Prospective cohort study of surgical outcome for spinal metastases in patients aged 70 years or older

Aims With recent progress in cancer treatment, the number of advanced-age patients with spinal metastases has been increasing. It is important to clarify the influence of advanced age on outcomes following surgery for spinal metastases, especially with a focus on subjective health state values. Methods We prospectively analyzed 101 patients with spinal metastases who underwent palliative surgery from 2013 to 2016. These patients were divided into two groups based on age (< 70 years and ≥ 70 years). The Eastern Cooperative Oncology Group (ECOG) performance status (PS), Barthel index (BI), and EuroQol-5 dimension (EQ-5D) score were assessed at study enrolment and at one, three, and six months after surgery. The survival times and complications were also collected. Results In total, 65 patients were aged < 70 years (mean 59.6 years; 32 to 69) and 36 patients were aged ≥ 70 years (mean 75.9 years; 70 to 90). In both groups, the PS improved from PS3 to PS1 by spine surgery, the mean BI improved from < 60 to > 80 points, and the mean EQ-5D score improved from 0.0 to > 0.7 points. However, no significant differences were found in the improvement rates and values of the PS, BI, and EQ-5D score at any time points between the two groups. The PS, BI, and EQ-5D score improved throughout the follow-up period in approximately 90% of patients in each group. However, the improved PS, BI, and EQ-5D scores subsequently deteriorated in some patients, and the redeterioration rate of the EQ-5D was significantly higher in patients aged ≥ 70 than < 70 years (p = 0.027). Conclusion Palliative surgery for spinal metastases improved the PS, activities of daily living, and quality of life, regardless of age. However, clinicians should be aware of the higher risk of redeterioration of the quality of life in advanced-age patients. Cite this article: Bone Joint J 2020;102-B(12):1709–1716.

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Metastatic Spine Disease: Should Patients With Short Life Expectancy Be Denied Surgical Care? An International Retrospective Cohort Study

Neurosurgery ◽

10.1093/neuros/nyz472 ◽

2019 ◽

Vol 87 (2) ◽

pp. 303-311 ◽

Cited By ~ 4

Author(s):

Nicolas Dea ◽

Anne L Versteeg ◽

Arjun Sahgal ◽

Jorrit-Jan Verlaan ◽

Raphaële Charest-Morin ◽

...

Keyword(s):

Quality Of Life ◽

Cohort Study ◽

Surgical Treatment ◽

Life Expectancy ◽

Performance Status ◽

Spinal Metastases ◽

Post Treatment ◽

Baseline Performance ◽

Significant Difference

Abstract BACKGROUND Despite our inability to accurately predict survival in many cancer patients, a life expectancy of at least 3 mo is historically necessary to be considered for surgical treatment of spinal metastases. OBJECTIVE To compare health-related quality of life (HRQOL) in patients surviving <3 mo after surgical treatment to patients surviving >3 mo to assess the validity of this inclusion criteria. METHODS Patients who underwent surgery for spinal metastases between August 2013 and May 2017 were retrospectively identified from an international cohort study. HRQOL was evaluated using generic and disease-specific outcome tools at baseline and at 6 and 12 wk postsurgery. The primary outcome was the HRQOL at 6 wk post-treatment measured by the Spine Oncology Study Group Outcomes Questionnaire (SOSGOQ). RESULTS A total of 253 patients were included: 40 patients died within the first 3 mo after surgery and 213 patients survived more than 3 mo. Patients surviving <3 mo after surgery presented with lower baseline performance status. Adjusted analyses for baseline performance status did not reveal a significant difference in HRQOL between both groups at 6 wk post-treatment. No significant difference in patient satisfaction at 6 wk with regard to their treatment could be detected between both groups. CONCLUSION When controlled for baseline performance status, quality of life 6 wk after surgery for spinal metastasis is independent of survival. To optimize improvement in HRQOL for this patient population, baseline performance status should take priority over expected survival in the surgical decision-making process.

