Longitudinal cumulative dose: A novel measure to assess multiple dimensions of chemotherapy adherence over time.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 3522-3522
Author(s):  
Michael Webster-Clark ◽  
Alexander P Keil ◽  
Hanna Kelly Sanoff ◽  
Til Sturmer ◽  
Daniel Westreich ◽  
...  
Keyword(s):  
Cumulative Dose ◽  
Standard Dose ◽  
Performance Status ◽  
Dose Intensity ◽  
International Study ◽  
Standard Regimen ◽  
Number Of Patients ◽  
And Performance ◽  
The Impact ◽  
Over Time

3522 Background: Adjuvant chemotherapy regimens take months to complete. Despite this, trials and observational studies evaluate chemotherapy adherence via measures assessed at the end of treatment (e.g. number of patients missing any dose, relative dose intensity [RDI]). This approach misses information that impacts outcomes, like treatment delays. We propose longitudinal cumulative dose (LCD) as a way to integrate the impact of dose reductions, missed doses, and dose delays at each cycle over time. Methods: We obtained data from the 2,246 participants in the Multicenter International Study of Oxaliplatin/5FU-LV in the Adjuvant Treatment of Colon Cancer (MOSAIC). We evaluated proportions of patients stopping treatment early and reducing (based on protocol), missing, or delaying a dose in each arm for each chemo agent at each visit. We obtained LCD, the fraction of the final standard dose a participant reached by a given day, for each participant and each chemo agent. We compared LCD medians over time and at the end of a standard regimen (24 weeks) between treatment arms and by age and performance status. We assessed agreement between oxaliplatin LCD and RDI with Fleiss’ kappa (Table). Results: Participants randomized to FOLFOX were more likely than those randomized to 5FU to stop treatment, reduce doses, miss doses, or delay visits; these differences increased over time. Median LCD for oxaliplatin in the FOLFOX arm at 24 weeks was 77%. Graphs of median LCD for 5FU showed a clear difference between arms (FOLFOX arm median LCD: 81%; 5FU arm median LCD, 96%). While 5FU LCD decreased with age in the FOLFOX arm (median LCD in those age <40: 85%; 40-64, 82%; 65-75, 76%), it was similar across ages in the 5FU arm (median LCD 94%, 96%, and 96%, respectively), with smaller performance status trends. RDI and LCD showed fair agreement (Fleiss’ kappa=0.34); 19% of those with RDI over 85% had LCD under 60%. Conclusions: Visualizing LCD highlighted the timing and scale of deviations from standard administration, with major differences in 5FU LCD across arms. Next steps include evaluating if LCD predicts clinical outcomes. [Table: see text]

scholarly journals QOLP-10. MONITORING TRENDS IN PATIENT DISTRESS IN GLIOBLASTOMA USING THE PHQ4 QUESTIONNAIRE

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii176-ii177
Author(s):  
Anh Huan Vo ◽  
Connor Hambelton ◽  
Lauren Popp ◽  
Verda Dew ◽  
Maria Turchan ◽  
...  
Keyword(s):  
Temporal Trend ◽  
Performance Status ◽  
Patient Characteristics ◽  
Patient Health ◽  
Post Radiation ◽  
Logistic Mixed Effects Model ◽  
And Performance ◽  
The Impact ◽  
Over Time ◽  
Time Point

Abstract OBJECTIVE To identify the trend of distress over time and whether palliative care (PC) referral and visit affected distress level in glioblastoma (GBM) patients. BACKGROUND GBM patients experience significant distress due to their prognosis and neurologic involvement. All subjects in the neuro-oncology clinic at our institution routinely receive the Patient Health Questionnaire-4 (PHQ4) which is a validated screening tool that comprises a section for generalized anxiety disorder (GAD2) and a depression screen (PHQ2). DESIGN This prospective study was approved by the institutional review board. GBM patients who started radiation therapy on 1/1/2019 or later were included. Patients with a GAD2 or PHQ2 of 3 or above were categorized as present for anxiety or depression. A logistic mixed-effects model was used to test the trend of anxiety or depression over time and the impact of PC referral and visit. RESULT 131 PHQ4 questionnaires from 39 newly diagnosed GBM patients (mean age: 59.9yrs ± 15.0; 23M/16F) at the pre-radiation, post radiation and at least every 2 months thereafter were reviewed. Before radiation, 54.8% of patients reported anxiety, higher than at 1-month post radiation (23.5%), 2-3 months (41.4%), 4-6 months (20.0%), and after 6 months (25.0%). This temporal trend is significant (P = 0.0385) after adjusting for patient characteristics such as age, gender and performance status. The proportions of anxiety were not different among visits without PC referral (23.7%), with PC referral and no PC visit (42.4%), and with PC visit (32.4%, P = 0.64). We did not identify a similar temporal trend in depression. CONCLUSION Our data suggests that anxiety is more prevalent than depression in this cohort. This study identifies subjects to be at a greatest likelihood of experiencing anxiety at the pre-radiation time point. Focused interventions at this time point may help improve the patient’s overall quality of life.

