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Palliation and Quality of Life

  • Bengt GlimeliusEmail author
Chapter

Abstract

About half of elderly patients with colorectal cancer are left with palliative interventions only due to non-curable disease. Tumor-controlling medical treatment may prolong life and improve quality of life also in elderly patients, but the likelihood of a favorable outcome is less than in younger patients. Multiple subgroup analyses of clinical trials have shown that elderly patients gain as much as younger patients, but selection to clinical trials is extensive and the elderly trial population is not representative of the general population. The transition from a curative to a palliative approach and from when tumor-controlling therapy is meaningful to when it is not are important to consider by the medical staff. The content of the palliative care, for example, not to abandon, be easily available, provide high medical competence, give rapid help, and continue to talk, is as relevant in elderly as in young patients. The aim is to maintain good quality of life as long as possible.

Keywords

Chemotherapy Clinical benefit Colorectal cancer Elderly Palliation Quality of life 

References

  1. 1.
    Sorbye H, Pfeiffer P, Cavalli-Bjorkman N, Qvortrup C, Holsen MH, Wentzel-Larsen T, et al. Clinical trial enrollment, patient characteristics, and survival differences in prospectively registered metastatic colorectal cancer patients. Cancer. 2009;115:4679–87.PubMedCrossRefGoogle Scholar
  2. 2.
    Glimelius B, Cavalli Björkman N. Metastatic colorectal cancer: current treatment and future options for improved survival. Scano J Gastroenterol 2012;47:296–314.Google Scholar
  3. 3.
    Lambert PC, Dickman PW, Osterlund P, Andersson T, Sankila R, Glimelius B. Temporal trends in the proportion cured for cancer of the colon and rectum: a population-based study using data from the Finnish Cancer Registry. Int J Cancer. 2007;121:2052–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Folprecht G, Cunningham D, Ross P, Glimelius B, Di Costanzo F, Wils J, et al. Efficacy of 5-fluorouracil-based chemotherapy in elderly patients with metastatic colorectal cancer: a pooled analysis of clinical trials. Ann Oncol. 2004;15:1330–8.PubMedCrossRefGoogle Scholar
  5. 5.
    Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45:228–47.PubMedCrossRefGoogle Scholar
  6. 6.
    Köhne C-H, Cunningham D, Di Costanzo F, Glimelius B, Blijham G, Aranda E, et al. Clinical determinants of survival in patients with 5-fluorouracil-based treatment for metastatic colorectal cancer: results of a multivariate analysis of 3825 patients. Ann Oncol. 2002;13:308–17.PubMedCrossRefGoogle Scholar
  7. 7.
    Goldberg RM, Tabah-Fisch I, Bleiberg H, de Gramont A, Tournigand C, Andre T, et al. Pooled analysis of safety and efficacy of oxaliplatin plus fluorouracil/leucovorin administered bimonthly in elderly patients with colorectal cancer. J Clin Oncol. 2006;24:4085–91.PubMedCrossRefGoogle Scholar
  8. 8.
    Sargent DJ, Kohne CH, Sanoff HK, Bot BM, Seymour MT, de Gramont A, et al. Pooled safety and efficacy analysis examining the effect of performance status on outcomes in nine first-line treatment trials using individual data from patients with metastatic colorectal cancer. J Clin Oncol. 2009;27:1948–55.PubMedCrossRefGoogle Scholar
  9. 9.
    Mitry E, Rougier P. Review article: benefits and risks of chemotherapy in elderly patients with metastatic colorectal cancer. Aliment Pharmacol Ther. 2009;29:161–71.PubMedCrossRefGoogle Scholar
