Download Mean FACT-E (SD)

Baseline Measure of Healthrelated Quality of Life
(FACT-E) Predicts Overall
Survival in Esophageal
Cancer Patients
Biniam Kidane1,2, Joanne Sulman3, Wei Xu4,
Qin Quinn Kong4, Rebecca Wong4, Jennifer J
Knox4, Gail E. Darling1,2,4
1Division
of Thoracic Surgery, University of Toronto, Toronto, ON, Canada 2Divison
of Thoracic Surgery, Toronto General Hospital, University Health Network,
Toronto, ON, Canada 3Factor-Inwentash Faculty of Social Work, University of
Toronto, Toronto, ON, Canada 4Princess Margaret Cancer Center, University
Health Network, Toronto, ON, Canada
Disclosures
•No disclosures
Background
•Esophageal ca significant effect on
HRQOL
•Poor HRQOL predicts poor long-term
survival in different cancers
•In esophageal cancer patients
• predictor of survival was either
• post-treatment HRQOL
• HRQOL changes over treatment
course
Background
•Since esophageal ca may present with
HRQOL issues, baseline HRQOL may
be prognostic
•Functional Assessment of Cancer
Therapy-Esophagus (FACT-E)
• HRQOL instrument validated in
esophageal ca
• general component (FACT-G) & an
esophageal cancer subscale (ECS)
Objective
•To determine if baseline FACT-E and
ECS by itself predict overall survival
in patients with Stage II-IV cancer of
the GE junction or thoracic
esophagus.
Methods
•Data from 4 prospective, nonrandomized studies in Canada
• included consecutive patients with:
• stage II-IV cancer of GEJ or thoracic
esophagus
• received chemotherapy & 50Gy of
radiation either as neoadjuvant or
definitive therapy
• 1 of 4 studies used adjuvant sunitinib
Methods
•Cox regression with FACT-E & ECS as
both continuous & dichotomous
variables
• Multivariate analysis controlling for :
• age, stage, histology
• treatment intent (curative vs palliative)
• Treatment received (surgery,
chemotherapy, radiation or adjuvant
sunitinib therapy)
Results
Variable
Number (Total=207)
Mean Age (standard
deviation)
61.0 (10.6)
Adenocarcinoma, N (%)
144 (69.6%)
Stage
2
81 (39.1%)
3
91 (44.0%)
4
35 (16.9%)
Results
Variable
Number (Total=207)
Received chemotherapy, N (%)
159 (76.8%)
Received radiation therapy, N
(%)
Surgery, N (%)
148 (75.1%)
Received chemoradiation +
surgery, N (%)
Received chemotherapy +
surgery, N (%)
Received surgery only, N (%)
108 (52.2%)
157 (75.8%)
21 (10.1%)
25 (12.1%)
Results
Variable
Number (Total=207)
Curative intent therapy, N (%)
172 (83.1%)
Mortality, N (%)
114 (55.1%)
Mean FACT-E (SD)
78.2 (17.5)
Mean ECS (SD)
45.4 (12.9)
Results
Predictor
Mean Age (SD)
Adenocarcinoma, N (%)
Stage
Alive (n=93) Mortality
(n=114)
60.3 (11.1) 61.6 (10.1)
65 (69.9%) 79 (69.3%)
2 41 (44.1%) 40 (35.1%)
3 38 (40.9%) 53 (46.5%)
4 14 (15.0%) 21 (18.4%)
Chemotherapy, N (%)
71 (76.3%) 88 (77.2%)
Radiation therapy, N (%)
67 (72.0%) 81 (71.0%)
Surgery, N (%)
72 (77.4%) 85 (74.6%)
Curative intent therapy, N (%) 80 (86.0%) 92 (80.7%)
p
0.41
1.00
0.43
1.00
0.75
0.16
0.35
Results
Predictor
Alive (n=93)
Mortality
(n=114)
p
Mean FACT-E (SD)
81.2 (16.8)
75.7 (17.7)
0.02
Mean ECS (SD)
49.0 (13.0)
42.5 (12.1) <0.001
Results
•On multivariate Cox regression
controlling for confounders:
• baseline FACT-E & ECS independently
predicted overall survival
•When treated as continuous variables,
• lower baseline FACT-E & ECS
predicted worse overall survival
• HR (FACT-E)=0.87 (0.81-0.93,p<0.001)
• HR (ECS)=0.69 (0.59-0.81, p<0.001)
Results
HR= 0.56 (0.38, 0.83, p=0.003)
Results
HR= 0.41 (0.28, 0.60, p<0.001)
Conclusions
•Higher baseline FACT-E & ECS
independently predict better overall
survival
•First study to report this prognostic
effect of baseline HRQOL in
esophageal cancer while controlling
for stage & treatment
Conclusions
•ECS is a focused, short questionnaire
•may be useful as a parsimonious
prognostic tool
• to inform patient decision-making
• patient selection criteria for studies
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