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Topotecan Versus Observation After Cisplatin Plus Etoposide in Extensive-Stage Small-Cell Lung Cancer: E7593—A Phase III Trial of the Eastern Cooperative Oncology Group

Journal of Clinical Oncology ◽

10.1200/jco.2001.19.8.2114 ◽

2001 ◽

Vol 19 (8) ◽

pp. 2114-2122 ◽

Cited By ~ 204

Author(s):

Joan H. Schiller ◽

Sudeshna Adak ◽

David Cella ◽

Russell F. DeVore ◽

David H. Johnson

Keyword(s):

Quality Of Life ◽

Performance Status ◽

Eastern Cooperative Oncology Group ◽

Small Cell ◽

Phase Iii ◽

Oncology Group ◽

Small Cell Lung ◽

Phase Iii Trial ◽

Extensive Stage

PURPOSE: To determine the efficacy of topotecan in combination with standard chemotherapy in previously untreated patients with extensive-stage small-cell lung cancer (SCLC), the Eastern Cooperative Oncology Group (ECOG) conducted a phase III trial. PATIENTS AND METHODS: Eligible patients had measurable or assessable disease and an ECOG performance status of 0 to 2; stable brain metastases were allowed. All patients received four cycles of cisplatin and etoposide every 3 weeks (step 1; PE). Patients with stable or responding disease were then randomized to observation or four cycles of topotecan (1.5 mg/m2/d for 5 days, every 3 weeks; step 2). A total of 402 eligible patients were registered to step 1, and 223 eligible patients were registered to step 2 (observation, n = 111; topotecan, n = 112). RESULTS: Complete and partial response rates to induction PE were 3% and 32%, respectively. A 7% response rate was observed with topotecan (complete response, 2%; partial response, 5%). The median survival time for all 402 eligible patients was 9.6 months. Progression-free survival (PFS) from date of randomization on step 2 was significantly better with topotecan compared with observation (3.6 months v 2.3 months; P < .001). However, overall survival from date of randomization on step 2 was not significantly different between the observation and topotecan arms (8.9 months v 9.3 months; P = .43). Grade 4 neutropenia and thrombocytopenia occurred in 50% and 3%, respectively, of PE patients in step 1 and 60% and 13% of topotecan patients in step 2. Grade 4/5 infection was observed in 4.6% of PE patients and 1.8% of topotecan patients. Grade 3/4 anemia developed in 22% of patients who received topotecan. No difference in quality of life between topotecan and observation was observed at any assessment time or for any of the subscale scores. CONCLUSION: Four cycles of PE induction therapy followed by four cycles of topotecan improved PFS but failed to improve overall survival or quality of life in extensive-stage SCLC. Four cycles of standard PE remains an appropriate first-line treatment for extensive-stage SCLC patients with good performance status.

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Validity and utility of the University of Texas M. D. Anderson Symptom Inventory (MDASI) among prostate cancer patients: Data from E2Z02: Symptom Outcomes and Practice Patterns (SOAPP).

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e15173 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e15173-e15173

Author(s):

Linda J. Patrick-Miller ◽

Fengmin Zhao ◽

Charles S. Cleeland ◽

Lynne I. Wagner ◽

Michael Fisch ◽

...

Keyword(s):

