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. 2023 Jan-Dec:30:10732748231185047.
doi: 10.1177/10732748231185047.

Baseline Quality of Life is a Strong and Independent Prognostic Factor for Overall Survival in Metastatic Colorectal Cancer

Patrick McGarrah  1 , Joleen Hubbard  1 , Paul J Novotny  2 , Megan E Branda  2 , Daniel S Sargent  2 , Roscoe F Morton  3 , Charles S Fuchs  4 , Al B Benson  5 , Stephen K Williamson  6 , Brian P Findlay  7 , Steven R Alberts  1 , Richard M Goldberg  8 , Jeff A Sloan  2
Affiliations

Baseline Quality of Life is a Strong and Independent Prognostic Factor for Overall Survival in Metastatic Colorectal Cancer

Patrick McGarrah et al. Cancer Control. 2023 Jan-Dec.

Abstract

Background: Previous studies have established that higher baseline quality of life (QOL) scores are associated with improved survival in patients with metastatic colorectal cancer (mCRC). We examined the relationship between overall survival (OS) and baseline QOL.

Patients and methods: A total of 1 247 patients with mCRC participating in N9741 (comparing bolus 5-FU/LV, irinotecan [IFL] vs infusional 5-FU/leucovorin [LV]/oxaliplatin [FOLFOX] vs. irinotecan/oxaliplatin [IROX]) provided data at baseline on overall QOL using a single-item linear analogue self-assessment (LASA) 0-100 point scale. The association of OS according to clinically deficient (defined as CD-QOL, score 0-50) vs not clinically deficient (nCD-QOL, score 51-100) baseline QOL scores was tested. A multivariable analysis using Cox proportional hazards modeling was performed to adjust for the effects of multiple baseline factors. An exploratory analysis was performed evaluating OS according to baseline QOL status among patients who did or did not receive second-line therapy.

Results: Baseline QOL was a strong predictor of OS for the whole cohort (CD-QOL vs nCD-QOL: 11.2 months vs 18.4 months, P < .0001), and in each arm IFL 12.4 vs 15.1 months, FOLFOX 11.1 months vs 20.6 months, and IROX 8.9 months vs 18.1 months. Baseline QOL was associated with baseline performance status (PS) (P < .0001). After adjusting for PS and treatment arm, baseline QOL was still associated with OS (P = .017).

Conclusions: Baseline QOL is an independent prognostic factor for OS in patients with mCRC. The demonstration that patient-assessed QOL and PS are independent prognostic indicators suggests that these assessments provide important complementary prognostic information.

Keywords: Intergroup N9741; colorectal cancer; patient-provided assessments; patient-reported outcomes; performance status; prognostic models; quality of life.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Distribution of baseline QOL scores in the entire cohort.
Figure 2.
Figure 2.
Overall survival based on CD-QOL vs nCD-QOL. Median OS was increased in the nCD-QOL group.
Figure 3.
Figure 3.
Association between OS and PS. Those with inferior ECOG PS had significantly decreased median OS.
Figure 4.
Figure 4.
Survival curves according to performance status. Patients with ECOG PS of 1 or 2 had improved median OS when baseline QOL was higher.
See this image and copyright information in PMC

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