Randomized phase II comparison of standard CHOP with weekly CHOP in elderly patients with non-Hodgkin's lymphoma.

1995 ◽  
Vol 13 (9) ◽  
pp. 2386-2393 ◽  
Author(s):  
R M Meyer ◽  
G P Browman ◽  
M L Samosh ◽  
A M Benger ◽  
D Bryant-Lukosius ◽  
...  
Keyword(s):  
Overall Survival ◽  
Survival Rate ◽  
Elderly Patients ◽  
Performance Status ◽  
Eastern Cooperative Oncology Group ◽  
Dose Intensity ◽  
Intermediate Grade ◽  
Ecog Performance Status ◽  
Standard Regimen ◽  
And Performance

PURPOSE To determine whether modifying the standard regimen of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) from full doses given every 3 weeks to one-third doses given weekly (chop) increases the received chemotherapy dose-intensity in elderly patients with advanced-stage intermediate-grade lymphoma. PATIENTS AND METHODS Consenting patients, age > or = 65 years who had acceptable cardiac, renal, and liver function and an Eastern Cooperative Oncology Group (ECOG) performance status less than 4, were stratified by bone marrow and performance status and randomized to receive standard CHOP or weekly chop. Drug doses were attenuated or escalated according to a defined dose-modification schedule. The primary outcome was average relative received dose-intensity. Secondary outcomes included response, progression-free and overall survival, toxicity, and performance status. RESULTS Nineteen patients were allocated to each group. No difference in received dose-intensity was seen. When dose-intensity was calculated for the first six cycles of therapy, average relative received dose-intensity was .92 with CHOP versus .89 with weekly chop (P = .5); when calculated for the first 18 weeks of therapy, values were .88 with CHOP versus .89 with weekly chop (P = .8). The complete response rate was 68% with CHOP versus 74% with weekly chop (P = .9). At 2 years, the progression-free survival rate was 57% with CHOP versus 46% with weekly chop (P = .16) and the survival rate was 74% with CHOP versus 51% with weekly chop (p = .05). More myelotoxicity was seen with CHOP. CONCLUSION We conclude that CHOP can be given in sufficient doses to elderly patients and that weekly chop does not increase received dose-intensity. Progression-free and overall survival are unlikely to be superior with weekly chop, and may be worse. CHOP should remain the standard against which new therapies for elderly patients with intermediate-grade lymphoma are compared.

Serum cathepsin B (CB) levels are prognostic in chemotherapy-naive patients (pts) with advanced non-small cell lung cancer (NSCLC) and performance status (PS) of 2

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 18036-18036
Author(s):  
J. W. Singer ◽  
F. B. Oldham ◽  
B. Bandstra ◽  
L. Sandalic ◽  
J. Bianco ◽  
...  
Keyword(s):  
Median Survival ◽  
Advanced Nsclc ◽  
Performance Status ◽  
Phase Iii ◽  
Serum Samples ◽  
Protein Levels ◽  
Lysosomal Cysteine Protease ◽  
Phase Iii Trials ◽  
And Performance ◽  
The Impact