Quality Of Life ◽

Prostate Cancer ◽

Medical Oncology ◽

Performance Status ◽

Eastern Cooperative Oncology Group ◽

Symptom Assessment ◽

Severe Nausea ◽

Patient Reported

e15173 Background: Optimal treatment outcomes for patients (pts) with prostate cancer are dependent upon rigorous symptom assessment. The MDSAI, a patient-reported outcome measure of symptoms (sxs) and their impact validated in a sample of patients of diverse cancer types has the potential to inform symptom experience and guide treatment specific to prostate cancer pts. Methods: SOAPP, an Eastern Cooperative Oncology Group (ECOG) study, was conducted at academic and community medical oncology clinics and included pts with prostate cancer of all stages and phases of care. At baseline and 4 weeks, pts completed a measure of symptom severity and functional interference (MDASI). Symptom experiences and psychometric properties of the MDASI in prostate cancer pts (n = 320) were analyzed. Results: The 5 most prevalent moderate/severe sxs reported at baseline were fatigue (34%), disturbed sleep (25%), drowsiness (18%), pain (17%), and dry mouth (15%); moderate/severe nausea (5%) and vomiting (2%) were the least prevalent. At baseline ECOG performance status (PS) was ≥2 in 9% of pts. Pain, sadness, and difficulty remembering things occurred in 17%, 14%, and 13% respectively, and among pts whose PS worsened, severity of these sxs had the highest change scores at follow-up. Internal consistency and test-retest reliability of the MDASI were good, with Cronbach coefficient alphas ≥0.84 and intra-class correlations ≥0.78 for all subscales. Significantly higher scores and moderately large effects for the MDASI severity scale were reported by pts with poorer PS (2.2 vs 1.0, ES=.83) and tumor progression (2.4 vs 1.2, ES=.73) p<.05. Results were similar for the interference scale, demonstrating MDASI known-group validity. Pts whose quality of life declined showed significantly greater increase in severity (1.1 vs .14, p<.01) and interference (1.9 vs .28, p<.004) from baseline to follow-up than pts whose quality of life was unchanged, demonstrating MDASI sensitivity to change. Conclusions: The MDASI is a valid, reliable, and sensitive symptom assessment method for descriptive and clinical studies, and patient care in medical oncology outpatients with prostate cancer.

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HEALTH-RELATED QUALITY OF LIFE IN EARLY BREAST CANCER PATIENTS WITH HORMONE RESPONSIVE

International Journal of Pharmacy and Pharmaceutical Sciences ◽

10.22159/ijpps.2018v10i12.29648 ◽

2018 ◽

Vol 10 (12) ◽

pp. 47

Author(s):

Fef Rukminingsih ◽

Tri Murti Andayani ◽

Fita Rahmawati ◽

Kartika Widayati

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Early Breast Cancer ◽

Disease Free Survival ◽

Anxiety Reduction ◽

Health State ◽

Breast Cancer Patients ◽

Cross Sectional ◽

The Mean

Objective: The management of early breast cancer (EBC) is performed with a series of treatments consisting of surgery and systemic therapy, along with long-term endocrine therapy for hormone responsive. The treatment generates a high illness effect that will affect the life quality of EBC patients. The objective of this study was to measure EBC patients’ quality of life after undergoing the treatment.Methods: A cross-sectional study was conducted by interviewing EBC patients using EQ-5D-5L instrument at private hospitals in Yogyakarta and Semarang, Indonesia. The EBC patients were women aged 18-60 y who had undergone surgery in 2010-2013 and received endocrine therapy.Results: Of the 71 patients identified, 45 patients were in disease-free survival (DFS) state, 8 patients were in locoregional recurrence (LR), and 18 patients were in metastasis (M) state. Mobility and self-care problems occurred in patients who had metastasis (4.23%). The problem of usual activities occured in patients who had recurrence (22.54%). Most of the patients (84.51%) had pain problem, and all patients had an anxiety problem. The mean utility score (SD) in DFS patients was 0.841 (0.052), in LR patients was 0.758 (0.092), and in patients who had metastasis was 0.653 (0.104). The mean scores of EQ-5D VAS (SD) for EBC patients in DFS, LR and M health state were 86.56 (6.29), 81.88 (5.30), and 69.17 (5.75), respectively.Conclusion: The health states of EBC significantly affect HRQOL of patients. Efforts should be made to improve the quality of life of EBC patients especially in terms of pain and anxiety reduction.

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Prediction of Quality of Life and Survival After Surgery for Symptomatic Spinal Metastases

Neurosurgery ◽

10.1227/neu.0000000000000907 ◽

2015 ◽

Vol 77 (5) ◽

pp. 698-708 ◽

Cited By ~ 54

Author(s):

David Choi ◽

Zoe Fox ◽

Todd Albert ◽

Mark Arts ◽

Laurent Balabaud ◽

...

