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Randomized Controlled Trial
. 2024 Jul 1;116(7):1087-1094.
doi: 10.1093/jnci/djae039.

Quality-of-life outcomes in metastatic spinal cord compression: findings from the SCORAD trial

Peter J Hoskin  1   2 , Krystyna Reczko  3 , Memuna Rashid  3 , Allan Hackshaw  3 , Andres Lopes  3 ; SCORAD Investigators
Collaborators, Affiliations
Randomized Controlled Trial

Quality-of-life outcomes in metastatic spinal cord compression: findings from the SCORAD trial

Peter J Hoskin et al. J Natl Cancer Inst. .

Erratum in

Abstract

Purpose: This article reports detailed quality-of-life data including preferred and actual place of care from SCORAD, the only large prospective randomized trial in metastatic spinal cord compression (MSCC).

Methods: SCORAD compared 2 doses of radiotherapy in patients with MSCC: 8 Gy single fraction and 20 Gy in 5 fractions. In total, 686 patients were randomized, of whom 590 had Health-Related Quality of Life (HRQoL) data collected at baseline and at least 1 later time point. HRQoL was measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 supplemented with the QLU-C10D and data on place of care at weeks 1, 4, 8, and 12 postrandomization. Quality-of-Life Adjusted Survival was computed by multiplying Kaplan-Meier survival probabilities with the UK utility weights obtained from the QLU-C10D.

Results: Patients with a baseline physical functioning score of above 50 demonstrated a 28% reduction in the risk of death (hazard ratio [HR] = 0.72, 99% confidence interval [CI] = 0.54 to 0.95; P = .003). An increased risk of death was associated with fatigue (HR = 1.35, 99% CI = 1.03 to 1.76; P = .0040), dyspnea (HR = 1.61, 99% CI = 1.24 to 2.08; P < .001), and appetite loss (HR = 1.25, 99% CI = 0.99 to 1.59; P = .014). The preferred place of care for the majority was at home or with relatives (61%-74% across the 12 weeks) but achieved by only 53% at 8 weeks.

Conclusions: Prolonged survival in patients with MSCC was associated with better HRQoL. More than 60% of patients preferred to be cared for at home or with relatives, but only half were able to achieve this. There was no difference in HRQoL between the multifraction and single-fraction groups.

Trial registration: ISRCTN97555949 and ISRCTN97108008.

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Conflict of interest statement

The authors confirm that they have no conflicts of interest.

Figures

Figure 1.
Figure 1.
Average scores for (A) global quality of life and (B) health utility score (QLU-C10D) and (C) physical functioning.
Figure 2.
Figure 2.
Preferred place of care (A) and actual place of care (B) for 668 patients (341 single fraction, 327 multifraction).
See this image and copyright information in PMC

References

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