Do drugs offering only PFS maintain quality of life sufficiently from a patient's perspective? Results from AVALPROFS (Assessing the 'VALue' to patients of PROgression Free Survival) study.
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Authors
May, S
Catt, S
Matthews, L
Shilling, V
Dickson, J
Simcock, R
Fallowfield, L
Publication Date
2018-11Journal Title
Support Care Cancer
ISSN
0941-4355
Publisher
Springer Science and Business Media LLC
Volume
26
Issue
11
Pages
3941-3949
Language
eng
Type
Article
Physical Medium
Print-Electronic
Metadata
Show full item recordCitation
Jenkins, V., Farewell, V., May, S., Catt, S., Matthews, L., Shilling, V., Dickson, J., et al. (2018). Do drugs offering only PFS maintain quality of life sufficiently from a patient's perspective? Results from AVALPROFS (Assessing the 'VALue' to patients of PROgression Free Survival) study.. Support Care Cancer, 26 (11), 3941-3949. https://doi.org/10.1007/s00520-018-4273-3
Abstract
PURPOSE: Trials of novel drugs used in advanced disease often show only progression-free survival or modest overall survival benefits. Hypothetical studies suggest that stabilisation of metastatic disease and/or symptom burden are worth treatment-related side effects. We examined this premise contemporaneously using qualitative and quantitative methods. METHODS: Patients with metastatic cancers expected to live > 6 months and prescribed drugs aimed at cancer control were interviewed: at baseline, at 6 weeks, at progression, and if treatment was stopped for toxicity. They also completed Functional Assessment of Cancer Therapy (FACT-G) plus Anti-Angiogenesis (AA) subscale questionnaires at baseline then monthly for 6 months. RESULTS: Ninety out of 120 (75%) eligible patients participated: 41 (45%) remained on study for 6 months, 36 progressed or died, 4 had treatment breaks, and 9 withdrew due to toxicity. By 6 weeks, 66/69 (96%) patients were experiencing side effects which impacted their activities. Low QoL scores at baseline did not predict a higher risk of death or dropout. At 6-week interviews, as the side effect severity increased, patients were significantly less inclined to view the benefit of cancer control as worthwhile (X2 = 50.7, P < 0.001). Emotional well-being initially improved from baseline by 10 weeks, then gradually returned to baseline levels. CONCLUSION: Maintaining QoL is vital to most patients with advanced cancer so minimising treatment-related side effects is essential. As side effect severity increased, drugs that controlled cancer for short periods were not viewed as worthwhile. Patients need to have the therapeutic aims of further anti-cancer treatment explained honestly and sensitively.
Keywords
Humans, Neoplasms, Neoplasm Metastasis, Disease Progression, Antineoplastic Combined Chemotherapy Protocols, Drugs, Investigational, Disease-Free Survival, Treatment Outcome, Immunotherapy, Attitude to Health, Perception, Quality of Life, Adult, Aged, Aged, 80 and over, Middle Aged, Female, Male, Surveys and Questionnaires
Identifiers
External DOI: https://doi.org/10.1007/s00520-018-4273-3
This record's URL: https://www.repository.cam.ac.uk/handle/1810/280071
Rights
Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Licence:
http://www.rioxx.net/licenses/all-rights-reserved
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