Patients' perspectives on palliative chemotherapy of colorectal and non - colorectal cancer: a prospective study in a chemotherapy- experienced population.

BMC Cancer (Impact Factor: 3.32). 02/2013; 13(1):66. DOI: 10.1186/1471-2407-13-66
Source: PubMed

ABSTRACT BACKGROUND: A better understanding of patients' views on the benefit and burden obtained from palliative chemotherapy would facilitate shared decision making. We evaluated palliative cancer patients' reported outcomes (PROs) for toxicity and investigated the survival threshold for which they would repeat chemotherapy (CTx). METHODS: Patients who had received a minimum of three months of palliative CTx for advanced colorectal (CRC) or non-colorectal (non-CRC: upper gastrointestinal, lung and head-and-neck) cancer were assessed by questionnaire. Patients were questioned about PROs for toxicity, subjective burden from side effects, and were asked for the survival threshold necessary for them to repeat CTx. Expected survival (sum of indicated survival threshold and median survival time with best supportive care) was compared to the patients' actual survival. RESULTS: One hundred and thirty-four patients (CRC: 58; non-CRC: 76) were surveyed. The most frequent PRO- grade 3/4 toxicities were acne (12.8%), fatigue (9.0%), and diarrhea (8.5%). The symptom causing the highest subjective burden was fatigue and was worse than expected in 29.9% of the patients. The median survival threshold for which patients would repeat CTx was significantly longer in CRC than in non-CRC patients (p=0.01). Median expected survival was significantly longer than actual median survival (CRC: 44.0 months [22.0-65.9] compared with 30.0 months of actual survival [20.9-39.1]; non-CRC: 22.0 months [15.3-28.6] compared with 19.0 months of actual survival [15.1-22.9], p=0.03). CONCLUSION: Fatigue deserves more attention when toxicity of treatment and symptoms of disease are explained to patients. Patients' survival expectations from palliative chemotherapy are higher than previously described, exceed the median survival time known from phase III trials, and are significantly longer than their actual survival.

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    ABSTRACT: Initially unresectable colorectal liver metastases can be resected after response to chemotherapy. While cetuximab has been shown to increase response and resection rates, the survival outcome for this conversion strategy needs further evaluation. Patients with technically unresectable and/or ≥5 liver metastases were treated with FOLFOX/cetuximab (arm A) or FOLFIRI/cetuximab (arm B) and evaluated with regard to resectability every 2 months. Tumour response and secondary resection data have been reported previously. A final analysis of overall survival (OS) and progression-free survival (PFS) was performed in December 2012. Between December 2004 and March 2008, 56 patients were randomised to arm A, 55 to arm B. The median OS was 35.7 [95% CI: 27.2-44.2] months (arm A: 35.8 [95% CI: 28.1- 43.6], arm B: 29.0 [95% CI: 16.0-41.9] months, HR 1.03 [95% CI: 0.66-1.61], p=0.9). The median PFS was 10.8 [95% CI: 9.3-12.2] months (arm A: 11.2 [95% CI: 7.2-15.3], arm B: 10.5 [95% CI: 8.9-12.2] months, HR 1.18 [95% CI: 0.79-1.74], p=0.4). Patients who underwent R0 resection (n=36) achieved a better median OS (53.9 [95% CI: 35.9-71.9] months) than those who did not (21.9 [95% CI:17.1-26.7] months, p<0.001). The median disease-free survival for R0 resected patients was 9.9 [95% CI: 5.8-14.0] months, and the 5-year OS rate was 46.2 [95% CI: 29.5-62.9] %. This study confirms a favourable long-term survival for patients with initially suboptimal or unresectable colorectal liver metastases who respond to conversion therapy and undergo secondary resection. Both FOLFOX/FOLFIRI plus cetuximab, appear to be appropriate regimens for "conversion" treatment in patients with K-RAS codon 12/13/61 wild-type tumours. Thus, liver surgery can be considered curative or alternatively as an additional "line of therapy" in those patients who are not cured. NCT00153998,
    Annals of Oncology 02/2014; · 6.58 Impact Factor

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