18036 Background: CB is an estrogen-influenced lysosomal cysteine protease produced by tumor cells and tumor-associated macrophages; tumor tissue CB protein levels and proteolytic activity are prognostic in NSCLC (Anticancer Res. 2004; 24:4147–61). The prognostic value of serum CB has not previously been evaluated in NSCLC. Here we evaluate the impact of pretreatment CB levels on survival in pts from 2 phase III trials in advanced NSCLC, STELLAR 3 and 4. These trials compared paclitaxel poliglumex (PPX) against commonly used regimens. As the intratumoral metabolic pathway of PPX is characterized by the CB-mediated release of paclitaxel (P) from a polymeric backbone (Ca Chemother Pharm. 2006. Epub ahead of print), correlation of CB levels with PPX efficacy was assessed as well. Methods: Pretreatment serum samples from 450 chemo-naive pts with advanced NSCLC and PS 2 enrolled in STELLAR 3 (P + carboplatin (C) v. PPX + C) (N=315) and STELLAR 4 (vinorelbine or gemcitabine v. PPX) (N=135) were assayed for CB by ELISA (ICON Labs). Values were assessed by quartiles and there was a clear breakpoint at the median. Pts were categorized as high or low CB based on values above or below the median (64 ng/ml). The effect of CB levels on survival was evaluated by log rank for pooled pts from the studies. Results: As detailed in the table , median survival for non-PPX-treated pts was worse if CB was high; in contrast, median survival for PPX-treated pts did not differ by CB level. Pts with high CB receiving PPX showed a trend towards better survival compared to those receiving control regimens. Conclusions: The data suggest that serum CB may be prognostic biomarker for NSCLC. Retrospective analysis suggests a trend towards improved survival in patients with high CB receiving PPX; prospective studies are required to confirm this observation. [Table: see text] No significant financial relationships to disclose.

Impact of socioeconomic status on treatment outcome in patients with advanced esophagogastric cancer in Northern Ireland

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e20531-e20531
Author(s):  
Y. Manikyam ◽  
G. G. Hanna ◽  
R. J. Harte ◽  
P. G. Henry ◽  
R. F. Houston ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Northern Ireland ◽  
Median Survival ◽  
Performance Status ◽  
Locally Advanced ◽  
Ecog Performance Status ◽  
Disease Extent ◽  
Esophagogastric Cancer ◽  
And Performance ◽  
The Impact

e20531 Background: The survival advantage for combination chemotherapy in advanced gastroesophageal adenocarcinoma is well documented. Epirubicin and cisplatin in combination with either 5FU (ECF) or capecitabine (ECX) result in response rates of 35–46% and a median survival of around 9 months in RCT. We report the impact of socioeconomic status on the outcome of ECF and ECX treatment in advanced gastroesophageal cancer patients in Northern Ireland between 2000 and 2007. Methods: All patients with advanced esophageal (O), gastric (G), or esophagogastric junction (OGJ) adenocarcinoma, receiving palliative chemotherapy from January 2000 to August 2007, were identified from our institutional database. Baseline demographics, clinical characteristics, treatment details, and clinical outcomes were recorded. Patients receiving chemotherapy in a clinical trial were excluded. Survival was estimated using the Kaplan-Meier method. Deprivation was assessed using the patient's home address deprivation index (DPI) (Northern Ireland Multiple Deprivation Measure 2005; May 2005. Northern Ireland Statistics and Research Agency. www.nisra.gov.uk ). Results: 274 eligible patients (m=200, f=74, O=114, OGJ=19, G=141) were identified. Median age was 62 years (range 22–83). 172 (62.8%) had ECOG performance status 0 or 1. 231 patients (84.3%) had metastatic disease, 43 (15.7%) had locally advanced disease. 216 (78.8%) patients received ECF and 58 (21.2%) patients received ECX. Overall median survival was 7.3 months. Treatment response and performance status were strong predictors of survival, however disease extent did not influence survival. Median survival was significantly longer in those with DPIs in the upper two quintiles than the lower 3 quintiles (9.5 months vs. 6.8 months, p=0.032). Conclusions: Outcomes achieved with palliative ECF/ECX treatment are similar to the reference clinical trials. Socioeconomic deprivation is significantly associated with reduced survival in this group of patients and is unrelated to disease extent at presentation; however it may be related to nutritional status and comorbidity and requires further investigation. No significant financial relationships to disclose.

