Quality of Life in Patients With Advanced Cancer: Differential Association With Performance Status and Systemic Inflammatory Response

Abstract

Quality of life is a key component of cancer care; however, the factors that determine quality of life are not well understood. The aim of this study was to examine the relationship between quality of life parameters, performance status (PS), and the systemic inflammatory response in patients with advanced cancer. MethodsAn international biobank of patients with advanced cancer was analyzed. Quality of life was assessed at a single time point by using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C-30 (EORTC QLQ-C30). PS was assessed by using the Eastern Cooperative Oncology Group (ECOG) classification. Systemic inflammation was assessed by using the modified Glasgow Prognostic Score (mGPS), which combines C-reactive protein and albumin.The relationship between quality of life parameters, ECOG PS, and the mGPS was examined. ResultsData were available for 2,520 patients, and the most common cancers were GI (585 patients [22.2%]) and pulmonary (443 patients [17.6%]). The median survival was 4.25 months (interquartile range, 1.36 to 12.9 months). Increasing mGPS (systemic inflammation) and deteriorating PS were associated with deterioration in quality-of-life parameters (P , .001). Increasing systemic inflammation was associated with deterioration in quality-of-life parameters independent of PS. ConclusionSystemic inflammation was associated with quality-of-life parameters independent of PS in patients with advanced cancer. Further investigation of these relationships in longitudinal studies and investigations of possible effects of attenuating systemic inflammation are now warranted.

“How Long Have I Got?”—A Prospective Cohort Study Comparing Validated Prognostic Factors for Use in Patients with Advanced Cancer

“…However, the findings should also alert clinicians that patients who have a good performance status and systemic inflammation are at increased risk of poorer quality of life and survival. The ECOG‐PS/mGPS framework reported herein has been validated previously by our group and could be used to stratify patients who may benefit from referral to palliative care services .…”

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“…TNF-α, IL-1β, IL-4 and IL-6 genes, is associated with elevated CRF [6]. In accordance with this finding, measurements of systemic inflammation relate to fatigue levels [7]. …”

Prognostic Value of the Glasgow Prognostic Score or Modified Glasgow Prognostic Score for Patients with Colorectal Cancer Receiving Various Treatments: a Systematic Review and Meta-Analysis

“…These indicators, whose prognostic role has been validated, include the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, C-reactive protein (CRP), systematic inflammatory index, and Glasgow Prognostic Score/modified Glasgow Prognostic Score (GPS/mGPS) [15][16][17]. By combining CRP and albumin [18], the GPS/mGPS reflects both the systematic inflammatory response and nutritional status [19][20][21]. The GPS score ranges from 0 to 2: patients with both an elevated CRP (>10 mg/l) and decreased albumin (<35 mg/l) are assigned a score of 2, whereas those with either an elevated CRP or decreased albumin alone are assigned a score of 1.…”