Correlation between overall survival and quality of life in colon cancer patients with chemotherapy.

BACKGROUND: Patients presenting with inoperable colon cancer at first onset (ICF) or at time of relapse (ICR) are considered in unrecoverable. The therapeutic goal for unrecoverable cancer is to prolong overall survival (OS) and maintain a high quality of life (QOL). As data on objective indicators of QOL in cancer patients, such as length of hospitalisation (LOH), outpatient consultation times (OCT), and hospital-free survival (HFS), is limited, this study compared ICF and ICR with respect to OS and QOL over the entire clinical course. METHODS: We retrospectively evaluated 90 inoperable colon cancer patients with chemotherapy and compared ICF and ICR in terms of OS, LOH, OCT, and HFS. RESULTS: Patients with ICF had a worse OS than those with ICR. In patients with ICF and ICR, OS and LOH were not correlated but OS and OCT and OS and HFS were strongly correlated. In patients with ICF and ICR, OCT and HFS accounted for approximately 8% and 90% of their OS, respectively. CONCLUSIONS: The LOH, OCT, and HFS are important factors for evaluating objective QOL of patients with inoperable colon cancer and should be considered when making treatment decisions.

The Appropriate First-Line Chemotherapy Regimen for Incurable Pancreatic Cancer in Clinical Practice: A Consideration of Patients' Overall Survival and Quality of Life.

Purpose: For incurable pancreatic cancer, the therapeutic goal is to prolong survival and maintain the quality of life (QOL). Unexpected outpatient consultation (OCT) and emergency hospitalization lead to QOL deterioration. The National Comprehensive Cancer Network (NCCN) guidelines recommend 5-fluorouracil/leucovorin, oxaliplatin, and irinotecan (FOLFIRINOX) and gemcitabine plus albumin-bound paclitaxel (nabPTX+GEM) as the preferred first-line regimens. Japanese clinical practice guidelines further recommend GEM and tegafur/gimeracil/oteracil potassium (S-1). Currently, no treatment strategy considers QOL at any stage during a patient's clinical course. Methods: In this study, hospital-free survival (HFS), defined as the period without hospitalization and OCT, was introduced as a new indicator of the qualitative aspect of overall survival (OS). We compared OS, length of hospitalization (LOH), OCT, and HFS for the four first-line chemotherapy groups. Results: No significant difference was observed in the median OS and HFS, nor was there a strong correlation between OS and LOH, based on the four first-line chemotherapy groups. In contrast, there were strong correlations between OS and OCT and between OS and HFS in all first-line chemotherapy groups. The ratio of OCT to OS was similar for mFOLFIRINOX and nabPTX+GEM. S-1 had the lowest OCT-to-OS ratio. The ratio of HFS to OS declined from highest to lowest in the order S-1, nabPTX+GEM, mFOLFIRINOX, and GEM. Conclusion: Our findings suggested existence of correlation differences between OS and HFS between first-line mFOLFIRINOX and first-line nabPTX+GEM. In addition, a good HFS was obtained with S-1 alone in some cases. In the future, clinical trials for chemotherapy should examine QOL during the entire clinical course.