Prognostic Value of Functional Assessment of Cancer Therapy-General (FACT-G) in Advanced Non-Small-Cell Lung Cancer Treated with Korean Medicine

Assessing the performance of QLQ-C30 in predicting all-cause mortality in community cancer patients

BACKGROUND

To evaluate the ability of QLQ-C30 in predicting mortality in community-based cancer patients in China.

METHODS

A whole-cluster sampling method was adopted to enroll cancer patients in four communities in Shanghai from 2018 to 2019. The patients were surveyed using a questionnaire enquiring demographic information, cancer types, and QLQ-C30 scale. Death information of participants was collected and updated from community health care centers. Cox regression models were used to assess the relationship between various QLQ-C30 scores (i.e., total score, five dimension scores, and utility score) and all-cause mortality.

RESULTS

A total of 3,304 participants were enrolled with a mean age of 63.9 years. Among them, 2,710 patients survived while 594 died by 2023. The mean total QLQ-C30 score in living patients was statistically significantly higher than that in deceased patients ( 92.96 vs. 85.21, p < 0.001); and the mean values of the five dimension scores and utility score were also significantly higher for the living patients. Cox regression models with the adjustment of covariates also confirmed that higher QLQ-C30 scores were associated with lower risk of death, with the hazard ratio value being 0.81 for the total score, 0.83-0.89 for the dimension scores, and 0.83 for the utility score, respectively (p < 0.001 for all).

CONCLUSIONS

QLQ-C30 could accurately predict all-cause mortality in Chinese community cancer patients.

Health-related quality of life of individuals dealing with cancer in the Free State: A survey

Background

Cancer is the main cause of morbidity and mortality worldwide, and its symptoms can affect an individual's life holistically.

Objectives

Our study aimed to determine the health-related quality of life (HRQoL) of individuals dealing with cancer in the Free State, South Africa.

Method

A descriptive, cross-sectional study design utilising the standardised Functional Assessment of Cancer Therapy - General (FACT-G) questionnaire as well as a self-developed sociodemographic and general health information questionnaire was used in this study. The study was conducted at the Universitas Annex Oncology Clinic.

Results

A total of 507 participants were conveniently sampled. The median age was 53 years with 73.8% being female. The FACT-G's overall score ranged from 11.7 to 108, with a median of 76.7 (interquartile range [IQR] 63-89.5). The Social or Family Well-Being subscale indicated the highest median of 22.2 and the Emotional Well-Being subscale the lowest of 18. The Physical Well-Being subscale found that 61.8% of individuals felt forced to spend time in bed and 53.4% experienced nausea. The Functional Well-Being subscale showed that 70.3% of individuals accepted their illness and 51.6% enjoyed their life.

Conclusion

Our study highlights the importance of using a clinical assessment tool to determine the influence of cancer on the individual's HRQoL. Involvement of the individual's family and friends during management, as well as identifying the need for psychosocial support, is crucial for positively influencing HRQoL.

Clinical implications

The FACT-G is a valuable tool in guiding physiotherapists and other healthcare professionals with patients' cancer-related treatment experiences.

Quality of Life Determinants in Patients with Metastatic Prostate Cancer: Insights from a Cross-Sectional Questionnaire-Based Study

INTRODUCTION

Prostate cancer is one of the most prevalent malignancies affecting men globally, with a significant impact on health-related quality of life (HRQOL). With the recent therapeutic advancements and improvements in survival, there is a need to understand the determinants of HRQOL in metastatic prostate cancer patients to optimize treatment strategies for quality of life as the number of survivors increases. The aim of this study was to identify clinical variables that affect HRQOL and its domains in patients with metastatic prostate cancer.

METHODS

We conducted a cross-sectional questionnaire-based study in patients diagnosed with metastatic prostate cancer at a tertiary cancer center in India. Baseline clinical features, treatment details, and completed Functional Assessment of Cancer Therapy-Prostate (FACT-P), composed of FACT-general (FACT-G) and prostate cancer-specific concerns subscale (PCS) and FACT-P Trial Outcome Index (FACT-P TOI) questionnaires, were collected. The mean total, as well as individual domain scores, were calculated. Additionally, these were stratified by the current treatment being received by patients. Linear regression was used to identify independent factors affecting HRQOL in these patients.

