Identifying Cancer Patients with Poor Quality of
Life May Spot Those with Aggressive Tumors
Quality of life predicts cancer survival in
University of Michigan study
May 29, 2008 - Head and neck cancer patients who
reported lower physical quality of life were more likely to die from
their disease, according to a new study from the University of Michigan
Comprehensive Cancer Center. The findings could mean that identifying
patients with poor quality of life could also identify patients with
particularly aggressive tumors.
"Low quality of life may have value in screening
patients for recurrence. By identifying patients with poor quality of
life, we may also be able to identify early on those who have
particularly aggressive tumors," says lead study author Carrie A.
Karvonen-Gutierrez, M.P.H., research associate at the U-M School of
Public Health and the VA Ann Arbor Healthcare System.
Results of the study appear in the June 1 issue of
the Journal of Clinical Oncology.
The researchers surveyed 495 people at four
hospitals who had been diagnosed with head and neck cancer within the
previous two years. Participants responded to questions about physical
and emotional quality of life, including pain, eating and swallowing,
speech and emotional well-being.
The researchers found that general physical health
and quality of life issues were highly associated with survival. And in
particular, patients who reported difficulty with pain, eating and
speech were significantly less likely to survive. The researchers
suggest that pain and declines in other physical quality of life
measures could be a marker for cancer recurrence.
"Our findings validate the concept that doctors
have long recognized: that persistent or increasing pain is a worrisome
clinical finding. Perhaps in the future, quality of life data will be
routinely collected in a standardized way, and trends in pain scores
will trigger more aggressive examinations for cancer recurrence," says
study author Sonia A. Duffy, Ph.D., R.N., a research scientist at the VA
Ann Arbor Healthcare System, associate professor of nursing at the U-M
School of Nursing and research assistant professor of otolaryngology at
the U-M Medical School.
"While patients are monitored and screened after
cancer treatment, small recurrences of cancer may be difficult to
detect, even with standard imaging techniques. But, for example, small
islands of cancer near a nerve can cause substantial pain before the
cancer is detected on routine examination or imaging scans," says study
author Jeffrey Terrell, M.D., associate professor of otolaryngology at
the U-M Medical School.
The next question for the researchers is to
understand whether treatments that improve quality of life can improve
survival.
"Although it is not yet clear how the association
works between survival and quality of life related to head and neck
pain, it is clearly advantageous to minimize pain for patients. And, if
in doing that, the chance of cancer recurrence or patient survival is
improved, the effort is worthwhile, regardless of why these factors are
related. Patients want improved quality of life after cancer
treatmentwhether it be to improve survival or simply to improve
everyday living and feel better," Duffy says.
Based on their findings, the study authors
recommend routine quality of life assessments of patients with head and
neck cancer, before treatment and again after six months, one year and
two years.
Editors Notes:
Additional study authors were David L. Ronis,
Ph.D., associate research scientist at the U-M School of Nursing and
research scientist at the VA Ann Arbor Healthcare System; Karen E.
Fowler, research associate at the U-M Medical School and VA Ann Arbor
Healthcare System; and Stephen B. Gruber, M.D., Ph.D., H. Marvin Pollard
Professor of Internal Medicine at the U-M Medical School.
Funding for the study was from the Department of
Veterans Affairs, GlaxoSmithKline through the Managed Care Forum, and
the National Cancer Institute.
Source: Journal of Clinical Oncology, Vol. 26, No.
16, June 1, 2008
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