This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Eton, D. T. Articles by Johnson, D. H. Search for Related Content PubMed PubMed Citation Articles by Eton, D. T. Articles by Johnson, D. H. Social Bookmarking                            What's this?

Early Change in Patient-Reported Health During Lung Cancer Chemotherapy Predicts Clinical Outcomes Beyond Those Predicted by Baseline Report: Results From Eastern Cooperative Oncology Group Study 5592

David T. Eton, Diane L. Fairclough, David Cella, Susan E. Yount, Philip Bonomi, David H. Johnson

From Evanston Northwestern Healthcare and Northwestern University, Evanston, and Rush-Presbyterian St. Luke’s Medical Center, Chicago, IL; University of Colorado Health Sciences Center, Denver, CO; and Vanderbilt University, Nashville, TN.

Address reprint requests to David T. Eton, PhD, 1001 University Place, Suite 100, Evanston, IL 60201; email: d-eton{at}northwestern.edu.

Purpose: To determine the ability of longitudinal patient-reported health (PRH) scores to enhance prediction of clinical outcomes beyond baseline scores.

Patients and Methods: In 573 advanced non–small-cell lung cancer patients enrolled in a phase III clinical trial, we used baseline and 6-week follow-up PRH scores to predict best response to treatment, disease progression, and survival. Using regression analyses, we tested the predictive ability of the five subscales of the Functional Assessment of Cancer Therapy–Lung (physical, functional, social/family, emotional well-being, and the lung cancer subscale) as well as the trial outcome index (TOI) aggregate score.

Results: After clinical factors were controlled for, baseline physical well-being (PWB) and TOI scores predicted all three clinical outcomes. A higher baseline PWB score was associated with a better response to treatment (odds ratio, 1.09; P < .001) and lower risk of death (risk ratio, 0.95; P < .001). Higher baseline TOI score was associated with a lower risk of disease progression (risk ratio, 0.98; P < .001). These two baseline predictors (PWB and TOI) were then used along with 6-week change scores to classify patients into four groups: low baseline-declined, low baseline-improved, high baseline-declined, and high baseline-improved. Patients with low baseline-declined PWB scores showed the worst responses to treatment and survived the shortest duration. Patients with low baseline-declined TOI scores had the shortest time to progression.

Conclusion: The physical aspects of baseline PRH and PRH change during chemotherapy are significant predictors of clinical outcomes in lung cancer. This has implications for patient stratification in clinical trials and may aid decision-making in clinical practice.

Supported in part by Public Health Service grants from the National Cancer Institute, National Institutes of Health, and the Department of Health and Human Services (CA23318, CA66636, CA21115, CA17145, and CA49957).

The contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				F. Efficace, P. F. Innominato, G. Bjarnason, C. Coens, Y. Humblet, S. Tumolo, D. Genet, M. Tampellini, A. Bottomley, C. Garufi, et al. Validation of Patient's Self-Reported Social Functioning As an Independent Prognostic Factor for Survival in Metastatic Colorectal Cancer Patients: Results of an International Study by the Chronotherapy Group of the European Organisation for Research and Treatment of Cancer J. Clin. Oncol., April 20, 2008; 26(12): 2020 - 2026. [Abstract] [Full Text] [PDF]

				C. C. Gotay, C. T. Kawamoto, A. Bottomley, and F. Efficace The Prognostic Significance of Patient-Reported Outcomes in Cancer Clinical Trials J. Clin. Oncol., March 10, 2008; 26(8): 1355 - 1363. [Abstract] [Full Text] [PDF]

				Y. Oh, R. S. Herbst, H. Burris, A. Cleverly, L. Musib, M. Lahn, and G. Bepler Enzastaurin, an Oral Serine/Threonine Kinase Inhibitor, As Second- or Third-Line Therapy of Non-Small-Cell Lung Cancer J. Clin. Oncol., March 1, 2008; 26(7): 1135 - 1141. [Abstract] [Full Text] [PDF]

				R. P. McQuellon, G. B. Russell, P. Shen, J. H. Stewart IV, W. Saunders, and E. A. Levine Survival and Health Outcomes After Cytoreductive Surgery With Intraperitoneal Hyperthermic Chemotherapy for Disseminated Peritoneal Cancer of Appendiceal Origin Ann. Surg. Oncol., January 1, 2008; 15(1): 125 - 133. [Abstract] [Full Text] [PDF]

				A. Bottomley, C. Coens, F. Efficace, R. Gaafar, C. Manegold, S. Burgers, M. Vincent, C. Legrand, and J. P. van Meerbeeck Symptoms and Patient-Reported Well-Being: Do They Predict Survival in Malignant Pleural Mesothelioma? A Prognostic Factor Analysis of EORTC-NCIC 08983: Randomized Phase III Study of Cisplatin With or Without Raltitrexed in Patients With Malignant Pleural Mesothelioma J. Clin. Oncol., December 20, 2007; 25(36): 5770 - 5776. [Abstract] [Full Text] [PDF]

				E. A. Hahn, D. Cella, O. Chassany, D. L. Fairclough, G. Y. Wong, R. D. Hays, and Clinical Significance Consensus Meeting Group Precision of Health-Related Quality-of-Life Data Compared With Other Clinical Measures Mayo Clin. Proc., October 1, 2007; 82(10): 1244 - 1254. [Abstract] [Full Text] [PDF]

				M. A. Socinski, R. Crowell, T. E. Hensing, C. J. Langer, R. Lilenbaum, A. B. Sandler, and D. Morris Treatment of Non-small Cell Lung Cancer, Stage IV: ACCP Evidence-Based Clinical Practice Guidelines (2nd Edition) Chest, September 1, 2007; 132(3_suppl): 277S - 289S. [Abstract] [Full Text] [PDF]

				F Efficace, A Bottomley, E. Smit, P Lianes, C Legrand, C Debruyne, F Schramel, H. Smit, R Gaafar, B Biesma, et al. Is a patient's self-reported health-related quality of life a prognostic factor for survival in non-small-cell lung cancer patients? A multivariate analysis of prognostic factors of EORTC study 08975 Ann. Onc., November 1, 2006; 17(11): 1698 - 1704. [Abstract] [Full Text] [PDF]

				L. Wenzel, H. Q. Huang, B. J. Monk, P. G. Rose, and D. Cella Quality-of-Life Comparisons in a Randomized Trial of Interval Secondary Cytoreduction in Advanced Ovarian Carcinoma: A Gynecologic Oncology Group Study J. Clin. Oncol., August 20, 2005; 23(24): 5605 - 5612. [Abstract] [Full Text] [PDF]

				E. Basch, D. Artz, D. Dulko, K. Scher, P. Sabbatini, M. Hensley, N. Mitra, J. Speakman, M. McCabe, and D. Schrag Patient Online Self-Reporting of Toxicity Symptoms During Chemotherapy J. Clin. Oncol., May 20, 2005; 23(15): 3552 - 3561. [Abstract] [Full Text] [PDF]

				M. G. Kris, R. B. Natale, R. S. Herbst, T. J. Lynch Jr, D. Prager, C. P. Belani, J. H. Schiller, K. Kelly, H. Spiridonidis, A. Sandler, et al. Efficacy of Gefitinib, an Inhibitor of the Epidermal Growth Factor Receptor Tyrosine Kinase, in Symptomatic Patients With Non-Small Cell Lung Cancer: A Randomized Trial JAMA, October 22, 2003; 290(16): 2149 - 2158. [Abstract] [Full Text] [PDF]