Despite More Side Effects, More CRC Treatment May Not Affect Quality of Life

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Adding debulking surgery to chemotherapy did not cause a significant decrease in health-related quality of life for patients with metastatic colorectal cancer, research showed.

Certain intensified treatment strategies may not impact overall quality of life in patients with metastatic colorectal cancer though it can lead to more side effects, according to an analysis from the ORCHESTRA trial that was recently published in the Journal of the National Comprehensive Cancer Network (NCCN).

The study included 300 patients with metastatic colorectal cancer. A total of 148 patients were randomly assigned to undergo surgery, ablative therapy and/or radiotherapy as a form of debulking treatment (a treatment with the goal of removing as much tumor as possible) alongside standard of care chemotherapy (FOLFOX or CAPOX with or without Avastin [bevacizumab]). The remaining 152 patients were assigned to receive chemotherapy only.

Findings showed that there were no statistical or clinically relevant differences between the two groups when it came to patient-reported outcomes regarding overall health-related quality of life — which included global health status, physical functioning, emotional functioning, general fatigue and physical fatigue.

Similar health-related quality of life was observed despite the fact that there was a higher rate of significant side effects in the debulking group compared to those in the chemotherapy-only group (43% versus 21%, respectively). In the study, the authors noted that there was a “remarkable lack of association between the occurrence of (significant side events) and the impact on (health-related quality of life).”

The researchers defined serious side effects as those that required inpatient hospitalization, resulted in persistent or significant disability or incapacity, were life-threatening or related in death.

“The outcome of no statistically significant or clinically relevant differences in (health-related quality of life) and fatigue after one year was surprising. More intriguing yet, is the fact that although the patients in the intervention group experienced local treatment related serious adverse events twice as often as patients in the standard group, there was a striking lack of association between the occurrence of (significant adverse events) and impact on (health-related quality of life),” Dr. Charles J. Schneider, professor of Clinical Medicine in the University of Pennsylvania Perelman School of Medicine and GI Medical Oncologist at Penn Medicine’s Abramson Cancer Center, said in a press release about the findings.

“Thus, this (health-related quality of life) ‘equivalence,’ even in the face of twice as many (significant adverse events) in the intervention group, should give guarded justification for multi-organ tumor debulking combined with palliative chemotherapy in select patients, if the survival data turns out to favor the intervention group as well.”

Additionally, for both patient groups, health-related quality of life was not significantly different one year after treatment than it was at the start of the trial.

Negative quality of life impacts from intensified colorectal cancer treatment may be temporary, Dr. Lotte Bakkerus said.

“This could mean that the negative impact of complications on quality of life is temporary and eventually balances out with a decrease in tumor-related symptoms after treatment. Patients might also adapt their (health-related quality of life) perceptions during the course of their disease and treatment,” lead author study author Dr. Lotte Bakkerus, from the Radboud Institute for Health Sciences in the Netherlands, explained in the release.

The ORCHESTRA trial is also analyzing if there is a survival benefit for patients with metastatic colorectal cancer who undergo tumor debulking compared with those who are only treated with standard of care.

“Tumor debulking for patients with synchronous oligo-metastatic colorectal cancer is often utilized for curative intent and endorsed in the NCCN Guidelines, with surgical resection preferred over other acceptable treatment-modalities such as radiation therapy or thermal ablation. However, the potential survival benefits for such interventions have not been established for patients with multi- organ rather than single-organ colorectal-cancer metastases. That’s a question that the ORCHESTRA trial is attempting to answer,” Schneider said.

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