Quality of Life & Extended Chemo

[CaroleHammett]

Numerous studies show that for lung cancer patients, the higher the Quality of Life, the longer the Survival Rate (see my postings in Healthy Living Forum), but the following article refers to a "meta-analysis" showing that while extending chemotherapy can also extend the Survival Rate, the extra cycles can likewise reduce Quality of Life.

In my own case, I cannot know if the extended cycles reduced my QoL, but I do know that the attempt to extend my Survival Rate with the use of 2nd line maintenance during last 8 months definitely caused me to experience lower Quality of Life during that period with no reduction of my Survival Rate (See link to My Story below).

Definitely food for thought here.

Affectionately,

Carole

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http://www.oncologystat.com/home/news/More_Chemotherapy_Cycles_Delay_NSCLC_Progression_but_Reduce_Quality_of_Life__US.html

More Chemotherapy Cycles Delay NSCLC Progression but Reduce Quality of Life

Elsevier Global Medical News.

2008 Jul 29

F Lowry

CHICAGO (EGMN) - The continuation of chemotherapy beyond three or four cycles results in a substantial 22% improvement in progression-free survival and a modest 6% gain in overall survival for patients with advanced non-small cell lung cancer, according to data from a meta-analysis of 13 randomized, controlled trials.

These benefits, however, came at the cost of more adverse events and a reduced quality of life, the lead author of the Australian analysis reported at the annual meeting of the American Society of Clinical Oncology.

"Our study supports the 2004 ASCO guidelines," said Yu Yang Soon of the Sydney Cancer Centre at the University of Sydney.

Those guidelines state that the optimal duration of chemotherapy is a matter of debate. They recommend that first-line chemotherapy be limited to six cycles and stopped after four cycles in nonresponders.

Published during 1989-2007, the trials in the meta-analysis included a total of 2,146 stage IIIB and IV NSCLC patients who were being treated with palliative intent. Mr. Soon and his coinvestigators classified them into three designs:

- Trial design 1. Randomization to four chemotherapy cycles, or to continuation of chemotherapy until disease progression or prohibitive toxicity (two trials).

- Trial design 2. Randomization to four or six cycles of chemotherapy (six trials).

- Trial design 3. Induction therapy, followed by randomization to more chemotherapy or to observation only (five trials).

Only two of the trials used non-platinum-based chemotherapy. Nine used chemotherapy regimens that included third-generation agents, such as paclitaxel (Taxol), vinorelbine (Navelbine), gemcitabine (Gemzar), and docetaxel (Taxotere), Mr. Soon said.

Eight trials compared a defined number of chemotherapy cycles (that is, two to eight cycles) with an extended number of cycles (five cycles until disease progression or prohibitive toxicity). In these trials, the continuation of therapy beyond a defined number of cycles resulted in a statistically significant 22% reduction in the rate of progression (hazard ratio, 0.78; P less than .00001).

The extension of chemotherapy had little effect on overall survival, however (HR 0.94; P = .10).

Another subgroup analysis showed that the benefit of improved progression-free survival resulted from additional cycles of a third-generation chemotherapy agent rather than an older agent (HR, 0.73; P = .02). The majority of patients (1,524) received the newer agents, Mr. Soon reported.

Toxicity was reported in 11 of the 13 trials, and all showed that standard duration of chemotherapy was safer, with fewer and less severe adverse events. Seven trials documented quality of life; of these, two trials favored standard chemotherapy and five found no difference between standard and extended chemotherapy, Mr. Soon reported.

"Future trials should test extending treatment with more effective or better tolerated alternatives," he concluded. "Extension of adjuvant chemotherapy is also worthy of investigation."

Mr. Soon reported no conflicts of interest.

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[recce101]

Numerous studies show that for lung cancer patients, the higher the Quality of Life, the longer the Survival...

That makes sense, but I wonder if we're reading too much into it? Maybe when we start making treatment decisions based on that premise, we're taking things a bit too far. It might be more accurate to say "someone who feels really good is likely to live longer than someone who feels really junk" -- a pretty safe general statement.

Personally, I'd much rather feel good for a short time than junk for a long time. At this point, longevity is not that important to me.

Aloha,

Ned

[CaroleHammett]

Ned:

The studies that show the higher the Quality of Life, the longer the Survival Rate, do not include data as to whether or how long the Quality of Life remains high, only that it was initially high.

These studies also each have different definitions of Quality of Life (of which, only one that I've found so far is totally from the patient's point of view).

One of the projects I've been working on (and will complete in the Lungevity Healthy Living Forum after I get back home) breaks Quality of Life factors down into segments, which will include ways to improve each.

I'd have already finished, but completing this project was not a high Quality of Life factor for me, and as you and others already know, since my 01/07 dx, every decision I've made has been based on appropriate balancing of Buying Time vs. Quality of Life (your "junk" vs. "feel good"), with Quality of Life winning out on each occasion!

Even though chemo has not worked out for me, I consider myself very fortunate in that, other than occasional chemo/radiation side effects, I've been relatively pain-free, which I consider a mandatory QoL factor (the reason I'm able to sun and fun in San Diego this week preparatory to jumping on a "Mexican Riviera" cruise ship next week! )

Affectionately,

Carole "Quality of Life" Hammett

[sunnyside]

I know I agonized before agreeing to proceed with chemotherapy beyond 6 cycles. My quality of life and sense of wellbeing have been great from the outset, though, and it just makes sense to me to continue something that is working and not knocking me out in any significant way. I think it's just one more piece of evidence that statistics don't apply to individuals.

[recce101]

The studies that show the higher the Quality of Life, the longer the Survival Rate, do not include data as to whether or how long the Quality of Life remains high, only that it was initially high.

Carole, I haven't read the studies, so I guess it's another one of those semantics things. What they're calling QOL sounds to me more like performance status, maybe with some other stuff thrown in. I think I'm resisting someone else telling me what my quality of life is.

It seems that all three of us are on the same page here. Aloha,

Ned

[cat127]

I will say this - QOL points are ones that are very difficult to study, there is so much subjectivity to them that it makes it very difficult to study. How you feel on a given day, versus the size of a tumor, are very different types of measurements. I think the idea that 'statistics don't apply to individuals', applies even more when you are talking things this subjective. One person's lousy day, is another person's "this isn't so bad". It makes studies based on looking for changes in QOL very difficult to conduct and to interpret.

But here is hoping for more days with better QOL, for one and all!

[CaroleHammett]

There is also the "new normal" that we all experience; i.e., if anyone had told me two years ago that I could be "happy" wheeling around Boulder on an electric scooter while using supplemental oxygen full time, I'd have told them they were nuts!

Affectionately,

Carole

PS We embark on "Mexican Riviera" cruise tomorrow; thus my Internet access will be limited until next Thursday, but will try to jump on at least once a day. (QoL permitting! ).