RESULTS

Of the 106 enrolled patients, 84 completed the FACT-P questionnaire and were included in the analysis. The median age was 66 years, and at the time of assessment, 3 patients (3.6%) were receiving androgen deprivation therapy only, 53 patients (63.1%) were on ADT + androgen receptor-targeted agents (ARTAs), and 18 patients (21.4%) patients received ADT + chemotherapy. The mean (±standard deviation) of the FACT-P TOI score was 70.33 (±15.16); the PCS subscale was the most affected, followed by functional well-being. Patients on chemotherapy scored significantly higher on PCS, but the composite scores were not significantly different. Univariable regression identified obesity (body mass index > 25 kg/m2) and duration of first-line treatment as significant predictors of better HRQOL; however, obesity was the only independent predictor in multivariable analysis (β = 8.2; 95% confidence interval, 1.2 to 15.0; p = 0.022). Obesity also independently predicted a better FACT-P and its physical well-being domain score and PCS.

CONCLUSION

Prostate cancer patients experience impaired QoL, especially in the prostate cancer-specific and functional well-being domains. Lower BMI is an independent predictor of poor QoL, and this requires efforts to assess the impact of strategies to manage the nutritional status of patients with metastatic disease on QoL outcomes.

Prediction of postoperative health-related quality of life among patients with metastatic spinal cord compression secondary to lung cancer

Background

Health-related quality of life (HRQoL) is a critical aspect of overall well-being for patients with lung cancer, particularly those with metastatic spinal cord compression (MSCC). However, there is currently a lack of universal evaluation of HRQoL in this specific patient population. The aim of this study was to develop a nomogram that can accurately predict HRQoL outcomes in patients with lung cancer-related MSCC.

Methods

A total of 119 patients diagnosed with MSCC secondary to lung cancer were prospectively collected for analysis in the study. The least absolute shrinkage and selection operator (LASSO) regression analysis, along with 10-fold cross-validation, was employed to select the most significant variables for inclusion in the nomogram. Discriminative and calibration abilities were assessed using the concordance index (C-index), discrimination slope, calibration plots, and goodness-of-fit tests. Net reclassification index (NRI) and integrated discrimination improvement (IDI) analyses were conducted to compare the nomogram's performance with and without the consideration of comorbidities.

Results

Four variables were selected to construct the final nomogram, including the Eastern Cooperative Oncology Group (ECOG) score, targeted therapy, anxiety scale, and number of comorbidities. The C-index was 0.87, with a discrimination slope of 0.47, indicating a favorable discriminative ability. Calibration plots and goodness-of-fit tests revealed a high level of consistency between the predicted and observed probabilities of poor HRQoL. The NRI (0.404, 95% CI: 0.074-0.734, p = 0.016) and the IDI (0.035, 95% CI: 0.004-0.066, p = 0.027) confirmed the superior performance of the nomogram with the consideration of comorbidities.

Conclusions

This study develops a prediction nomogram that can assist clinicians in evaluating postoperative HRQoL in patients with lung cancer-related MSCC. This nomogram provides a valuable tool for risk stratification and personalized treatment planning in this specific patient population.

Prognostic value of patient-reported outcome measures (PROMs) in adults with non-small cell Lung Cancer: a scoping review

BACKGROUND

There is growing interest in the collection and use of patient-reported outcome measures (PROMs) to support clinical decision making in patients with non-small cell lung cancer (NSCLC). However, an overview of research into the prognostic value of PROMs is currently lacking.

AIM

To explore to what extent, how, and how robustly the value of PROMs for prognostic prediction has been investigated in adults diagnosed with NSCLC.

METHODS

We systematically searched Medline, Embase, CINAHL Plus and Scopus for English-language articles published from 2011 to 2021 that report prognostic factor study, prognostic model development or validation study. Example data charting forms from the Cochrane Prognosis Methods Group guided our data charting on study characteristics, PROMs as predictors, predicted outcomes, and statistical methods. Two reviewers independently charted the data and critically appraised studies using the QUality In Prognosis Studies (QUIPS) tool for prognostic factor studies, and the risk of bias assessment section of the Prediction model Risk Of Bias ASsessment Tool (PROBAST) for prognostic model studies.

RESULTS

Our search yielded 2,769 unique titles of which we included 31 studies, reporting the results of 33 unique analyses and models. Out of the 17 PROMs used for prediction, the EORTC QLQ-C30 was most frequently used (16/33); 12/33 analyses used PROM subdomain scores instead of the overall scores. PROMs data was mostly collected at baseline (24/33) and predominantly used to predict survival (32/33) but seldom other clinical outcomes (1/33). Almost all prognostic factor studies (26/27) had moderate to high risk of bias and all four prognostic model development studies had high risk of bias.

CONCLUSION

There is an emerging body of research into the value of PROMs as a prognostic factor for survival in people with NSCLC but the methodological quality of this research is poor with significant bias. This warrants more robust studies into the prognostic value of PROMs, in particular for predicting outcomes other than survival. This will enable further development of PROM-based prediction models to support clinical decision making in NSCLC.