Quality of life in patients with cisplatin-resistant urothelial cancer: Typical ailments and effect of paclitaxel-based salvage therapy

Abstract

Introduction: Efficacy of palliative second-line treatment in patients suffering from advanced urothelial cancer (aUC) is limited. Accordingly, careful observation of patient-reported and treatment-related changes of quality of life (QoL) is mandatory. Therefore, we evaluated "typical" ailments and treatment related QoL changes in these patients.

Patients and methods: Results of the EORTC QLQ-C30 questionnaire were reviewed in 129 patients included in 2 prospective trials on paclitaxel-based treatment of cisplatin-resistant aUC (gemcitabine/paclitaxel: 102 patients [AB 20/99]; paclitaxel/everolimus: 27 patients [AB 35/09]). Eligible patients had completed EORTC QLQ-C30 questionnaire questionnaire before treatment start and available data on response. Global health status (QL), functional scales (FuSc) and symptom scales (SySc) were compared with published normative data for patients suffering from metastatic/recurrent cancers. Treatment related changes of QoL were evaluated. For statistical evaluation 2-way analysis of variance was used.

Results: A total of 87 patients were eligible (63 men and 24 women, median age = 65 [interquartile range: 60-71]y, AB 20/99: 63 patients [72%], AB 35/09: 24 patients [28%]). Compared with metastatic/recurrent cancers normative data, impaired emotional FuSc (-11.6 [95% CI:-21.0 to-2.1] points, P<0.01) and higher pain SySc (+12.9 [CI: 3.7-22.1] points, P<0.001) were the most relevant differences. QL and further FuSc/SySc were comparable. Pain SySc was significantly lower after 3 (-15.8 [CI:-31.4 to-0.7] points, P<0.01] and 4 cycles (-13.6 [CI:-29.2-2.1] points, P<0.05). Further changes of QL, FuSc or SySc during treatment were not observed. QL, FuSc, and SySc at baseline and during treatment did not differ between responders and nonresponders.

Conclusions: Patients with aUC who received additional treatment demonstrated QoL changes similar to persons with other recurrent/metastatic cancers. Special emphasis should be attributed to pain and emotional problems. Despite treatment related side effects, patients did not report impairment of QoL.

Keywords: Chemotherapy; Patient-reported outcomes; Quality of life; Urothelial carcinoma.