Keyword(s):

Quality Of Life ◽

Karnofsky Performance Status ◽

Performance Status ◽

Spinal Metastases ◽

Patient Characteristics ◽

Complication Rates ◽

Tumor Type ◽

Karnofsky Score ◽

Visceral Metastases

Abstract BACKGROUND: Surgery for symptomatic spinal metastases aims to improve quality of life, pain, function, and stability. Complications in the postoperative period are not uncommon; therefore, it is important to select appropriate patients who are likely to benefit the greatest from surgery. Previous studies have focused on predicting survival rather than quality of life after surgery. OBJECTIVE: To determine preoperative patient characteristics that predict postoperative quality of life and survival in patients who undergo surgery for spinal metastases. METHODS: In a prospective cohort study of 922 patients with spinal metastases who underwent surgery, we performed preoperative and postoperative assessment of EuroQol EQ-5D quality of life, visual analog score for pain, Karnofsky physical functioning score, complication rates, and survival. RESULTS: The primary tumor type, number of spinal metastases, and presence of visceral metastases were independent predictors of survival. Predictors of quality of life after surgery included preoperative EQ-5D (P = .002), Frankel score (P < .001), and Karnofsky Performance Status (P < .001). CONCLUSION: Data from the largest prospective surgical series of patients with symptomatic spinal metastases revealed that tumor type, the number of spinal metastases, and the presence of visceral metastases are the most useful predictors of survival and that quality of life is best predicted by preoperative Karnofsky, Frankel, and EQ-5D scores. The Karnofsky score predicts quality of life and survival and is easy to determine at the bedside, unlike the EQ-5D index. Karnofsky score, tumor type, and spinal and visceral metastases should be considered the 4 most important prognostic variables that influence patient management.

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Long-Term Quality of Life after Pancreatic Surgery for Intraductal Papillary Mucinous Neoplasm

European Surgical Research ◽

10.1159/000515459 ◽

2021 ◽

pp. 1-8

Author(s):

Helwig Valentin Wundsam ◽

Christiane Sophie Rösch ◽

Patrick Kirchweger ◽

Ines Fischer ◽

Michael Weitzendorfer ◽

...

Keyword(s):

Quality Of Life ◽

Performance Status ◽

Eastern Cooperative Oncology Group ◽

Life Questionnaire ◽

Ecog Performance Status ◽

Long Term Follow Up ◽

Eortc Qlq

Introduction: Intraductal papillary mucinous neoplasms (IPMNs) represent the most common precancerous cystic lesions of the pancreas. The aim of our study was to investigate if resection for non-invasive IPMNs alters quality of life (QoL) in a long-term follow-up. Methods: Patients (n = 50) included in the analysis were diagnosed and resected from 2010 to 2016. QoL was assessed at a median of 5.5 years after resection. At that point in time, the current QoL as well as the QoL before resection was evaluated retrospectively. The standardised European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire for Pancreatic Cancer (EORTC QLQ – PAN26) was applied for the QoL assessment. Results: After a median of 66 months postoperatively, the total QoL score significantly worsened (92.13 vs. 88.04, p = 0.020, maximum achievable score = 100) for patients (median age at surgery 68.0 years), mostly due to digestive symptoms. During the same follow-up period, median Eastern Cooperative Oncology Group (ECOG) performance status did not worsen (p = 0.003). Conclusions: Long-term QoL statistically significantly worsened after pancreatic resection for IPMN. The extent of worsening, however, was small, and QoL still remained excellent. Therefore, resection in cases of IPMN is appropriate, if indicated carefully.

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Palliative surgery in gastrointestinal malignancy: experience from a regional cancer centre

International Surgery Journal ◽

10.18203/2349-2902.isj20203784 ◽

2020 ◽

Vol 7 (9) ◽

pp. 3004

Author(s):

Prafulla Kumar Das ◽

Kalyan Pandey ◽

Padmalaya Deavi ◽

Swodeep Mohanty ◽

Kunal Goutam ◽

...