Development and validation of a risk prediction model for poor performance status and severe symptoms among cancer patients.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 12097-12097
Author(s):  
Hsien Seow ◽  
Peter Tanuseputro ◽  
Lisa Catherine Barbera ◽  
Craig Earle ◽  
Dawn Guthrie ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Index Date ◽  
Performance Status ◽  
Poor Performance ◽  
Population Based ◽  
Assessment System ◽  
Poor Performance Status ◽  
Secondary Outcomes ◽  
And Performance ◽  
Over Time

12097 Background: Existing cancer predictive tools focus on survival, but few incorporate patient-reported outcomes to predict quality-of-life domains, such as symptoms and performance status. The objective was to develop and validate a predictive cancer model (called PROVIEW) for poor performance status and severe symptoms over time. Methods: We used a retrospective, population-based, cohort study of patients, with a cancer diagnosis, in Ontario, Canada between 2008-2015. We randomly selected 60% of patients for model derivation and 40% for validation. Using the derivation cohort, we developed multivariable logistic regression models with baseline characteristics, using a backward stepwise variable selection process. The primary outcome was odds of having poor performance status six months from index date, as measured by a score < = 30 out of 100 on the Palliative Performance Scale. The index date for each model was diagnosis (Year 0), which was then re-calculated at each of 4 annual survivor marks after diagnosis (up to Year 4). Secondary outcomes included having severe pain, dyspnea, well-being, or depression, as measured by a score of > = 7 out of 10 on the Edmonton Symptom Assessment System. Covariates included demographics, clinical information, current symptoms and performance status, and healthcare utilization. Model performance was assessed by AUC statistics and calibration plots. Results: Our population-based cohort identified 125,479 cancer patients for the performance status model in Year 0. The median diagnosis age was 64 years, 57% were female, and the most common cancers were breast (24%), lung (13%), and prostate (9%). 32% had Stage 3 or 4 disease. In Year 0 after backwards selection, the odds of having a poor performance status in 6 months was increased by more than 10% when the patient had: COPD, dementia, diabetes; radiation treatment; a hospital admission in the prior 3 months; high pain or depression; a current performance status < = 30; any issues with appetite; or received end-of-life homecare. Generally, these variables were also associated with a > 10% increased odds in other years and for the secondary outcomes. The average AUC across all 25 models is 0.7676 which indicates high model discrimination. Conclusions: The PROVIEW model accurately predicts risk of having a poor performance status or severe symptoms over time among cancer patients. It has the potential to be a useful online tool for patients to integrate earlier supportive and palliative care.

The impact of single-hetero UGT1A1 on clinical outcomes of irinotecan monotherapy in gastric cancer after fluoropyrimidine, platinum, and taxanes: Multicenter retrospective study.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 296-296
Author(s):  
Ken Ito ◽  
Yoshito Komatsu ◽  
Satoshi Yuki ◽  
Shintaro Nakano ◽  
Hiroshi Nakatsumi ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Retrospective Study ◽  
Treatment Guidelines ◽  
Performance Status ◽  
Dose Intensity ◽  
Progression Free Survival ◽  
Her2 Status ◽  
Gastric Cancer Treatment ◽  
Third Line ◽  
The Impact

296 Background: Japanese gastric cancer treatment guidelines (5th edition) recommend irinotecan (IRI) after fluoropyrimidine, platinum and taxanes as a third line chemotherapy. We previously reported that patients with UGT1A1 single heterozygous (SH) had significantly high frequency of severe hematological adverse events (AEs) compared to patients with UGT1A1 wild type (WT) in IRI monotherapy for advanced gastric cancer (AGC). However, it remains unclear that UGT1A1 SH affect efficacy and safety of IRI after fluoropyrimidine, platinum and taxanes compared to WT as a salvage line. Methods: We retrospectively analyzed the clinical data of patients who received IRI monotherapy after fluoropyrimidine, platinum and taxanes in the multi-institutional retrospective study. From January 2010 to December 2017, 69 eligible patients were registered from 8 centers in Japan. Results: Forty one patients with UGT1A1 WT and 28 patients with UGT1A1 SH were included in this study. In WT/SH patients, performance status 0/1/≥2 was 12/25/4 and 5/17/6, treatment line 3rd/4th or later was 33/8 and 26/2, HER2 status positive/negative was 12/29 and 5/23, respectively. In WT/SH patients, rate of initial dose reduction was 22 and 28% (P = 0.363), median relative dose intensity (RDI) was 82% and 80% (P = 0.309). Of 88 patients who have measurable lesions, the overall response rate (ORR) was 5.7% and 4.2% (P = 1.000), disease control rate (DCR) was 54% and 38% (P = 0.289). Median progression free survival was 3.2 and 2.1 months (HR 0.607, P = 0.058) and median overall survival from initial day of IRI monotherapy was 10.0 and 7.0 months (HR 0.618 P = 0.086). In WT/SH patients, severe hematological AEs (≥G3) were observed more frequently in patients with UGT1A1 SH (WT: 43% and SH: 68%, P = 0.050), although frequency of severe non-hematological AEs (≥G3) were not significantly different in both groups (13% and 25%, P = 0.211). Conclusions: Compared to UGT1A1 WT, UGT1A1 SH status may be associated with poor efficacy and be a risk factor of higher frequency of severe hematological AEs.