  10. 10.
    Seymour MT, Thompson LC, Wasan HS, Middleton G, Brewster AE, Shepherd SF, et al. Chemotherapy options in elderly and frail patients with metastatic colorectal cancer (MRC FOCUS2): an open-label, randomised factorial trial. Lancet. 2011;377:1749–59.PubMedCrossRefGoogle Scholar
  11. 11.
    Glimelius B. Biochemical modulation of 5-fluorouracil: a randomized comparison of sequential methotrexate, 5-fluorouracil and leucovorin versus sequential 5-fluorouracil and leucovorin in patients with advanced symptomatic colorectal cancer. The Nordic Gastrointestinal Tumor Adjuvant Therapy Group. Ann Oncol. 1993;4:235–40.PubMedGoogle Scholar
  12. 12.
    Glimelius B, Hoffman K, Graf W, Påhlman L, Sjödén P-O, Wennberg A. Quality of life during chemotherapy in symptomatic patients with advanced colorectal cancer. Cancer. 1994;73:556–62.PubMedCrossRefGoogle Scholar
  13. 13.
    de Kort SJ, Willemse PH, Habraken JM, de Haes HC, Willems DL, Richel DJ. Quality of life versus prolongation of life in patients treated with chemotherapy in advanced colorectal cancer: a review of randomized controlled clinical trials. Eur J Cancer. 2006;42:835–45.PubMedCrossRefGoogle Scholar
  14. 14.
    Funaioli C, Longobardi C, Martoni AA. The impact of chemotherapy on overall survival and quality of life of patients with metastatic colorectal cancer: a review of phase III trials. J Chemother. 2008;20:14–27.PubMedGoogle Scholar
  15. 15.
    Glimelius B, Sorbye H, Balteskard L, Bystrom P, Pfeiffer P, Tveit KM, et al. A randomized phase III multicenter trial comparing irinotecan in combination with the Nordic bolus 5-FU and folinic acid schedule or the bolus/infused de Gramont schedule (LV5FU2) in patients with metastatic colorectal cancer. Ann Oncol. 2008;19:909–14.PubMedCrossRefGoogle Scholar
  16. 16.
    Byström P, Johansson B, Bergström I, Berglund Å, Sorbye H, Tveit KM, et al. Health-related quality of life as therapeutic guidance in patients with advanced colorectal cancer receiving palliative combination chemotherapy. Acta Oncol. 2012 (in press).Google Scholar
  17. 17.
    Wedding U, Honecker F, Bokemeyer C, Pientka L, Hoffken K. Tolerance to chemotherapy in elderly patients with cancer. Cancer Control. 2007;14:44–56.PubMedGoogle Scholar
  18. 18.
    Balducci L. Myelosuppression and its consequences in elderly patients with cancer. Oncology (Williston Park). 2003;17:27–32.Google Scholar
  19. 19.
    Ziepert M, Schmits R, Trumper L, Pfreundschuh M, Loeffler M. Prognostic factors for hematotoxicity of chemotherapy in aggressive non-Hodgkin’s lymphoma. Ann Oncol. 2008;19:752–62.PubMedCrossRefGoogle Scholar
  20. 20.
    Kozloff M, Yood MU, Berlin J, Flynn PJ, Kabbinavar FF, Purdie DM, et al. Clinical outcomes associated with bevacizumab-containing treatment of metastatic colorectal cancer: the BRiTE observational cohort study. Oncologist. 2009;14:862–70.PubMedCrossRefGoogle Scholar
  21. 21.
    Folprecht G, Seymour MT, Saltz L, Douillard JY, Hecker H, Stephens RJ, et al. Irinotecan/fluorouracil combination in first-line therapy of older and younger patients with metastatic colorectal cancer: combined analysis of 2,691 patients in randomized controlled trials. J Clin Oncol. 2008;26:1443–51.PubMedCrossRefGoogle Scholar
  22. 22.
    Conroy T, Bleiberg H, Glimelius B. Quality of life in patients with advanced colorectal cancer. What has been learnt? Eur J Cancer. 2003;39:287–94.PubMedCrossRefGoogle Scholar
  23. 23.