Keyword(s):

Quality Of Life ◽

Symptomatic Relief ◽

Palliative Surgery ◽

Gastrointestinal Malignancies ◽

Gastrointestinal Malignancy ◽

Incurable Disease ◽

The Mean ◽

Regional Cancer Centre

Background: With so much burden of advanced incurable disease, the role of palliative surgery is paramount for gastrointestinal malignancies improving quality of life. Aim of the study was to study the indications, risks and outcome of palliative surgeries in gastrointestinal malignancies, the burden of disease requiring palliative surgery, and to describe strategies to improve end of life care.Methods: All the patients diagnosed with gastrointestinal malignancy and who underwent palliative surgery between January 2017 and December 2017 were analysed.Results: A total of 186 cases underwent palliative surgery. The most common age group affected was between 50-60 years and the mean age was 54.55 years. Stomach was the most common primary consisting of 58.60% followed by colorectal (23.66%), small intestine (9.68%), hepato-pacreatico-billiary (4.30%), and oesophageal (3.76%) primary. Major complications were seen in 4.84% of cases. Average symptomatic relief was observed for 5.5 months in cases of stomach and 7 months in case of colorectal malignancies. 35.48% cases were alive at the end of one year.Conclusions: Present study concludes that palliative surgery improves quality of life of the patient, provides them with time to accept death and live rest of the life in a dignified manner.

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Weekly Paclitaxel versus Three-Weekly Paclitaxel in Recurrent Platinum-Resistant Epithelial Ovarian and Peritoneal Cancers: A Phase III Study

Clinical Medicine Insights Oncology ◽

10.4137/cmo.s38204 ◽

2016 ◽

Vol 10 ◽

pp. CMO.S38204 ◽

Cited By ~ 7

Author(s):

Mohammed A. Osman ◽

Mohammad S. Elkady ◽

Khalid E. Nasr

Keyword(s):

Quality Of Life ◽

Performance Status ◽

Objective Response ◽

Eastern Cooperative Oncology Group ◽

Progression Free Survival ◽

Phase Iii ◽

Weekly Paclitaxel ◽

Peritoneal Cancer ◽

Platinum Resistant

Introduction Treatment of recurrent platinum-resistant ovarian and peritoneal cancers represents a therapeutic challenge. The aim of this Phase III prospective study was to compare the survival benefits, objective response rate, and toxicities among patients treated by weekly paclitaxel with those who underwent three-weekly paclitaxel in recurrent platinum-resistant ovarian and peritoneal cancers. Method Patients with recurrent platinum-resistant ovarian and peritoneal cancer were allocated to receive either weekly paclitaxel (arm 1) at 80 m/m2 or three-weekly paclitaxel (arm 2) at 175 mg/m2. Results Fifty-five patients were enrolled (30 arm 1, 25 arm 2). The mean age was 56.7 years, and the median performance status was 0 (Eastern Cooperative Oncology Group [ECOG]). For arms 1 and 2, the objective response rates were 27% and 16%, the median progression-free survival were 7 and 4.5 months, and the median overall survival were 15.5 and 12.5 months, respectively. Treatments also significantly improved the quality of life. Treatment was associated with mild toxicities, and while neuropathy was slightly higher for weekly paclitaxel over three-weekly paclitaxel, hematological toxicities were significantly lower for the former than the latter. Conclusion Paclitaxel rechallenge showed antitumor activity in recurrent platinum-resistant ovarian and peritoneal cancers. Weekly paclitaxel achieved better results than three-weekly paclitaxel in terms of survival benefits, quality of life, and toxicities.

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Current opportunities of comprehensive therapy for bone metastases from thyroid cancer

Head and neck tumors (HNT) ◽

10.17650/2222-1468-2020-10-3-12-18 ◽

2020 ◽

Vol 10 (3) ◽

pp. 12-18

Author(s):

A. P. Polyakov ◽

P. O. Rumyantsev ◽

P. A. Nikiforovich ◽

A. V. Mordovsky ◽

E. A. Chistyakova

Keyword(s):