scholarly journals Conditional Survival and the Choice of Conditioning Set for Patients With Colon Cancer: An Analysis of NSABP Trials C-03 Through C-07

2010 ◽  
Vol 28 (15) ◽  
pp. 2544-2548 ◽  
Author(s):  
Beth A. Zamboni ◽  
Greg Yothers ◽  
Mehee Choi ◽  
Clifton D. Fuller ◽  
James J. Dignam ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Performance Status ◽  
Disease Free Survival ◽  
Second Primary ◽  
Alternative Measure ◽  
Conditional Survival ◽  
Prognostic Information ◽  
And Performance ◽  
Disease Free ◽  
Over Time

PurposeColon cancer overall survival (OS) is usually computed from the time of diagnosis. Survival gives the initial prognosis but does not reflect how prognosis changes with changing hazard rates over time. Conditional survival (probability of surviving y additional years given they have survived x years [CS or OS|OS]) is an alternative measure that accounts for elapsed time since diagnosis, providing more relevant prognostic information. We extend the concept of CS to condition on the set of patients alive, recurrence-free, and second primary cancer-free (disease-free survival [OS|DFS]).Patients and MethodsUsing data from National Surgical Adjuvant Breast and Bowel Project trials C-03 through C-07, 5-year OS|DFS was calculated on patients who were disease free up to 5 years after diagnosis, stratified by age, stage, nodal status, and performance status (PS).ResultsFor stage II, OS|DFS improved from 87% to 92% at 5 years. For stage III, OS|DFS improved from 69% to 88%. Patients younger than 50 years showed OS|DFS improvement from 79% to 95%; those older than 70 years showed no sustained increase in OS|DFS. Node-negative patients with ≥ 12 nodes resected showed little change (89% to 94%); those with more than four positive nodes showed an improvement (57% to 86%). Patients with a PS of 0 or 1 demonstrated a small improvement; those with a PS of 2 did not (64% to 58%).ConclusionPrognosis improves over time for almost all groups of patients with colon cancer, especially those with positive nodes. OS|DFS is a more relevant measure of prognosis for those who have already survived disease free a period of time after diagnosis.

scholarly journals Comparison of the Freiburg and Charlson Comorbidity Indices in Predicting Overall Survival in Elderly Patients with Newly Diagnosed Multiple Myeloma

2014 ◽  
Vol 2014 ◽  
pp. 1-11 ◽  
Author(s):  
Sung Min Kim ◽  
Moon Jin Kim ◽  
Hyun Ae Jung ◽  
Kihyun Kim ◽  
Seok Jin Kim ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Overall Survival ◽  
Elderly Patients ◽  
Performance Status ◽  
Solid Cancer ◽  
Newly Diagnosed ◽  
History Of ◽  
Comorbidity Index ◽  
And Performance ◽  
The Impact

