Patient-Reported Outcomes Associated With Survival in Early-Stage CRC

Certain patient-reported outcomes (PROs) including fatigue and emotional support are associated with survival outcomes in patients with early-stage colorectal cancer (CRC), according to a new study. Collecting such PROs could help clinicians identify patients who may require more careful follow-up.

“Patient-reported outcomes refer to information obtained from the patient that is not interpreted by the clinician and represent an increasingly popular method for determining patient symptoms, function, health status, and quality of life at diagnosis and throughout the disease trajectory,” wrote study authors led by Winson Y. Cheung, MD, MPH, of the Tom Baker Cancer Center at the University of Calgary in Canada.

Earlier research has shown correlations between PROs and survival, but most have been conducted in breast and lung cancer, or in CRC but not focused on those with early-stage disease. The new study examined the correlation of prospectively collected PROs in 692 patients with stage II or III CRC with outcome, and also assessed the feasibility of using a brief survey to collect the information. The results were published online ahead of print in Cancer.

PROs were collected using the Psychosocial Screen for Cancer (PSSCAN) at each patient’s first consultation with a medical oncologist. PSSCAN includes questions regarding quality of life, social supports, and overall health. The median age of patients in the study was 67 years; most had colon cancer (61%) and most had stage III disease (54%) and received chemotherapy (58%).

Most patients reported strong social support, with 90% saying they had regular contact with friends and family; 86% said they could count on someone to help when necessary, and 87% reported they had someone to depend on for emotional support. Most patients (71%) reported low fatigue, and overall quality-of-life scores were good.

On a multivariate analysis, several PROs were significantly associated with overall survival. Self-reported “high” fatigue had a hazard ratio (HR) for overall survival of 1.99 (95% CI, 1.34–2.95; P = .0007) compared with “low” fatigue. The lack of anyone to count on for emotional support had an HR of 4.36 (95% CI, 1.97–9.64; P = .0003).

Both those PROs were also significantly associated with disease-specific survival. High fatigue had an HR of 1.63 (95% CI, 1.04–2.56; P = .035), and lack of emotional support had an HR of 1.92 (95% CI, 1.11–3.32; P = 0.02).

The authors noted that fatigue’s correlation with outcome is not surprising, given that fatigue could reflect comorbidity burden and/or treatment toxicity. Lack of emotional support’s effect on outcome could be explained through treatment adherence. “Treatment and its toxicities can be taxing, and those without an adequate social support system may face particular hardship during treatment,” they wrote.

The study shows that abbreviated PROs can be collected and used successfully in this patient population, the authors concluded. “Future work should focus on incorporating additional, clinically relevant items, such as disease-related and treatment-related symptoms, into PRO instruments that can still be easily administered in increasingly busy oncology practices.”