2), 22. https://doi.org/10.3390/jcm7020022.

    Article  PubMed Central  Google Scholar 

  11. Howlader, N., Noone, A., Krapcho, M., Miller, D., Bishop, K., Altekruse, S., et al. (2016). SEER Cancer Statistics Review, 1975–2013, National Cancer Institute. Based on November 2015 SEER data submission, posted to the SEER web site, 2016. Bethesda, MD.

  12. Siegel, R. L., Miller, K. D., Fedewa, S. A., Ahnen, D. J., Meester, R. G. S., Barzi, A., et al. (2017). Colorectal cancer statistics, 2017. CA: A Cancer Journal for Clinicians, 67(3), 177–193. https://doi.org/10.3322/caac.21395.

    Article  Google Scholar 

  13. Jansen, L., Koch, L., Brenner, H., & Arndt, V. (2010). Quality of life among long-term (>/=5 years) colorectal cancer survivors–systematic review. European Journal of Cancer, 46(16), 2879–2888. https://doi.org/10.1016/j.ejca.2010.06.010.

    Article  CAS  PubMed  Google Scholar 

  14. Braun, D. P., Gupta, D., Grutsch, J. F., & Staren, E. D. (2011). Can changes in health related quality of life scores predict survival in stages III and IV colorectal cancer? Health Quality Life Outcomes, 9, 62. https://doi.org/10.1186/1477-7525-9-62.

    Article  Google Scholar 

  15. Centre for Reviews and Dissemination (2001). Undertaking systematic reviews of research on effectiveness. University of York. http://www.york.ac.uk/inst/crd/report4.htm. Accessed 25 Jan 2019.

  16. Curry, S., Byers, T., Hewitt, M., & Editors (2003). Fulfilling the Potential of Cancer Prevention and Early Detection. Washington (DC): National Academies Press (US).

  17. Sharma, A., Walker, L. G., & Monson, J. R. (2013). Baseline quality of life factors predict long term survival after elective resection for colorectal cancer. International Journal of Surgical Oncology, 2013, 269510.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Fournier, E., Jooste, V., Woronoff, A. S., Quipourt, V., Bouvier, A. M., & Mercier, M. (2016). Health-related quality of life is a prognostic factor for survival in older patients after colorectal cancer diagnosis: A population-based study. Digestive and Liver Disease, 48(1), 87–93. https://doi.org/10.1016/j.dld.2015.09.006.

    Article  PubMed  Google Scholar 

  19. Hsu, T., Speers, C. H., Kennecke, H. F., & Cheung, W. Y. (2017). The utility of abbreviated patient-reported outcomes for predicting survival in early stage colorectal cancer. Cancer, 123(10), 1839–1847. https://doi.org/10.1002/cncr.30511.

    Article  PubMed  Google Scholar 

  20. Aparicio, T., Gargot, D., Teillet, L., Maillard, E., Genet, D., Cretin, J., et al. (2017). Geriatric factors analyses from FFCD 2001-02 phase III study of first-line chemotherapy for elderly metastatic colorectal cancer patients. European Journal of Cancer, 74, 98–108.

    Article  PubMed  Google Scholar 

  21. Comella, P., Casaretti, R., Manzo, R., Sandomenico, C., Licenziato, M., Avallone, A., et al. (2010). Baseline physical functioning status of metastatic colorectal cancer patients predicts the overall survival but not the activity of a front-line oxaliplatin-fluoropyrimidine doublet. Acta Oncologica, 49(1), 50–56. https://doi.org/10.3109/02841860903369540.

    Article  CAS  PubMed  Google Scholar 

  22. Efficace, F., Bottomley, A., Coens, C., Van Steen, K., Conroy, T., Schoffski, P., et al. (2006). Does a patient’s self-reported health-related quality of life predict survival beyond key biomedical data in advanced colorectal cancer? European Journal of Cancer, 42(1), 42–49. https://doi.org/10.1016/j.ejca.2005.07.025.

    Article  PubMed  Google Scholar 

  23. Efficace, F., Innominato, P. F., Bjarnason, G., Coens, C., Humblet, Y., Tumolo, S., et al. (2008). Validation of patient’s self-reported social functioning as an independent prognostic factor for survival in metastatic colorectal cancer patients: Results of an international study by the Chronotherapy Group of the European Organisation for Research and Treatment of Cancer. Journal of Clinical Oncology, 26(12), 2020–2026.