Multiple myeloma occurs primarily in elderly patients. Considering the high prevalence of comorbidities, comorbidity is an important issue for the management of myeloma. However, the impact of comorbidity on clinical outcomes has not been fully investigated. We retrospectively analyzed patients with newly diagnosed myeloma. Comorbidities were assessed based on the Charlson comorbidity index (CCI) and the Freiburg comorbidity index (FCI). The CCI is a summary measure of 19 comorbid conditions. FCI is determined by performance status, renal impairment, and lung disease. This study included 127 patients with a median age of 71 years. Approximately half of the patients had additional disorders at the time of diagnosis, and diabetes mellitus was the most frequent diagnosis (18.9%). The most significant factors for prognosis among patient-related conditions were a history of solid cancer and performance status (ECOG ≥ 2). The FCI score was divided into 3 groups (0, 1, and 2-3), and the CCI score was divided into 2 groups (2-3 and ≥4). FCI was a strong prognostic tool for OS (P>0.001) and predicted clinical outcome better than CCI (P=0.059). In conclusion, FCI was more useful than CCI in predicting overall survival in elderly patients with myeloma.

Examining the Direction of Imagery and Self-Talk on Dart-Throwing Performance and Self Efficacy

2006 ◽  
Vol 20 (3) ◽  
pp. 257-274 ◽  
Author(s):  
Jennifer Cumming ◽  
Sanna M. Nordin ◽  
Robin Horton ◽  
Scott Reynolds
Keyword(s):  
Self Efficacy ◽  
Mixed Design ◽  
Self Talk ◽  
Dart Throwing ◽  
And Performance ◽  
The Impact ◽  
Over Time

The study investigated the impact of varying combinations of facilitative and debilitative imagery and self-talk (ST) on self-efficacy and performance of a dart-throwing task. Participants (N = 95) were allocated to 1 of 5 groups: (a) facilitative imagery/facilitative ST, (b) facilitative imagery/debilitative ST, (c) debilitative imagery/facilitative ST, (d) debilitative imagery/debilitative ST, or (e) control. Mixed-design ANOVAs revealed that performance, but not self-efficacy, changed over time as a function of the assigned experimental condition. Participants in the debilitative imagery/debilitative ST condition worsened their performance, and participants in the facilitative imagery/facilitative ST condition achieved better scores. These findings demonstrate that a combination of facilitative imagery and ST can enhance performance whereas debilitative imagery and ST can hamper it.

scholarly journals Impact of molecular alterations on quality of life and prognostic understanding over time in patients with incurable lung cancer: a multicenter, longitudinal, prospective cohort study

2021 ◽  
Author(s):  
Jonas Kuon ◽  
Miriam Blasi ◽  
Laura Unsöld ◽  
Jeannette Vogt ◽  
Anja Mehnert ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lung Cancer ◽  
Psychological Distress ◽  
Performance Status ◽  
Multicentric Study ◽  
Molecular Alterations ◽  
Prospective Longitudinal ◽  
The Impact ◽  
Over Time

Abstract Purpose The purpose of this study is to investigate changes over time in quality of life (QoL) in incurable lung cancer patients and the impact of determinants like molecular alterations (MA). Methods In a prospective, longitudinal, multicentric study, we assessed QoL, symptom burden, psychological distress, unmet needs, and prognostic understanding of patients diagnosed with incurable lung cancer at the time of the diagnosis (T0) and after 3 (T1), 6 (T2) and 12 months (T3) using validated questionnaires like FACT-L, National Comprehensive Cancer Network (NCCN) Distress Thermometer (DT), PHQ-4, SCNS-SF-34, and SEIQoL. Results Two hundred seventeen patients were enrolled, 22 (10%) with reported MA. QoL scores improved over time, with a significant trend for DT, PHQ-4, and SCNS-SF-34. Significant determinants for stable or improving scores over time were survival > 6 months, performance status at the time of diagnosis, and presence of MA. Patients with MA showed better QoL scores (FACT-L at T1 104.4 vs 86.3; at T2 107.5 vs 90.0; at T3 100.9 vs 92.8) and lower psychological distress (NCCN DT at T1 3.3 vs 5; at T2 2.7 vs 4.5; at T3 3.7 vs 4.5; PHQ-4 at T1 2.3 vs 4.1; at T2 1.7 vs 3.6; at T3 2.2 vs 3.6), but also a worsening of the scores at 1 year and a higher percentage of inaccurate prognostic understanding (27 vs 17%) compared to patients without MA. Conclusion Patients with tumors harboring MA are at risk of QoL deterioration during the course of the disease. Physicians should adapt their communication strategies in order to maintain or improve QoL.

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