Quality Of Life ◽

Thyroid Cancer ◽

Bone Metastases ◽

Pain Intensity ◽

Performance Status ◽

Eastern Cooperative Oncology Group ◽

Response To Therapy ◽

Pain Severity ◽

Oncology Group

Background. Approximately 10 % of patients with well-differentiated thyroid cancer (WDTC) develop distant metastases. Of them, only 23 % have bone metastases. Complications associated with metastatic lesion in the skeleton significantly affect overall condition of patients and their quality of life. Surgery and pharmacotherapy are highly traumatic and toxic. Bisphosphonates are stable structural analogues of pyrophosphate that inhibit osteoclast activity, thereby reducing bone resorption, which increases the time to development of bone complications, improves patient’s quality of life, and reduces pain.The study objective is to assess performance status and pain severity in WDTC patients with distant bone metastases after bisphosphonate therapy.Materials and methods. We analyzed clinical experience in using bisphosphonates in WDTC patients treated in P.A. Herzen Moscow Oncology Research Institute between 2016 and 2020. This study included 41 patients with WDTC and bone metastases of various locations. Pain severity was evaluated using a 5-point verbal scale; performance status was evaluated using the Eastern Cooperative Oncology Group scale.Results. We observed an improvement in patients’ performance status (from score 2 to 0 according to the Eastern Cooperative Oncology Group scale) in response to therapy. We also found a decrease in pain intensity (from score 4 to 1.5).Conclusion. The inclusion of bisphosphonates into the treatment scheme for WDTC patients with bone metastases can reduce pain intensity and improve performance status.

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Comparison of Various Radiotherapy Dose Fractionation Schedules in Palliation of Bone Metastasis

10.1055/s-0041-1735374 ◽

2021 ◽

Author(s):

Donald J. Fernandes ◽

Mariappan Senthiappan Athiyamaan ◽

Sandesh Rao ◽

Sharaschandra Shankar ◽

Abhishek Krishna

Keyword(s):

Quality Of Life ◽

Bone Metastasis ◽

Pain Relief ◽

Bone Metastases ◽

Performance Status ◽

Pain Reduction ◽

The Mean ◽

Painful Bone Metastases ◽

Fractionation Schedules

Abstract Introduction Bone metastasis is a common manifestation of malignancy. Bone metastases causes various morbidities and affect the quality of life. External beam radiotherapy is the mainstay of treatment of uncomplicated painful bone metastases. Different radiotherapy fractionation schedules are in practice for palliation of painful bone metastases. Objectives This study was aimed to compare and report the outcomes of various fractionation schedules of radiation therapy (RT) in terms of pain relief and quality of life in patients with painful bone metastases. Materials and Methods Eighty patients were randomized into four treatment arms with different RT fractionation schedules, namely, 8 Gy in 1 fraction, 20 Gy in 5 fractions, 24 Gy in 6 fractions, and 30 Gy in 10 fractions. Patients were assessed for pain by visual analog scale (VAS), performance status and quality of life before initiating the treatment, on the day of completion of treatment, and 1 week, 1 month, and 3 months of treatment completion. Results Majority of the metastases constituted from breast followed by lung cancer. Of these, 27.5% had metastases to the thoracic vertebra, 26.25% to the lumbar vertebra, 22.5% to the pelvis, 8.75% to the sternum, 6.25% each to cervical vertebra and femur, and 1.25% each to humerus and ribs. The mean VAS score prior to start of RT was 5.31, 5.21, 5.54, and 4.87 in arms A, B, C, and D, respectively. At the end of treatment, the scores were 3.0, 3.29, 2.77, and 2.47, respectively. At the end of 3 months, the scores were 1.54, 0.57, 0.54, and 0.60, respectively. The pain reduction was significant in all the four arms (p < 0.05). Also, 25% of the patients’ arm A had complete pain relief, whereas 45% of patients in arms B, C, and D had complete pain relief. In arm A, the performance status failed to improve at 3 months when compared with 1-week post-RT but the improvement was significant in the remaining three arms. There was improvement in the quality of life in all the arms, both in terms of function and symptoms. The mean score of symptomatic quality of life based on the EORTC BM22 module prior to start of RT was 38.14, 34.91, 28.85, and 29.17 in arms A, B, C, and D, respectively. There was a significant drop to 9.29, 6.55, 5.13, and 6.11 at 1-month posttreatment in the four arms, respectively. The outcomes in terms of functional quality of life showed a similar trend. Conclusion This study demonstrated that pain reduction by various RT fractionation schedules were similar, and no statistically significant difference was noted. Performance status and quality of life improved in all the four treatment arms post-RT.

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