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QoL provides a better survival estimate than measurement of tumor size and could be used as a surrogate end point for survival in treatment trials.

BACKGROUND Management of unresectable colorectal liver metastases (CLM) can be by regional (hepatic arterial infusion [HAI]) or systemic chemotherapy, or by symptom control alone. In this study the costs of each type of management were related to clinical outcome in 134 patients with CLM. METHODS The costs (both in terms of health care and to society) and benefits (treatment‐added survival and normal quality of life survival) of chemotherapy treatment of 85 patients (HAI with implanted pump: 51 patients; and systemic chemotherapy: 34 patients) were compared with those in 49 patients managed by symptom control only. RESULTS HAI chemotherapy cost the most (£18,263 per patient) and symptom control the least (£2136 per patient). When survival was included, HAI was the most cost‐effective treatment (health care cost per life year gained with HAI vs. systemic chemotherapy: £24,604; systemic chemotherapy vs. symptom control: £32,788), but there was no difference with regard to health care cost per normal quality of life gained. Societal costs incurred by lost work time and welfare payments during illness were higher for HAI (£12,897) than systemic chemotherapy (£9143) or symptom control (£8090) because HAI‐treated patients lived longer and, although working longer and contributing more productivity to society, lost more work days than other patients. CONCLUSIONS The least expensive management for CLM was symptom control, whereas systemic and HAI chemotherapies were equally cost‐effective in producing added normal quality survival for health care resources expended. Although overall societal costs were higher for HAI than for either systemic chemotherapy or symptom control, the cost benefit was difficult to interpret because of uncertain attitudes regarding continued work during terminal illness. [See editorial on pages 837‐8, this issue.] Cancer 1998;83:882‐888. © 1998 American Cancer Society.

SUMMARYWe have previously suggested that colorectal liver metastases might produce 'toxins' that reduce both quality of life (QoL) and survival. In this study we assessed whether QoL in patients with such metastases was related to immune activation, as determined by increased serum levels of interleukin 6 (1L6), soluble tumour necrosis factor receptor 1 (sTNFrl), soluble interleukin 2 receptor alpha (slL2ra) or the interferon-y marker neopterin. sIL2ra, sTNFrl and 1L6 levels were higher, the ability of slL2ra to predict HAD depression score was independent of survival.