    Nordin K, Steel J, Hoffman K, Glimelius B. Alternative methods of interpreting quality of life data in advanced gastrointestinal cancer patients. Br J Cancer. 2001;85:1265–72.PubMedCrossRefGoogle Scholar
  24. 24.
    Hill M, Norman A, Cunningham D, Findlay M, Watson M, Nicolson V, et al. Impact of protracted venous infusion fluorouracil with or without interferon alpha-2b on tumor response, survival, and quality of life in advanced colorectal cancer. J Clin Oncol. 1995;13:2317–23.PubMedGoogle Scholar
  25. 25.
    de Gramont A, Figer A, Seymour M, Homerin M, Hmissi A, Cassidy J, et al. Leucovorin and fluorouracil with or without oxaliplatin as first-line treatment in advanced colorectal cancer. J Clin Oncol. 2000;18:2938–47.PubMedGoogle Scholar
  26. 26.
    Douillard JY, Cunningham D, Roth AD, Navarro M, James RD, Karasek P, et al. Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomised trial. Lancet. 2000;355:1041–7.PubMedCrossRefGoogle Scholar
  27. 27.
    Bennett L, Zhao Z, Barber B, Zhou X, Peeters M, Zhang J, et al. Health-related quality of life in patients with metastatic colorectal cancer treated with panitumumab in first- or second-line treatment. Br J Cancer. 2011;105:1495–502.PubMedCrossRefGoogle Scholar
  28. 28.
    Sprangers MAG. Sneeuw KCA Are healthcare providers adequate raters of patients’ quality of life – perhaps more than we think? Acta Oncol. 2000;39:5–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Lindblad AK, Ring L, Glimelius B, Hansson MG. Focus on the individual – quality of life assessments in oncology. Acta Oncol. 2002;41:507–16.PubMedCrossRefGoogle Scholar
  30. 30.
    Sprangers MA. Disregarding clinical trial-based patient-reported outcomes is unwarranted: five advances to substantiate the scientific stringency of quality-of-life measurement. Acta Oncol. 2010;49:155–63.PubMedCrossRefGoogle Scholar
  31. 31.
    Efficace F, Bottomley A, Vanvoorden V, Blazeby JM. Methodological issues in assessing health-related quality of life of colorectal cancer patients in randomised controlled trials. Eur J Cancer. 2004;40:187–97.PubMedCrossRefGoogle Scholar
  32. 32.
    Bernhard J, Cella DF, Coates AS, Fallowfield L, Ganz PA, Moinpour CM, et al. Missing quality of life data in cancer clinical trials: serious problems and challenges. Stat Med. 1998;17:517–32.PubMedCrossRefGoogle Scholar
  33. 33.
    Moinpour CM, Sawyers Triplett J, McKnight B, Lovato LC, Upchurch C, Leichman CG, et al. Challenges posed by non-random missing quality of life data in an advanced-stage colorectal cancer clinical trial. Psychooncology. 2000;9:340–54.PubMedCrossRefGoogle Scholar
  34. 34.
    Derogar M, van der Schaaf M, Lagergren P. Reference values for the EORTC QLQ-C30 quality of life questionnaire in a random sample of the Swedish population. Acta Oncol. 2012;51:10–6.PubMedCrossRefGoogle Scholar
  35. 35.
    Cheng KK, Lee DT. Effects of pain, fatigue, insomnia, and mood disturbance on functional status and quality of life of elderly patients with cancer. Crit Rev Oncol Hematol. 2011;78:127–37.PubMedCrossRefGoogle Scholar
  36. 36.
    Sanoff HK, Goldberg RM, Pignone MP. A systematic review of the use of quality of life measures in colorectal cancer research with attention to outcomes in elderly patients. Clin Colorectal Cancer. 2007;6:700–9.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  1. 1.Department of Radiology, Oncology and Radiation ScienceUppsala UniversityUppsalaSweden

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