    Article  PubMed  Google Scholar 

  24. Hernandez-Socorro, C. R., Saavedra, P., Ramirez Felipe, J., Bohn Sarmiento, U., & Ruiz-Santana, S. (2017). Predictive factors of long-term colorectal cancer survival after ultrasound-controlled ablation of hepatic metastases. Medicina Clinica, 148(8), 345–350. https://doi.org/10.1016/j.medcli.2016.11.024.

    Article  PubMed  Google Scholar 

  25. Innominato, P. F., Spiegel, D., Ulusakarya, A., Giacchetti, S., Bjarnason, G. A., Levi, F., et al. (2015). Subjective sleep and overall survival in chemotherapy-naive patients with metastatic colorectal cancer. Sleep Medicine, 16(3), 391–398.

    Article  PubMed  Google Scholar 

  26. Mol, L., Ottevanger, P. B., Koopman, M., & Punt, C. J. A. (2016). The prognostic value of WHO performance status in relation to quality of life in advanced colorectal cancer patients. European Journal of Cancer, 66, 138–143. https://doi.org/10.1016/j.ejca.2016.07.013.

    Article  CAS  PubMed  Google Scholar 

  27. Rich, T., Innominato, P. F., Boerner, J., Mormont, M. C., Iacobelli, S., Baron, B., et al. (2005). Elevated serum cytokines correlated with altered behavior, serum cortisol rhythm, and dampened 24-hour rest-activity patterns in patients with metastatic colorectal cancer. Clinical Cancer Research, 11(5), 1757–1764.

    Article  CAS  PubMed  Google Scholar 

  28. Sullivan, B. A., McKinnis, R., & Laufman, L. R. (1995). Quality of life in patients with metastatic colorectal cancer receiving chemotherapy: A randomized, double-blind trial comparing 5-FU versus 5-FU with leucovorin. Pharmacotherapy, 15(5I), 600–607.

    Article  CAS  PubMed  Google Scholar 

  29. Ward, P., Hecht, J. R., Wang, H. J., Dichmann, R., Liem, A. K. D., Chan, D., et al. (2014). Physical function and quality of life in frail and/or elderly patients with metastatic colorectal cancer treated with capecitabine and bevacizumab: An exploratory analysis. Journal of Geriatric Oncology, 5(4), 368–375. https://doi.org/10.1016/j.jgo.2014.05.002.

    Article  PubMed  Google Scholar 

  30. Diouf, M., Chibaudel, B., Filleron, T., Tournigand, C., Hug de Larauze, M., Garcia-Larnicol, M. L., et al. (2014). Could baseline health-related quality of life (QoL) predict overall survival in metastatic colorectal cancer? The results of the GERCOR OPTIMOX 1 study. Health Quality Life Outcomes, 12, 69.

    Article  Google Scholar 

  31. Reyes, M. E., Ye, Y., Zhou, Y., Liang, A., Kopetz, S., Rodriquez, M. A., et al. (2017). Predictors of health-related quality of life and association with survival may identify colorectal cancer patients at high risk of poor prognosis. Quality of Life Research, 26(2), 319–330. https://doi.org/10.1007/s11136-016-1381-8.

    Article  PubMed  Google Scholar 

  32. You, Y. N., Habiba, H., Chang, G. J., Rodriguez-bigas, M. A., & Skibber, J. M. (2011). Prognostic value of quality of life and pain in patients with locally recurrent rectal cancer. Annals of Surgical Oncology, 18(4), 989–996. https://doi.org/10.1245/s10434-010-1218-6.

    Article  PubMed  Google Scholar 

  33. Mormont, M. C., Waterhouse, J., Bleuzen, P., Giacchetti, S., Jami, A., Bogdan, A., et al. (2000). Marked 24-h rest/activity rhythms are associated with better quality of life, better response, and longer survival in patients with metastatic colorectal cancer and good performance status. Clinical Cancer Research, 6(8), 3038–3045.

