Reducing Uncertainty: Predictors of Stopping Chemotherapy Early and Shortened Survival Time in Platinum Resistant/Refractory Ovarian Cancer-The GCIG Symptom Benefit Study
Felicia T Roncolato, Florence Joly, Rachel O'Connell, Anne Lanceley, Felix Hilpert, Luke Buizen, Aikou Okamoto, Eriko Aotani, Sandro Pignata, Paul Donnellan, Amit Oza, Elisabeth Avall-Lundqvist, Jonathan S Berek, Florian Heitz, Amanda Feeney, Dominique Berton-Rigaud, Martin R Stockler, Madeleine King, Michael Friedlander, GCIG Symptom Benefit group, Felicia T Roncolato, Florence Joly, Rachel O'Connell, Anne Lanceley, Felix Hilpert, Luke Buizen, Aikou Okamoto, Eriko Aotani, Sandro Pignata, Paul Donnellan, Amit Oza, Elisabeth Avall-Lundqvist, Jonathan S Berek, Florian Heitz, Amanda Feeney, Dominique Berton-Rigaud, Martin R Stockler, Madeleine King, Michael Friedlander, GCIG Symptom Benefit group
Abstract
Background: Clinicians and patients often overestimate the benefits of chemotherapy, and overall survival (OS), in platinum resistant/refractory ovarian cancer (PRROC). This study sought to determine aspects of health-related quality of life and clinicopathological characteristics before starting chemotherapy that were associated with stopping chemotherapy early, shortened survival, and death within 30 days of chemotherapy.
Materials and methods: This study enrolled women with PRROC before starting palliative chemotherapy. Health-related quality of life was measured with EORTC QLQ-C30/QLQ-OV28. Chemotherapy stopped within 8 weeks of starting was defined as stopping early. Logistic regression was used to assess univariable and multivariable associations with stopping chemotherapy early and death within 30 days of chemotherapy; Cox proportional hazards regression was used to assess associations with progression-free and OS.
Results: Low baseline global health status (GHS), role function (RF), physical function (PF), and high abdominal/gastrointestinal symptom (AGIS) were associated with stopping chemotherapy early (all p < .007); low PF and RF remained significant after adjusting for clinicopathological factors (both p < .0401). Most who stopped chemotherapy early had Eastern Cooperative Oncology Group Performance Score 0-1 at baseline (79%); PF, RF, and GHS remained independently significant predictors of stopping chemotherapy early in this subgroup. Death within 30 days of chemotherapy occurred in 14%. Low GHS, RF, and PF remained significantly associated with death within 30 days of chemotherapy after adjusting for clinicopathological factors (all p < .012).
Conclusion: Women with low GHS, RF, or PF before starting chemotherapy were more likely to stop chemotherapy early, with short OS. Self-ratings of GHS, RF, and PF could improve patient-clinician communication regarding prognosis and help decision-making in women considering chemotherapy for PRROC.
Implications for practice: Measuring aspects of health-related quality of life when considering further chemotherapy in platinum resistant/refractory ovarian cancer (PRROC) could help identify women with a particularly poor prognosis who are unlikely to benefit from chemotherapy and could therefore be spared unnecessary treatment and toxicity in their last months of life. Self-ratings of global health status, role function, and physical function could improve patient-clinician communication regarding prognosis and help decision-making in women considering chemotherapy for PRROC.
Keywords: Patient‐reported outcomes; Platinum‐resistant ovarian cancer; Prognosis; Quality of life.
Conflict of interest statement
Disclosures of potential conflicts of interest may be found at the end of this article.
© AlphaMed Press 2017.
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Source: PubMed