Patient-reported outcomes as predictors of survival in patients with bowel cancer: a systematic review
The prognostic value of patient-reported outcomes (PROs) has been determined in some cancers, but a focussed review in colorectal cancer (CRC) has not yet been conducted. We systematically reviewed PRO predictors of CRC patient survival.
We searched four electronic databases (from inception to May 2018), reference lists and professional organisations to identify studies reporting pre-treatment PRO predictors of overall survival (OS) or progression-free survival (PFS) in CRC identified through univariate or multivariate models. Two reviewers independently applied inclusion criteria and extracted data on study characteristics, median and 1-year survival rates, PROs assessed and model results.
In 25 of 27 studies (n = 12,544), at least one PRO was significantly associated with survival. Physical functioning, fatigue, pain and appetite loss predicted OS more often than other PROs in metastatic disease (19/27 studies). One study explored PRO predictors in early-stage CRC, finding emotional well-being and mood predicted OS. In mixed-stage samples (7/27 studies), physical functioning predicted OS more often than other PROs. Few studies modelled PFS, for which few PROs had predictive value.
Physical and psychological functioning, pain, fatigue and appetite loss had prognostic significance above and beyond clinical predictors in CRC. Routine monitoring of these PROs may allow earlier detection and amelioration of problems, which may improve quality of life and perhaps extend survival. More research is needed to determine prognostic value of PROs in early-stage CRC, and prognostic significance of changes in PRO scores.
KeywordsBowel cancer Systematic review Patient-reported outcomes Survival Predictors
CR conception of the study and led the design, analysis plan, data interpretation and manuscript writing. RC conducted the data extraction and contributed to results interpretation and writing of the manuscript. KW contributed to study conception, design considerations, results interpretation and revision of the manuscript. MK contributed to study conception, study design, resolved data extraction queries, data interpretation and revision of the manuscript. All authors read and approved the final manuscript.
This project has been supported by the generous contributions of the Estate of the Late Emma Elwin (Ellie) a’Beckett.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interests.
Ethics approval and Informed consent
Ethics approval and consent to participate was not required for this secondary analysis.
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