    CAS  PubMed  Google Scholar 

  34. Wong, C. K. H., Law, W. L., Wan, Y. F., Poon, J. T. C., & Lam, C. L. K. (2014). Health-related quality of life and risk of colorectal cancer recurrence and All-cause death among advanced stages of colorectal cancer 1-year after diagnosis. BMC Cancer, 14(1), 337. https://doi.org/10.1186/1471-2407-14-337.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Earlam, S., Glover, C., Fordy, C., Burke, D., & Allen-Mersh, T. G. (1996). Relation between tumor size, quality of life, and survival in patients with colorectal liver metastases. Journal of Clinical Oncology, 14(1), 171–175.

    Article  CAS  PubMed  Google Scholar 

  36. Allen-Marsh, T. G., Glover, C., Fordy, C., Henderson, D. C., & Davies, M. (1998). Relation between depression and circulating immune products in patients with advanced colorectal cancer. Journal of the Royal Society of Medicine, 91(8), 408–413.

    Article  Google Scholar 

  37. Camilleri-Brennan, J., & Steele, R. J. C. (2001). Prospective analysis of quality of life and survival following mesorectal excision for rectal cancer. British Journal of Surgery, 88(12), 1617–1622. https://doi.org/10.1046/j.0007-1323.2001.01933.x.

    Article  CAS  Google Scholar 

  38. Van Steen, K., Curran, D., Kramer, J., Molenberghs, G., Van Vreckem, A., Bottomley, A., et al. (2002). Multicollinearity in prognostic factor analyses using the EORTC QLQ-C30: Identification and impact on model selection. Statistics in Medicine, 21(24), 3865–3884. https://doi.org/10.1002/sim.1358.

    Article  PubMed  Google Scholar 

  39. Cottone, F., Deliu, N., Collins, G. S., Anota, A., Bonnetain, F., Van Steen, K., et al. (2019). Modeling strategies to improve parameter estimates in prognostic factors analyses with patient-reported outcomes in oncology. Quality of Life Research, 28(5), 1315–1325. https://doi.org/10.1007/s11136-018-02097-2.

    Article  PubMed  Google Scholar 

  40. van Eeghen, E. E., Bakker, S. D., van Bochove, A., & Loffeld, R. J. L. F. (2015). Impact of age and comorbidity on survival in colorectal cancer. Journal of Gastrointestinal Oncology, 6(6), 605–612. https://doi.org/10.3978/j.issn.2078-6891.2015.070.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Hines, R. B., Shanmugam, C., Waterbor, J. W., McGwin, G., Jr., Funkhouser, E., Coffey, C. S., et al. (2009). Effect of comorbidity and body mass index on the survival of African-American and Caucasian patients with colon cancer. Cancer, 115(24), 5798–5806. https://doi.org/10.1002/cncr.24598.

    Article  PubMed  Google Scholar 

  42. Cuthbert, C. A., Hemmelgarn, B. R., Xu, Y., & Cheung, W. Y. (2018). The effect of comorbidities on outcomes in colorectal cancer survivors: A population-based cohort study. Journal of Cancer Survivorship, 12(6), 733–743. https://doi.org/10.1007/s11764-018-0710-z.

    Article  PubMed  Google Scholar 

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Funding

This project has been supported by the generous contributions of the Estate of the Late Emma Elwin (Ellie) a’Beckett.

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Authors and Affiliations

  1. Faculty of Science, School of Psychology, Quality of Life Office, The University of Sydney, Sydney, NSW, Australia

    Claudia Rutherford, Rachel Campbell & Madeleine King

  2. Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Cancer Nursing Research Unit (CNRU), The University of Sydney, Sydney, NSW, 2006, Australia

    Claudia Rutherford & Kate White

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  1. Claudia Rutherford
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Contributions

CR conception of the study and led the design, analysis plan, data interpretation and manuscript writing. RC conducted the data extraction and contributed to results interpretation and writing of the manuscript. KW contributed to study conception, design considerations, results interpretation and revision of the manuscript. MK contributed to study conception, study design, resolved data extraction queries, data interpretation and revision of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Claudia Rutherford.

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Rutherford, C., Campbell, R., White, K. et al. Patient-reported outcomes as predictors of survival in patients with bowel cancer: a systematic review. Qual Life Res 28, 2871–2887 (2019). https://doi.org/10.1007/s11136-019-02255-0

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