Lari Wenzel1, Kathryn Osann1, Chelsea McKinney1, David Cella2, Giulia Fulci3, Mary J Scroggins4, Heather A Lankes5, Victoria Wang6, Kenneth P Nephew7, George L Maxwell8, Samuel C Mok9, Thomas P Conrads8, Austin Miller10, Robert S Mannel11, Heidi J Gray12, Parviz Hanjani13, Warner K Huh14, Nick Spirtos15, Mario M Leitao16, Gretchen Glaser17, Sudarshan K Sharma18, Alessandro D Santin19, Paul Sperduto20, Shashikant B Lele10, Robert A Burger21, Bradley J Monk22, Michael Birrer23. 1. Department of Medicine and Program in Public Health, University of California, Irvine, CA, USA. 2. Department of Medical Social Sciences, Northwestern University Health System, Chicago, IL, USA. 3. GlaxoSmithKline; Waltham, MA, USA. 4. International Gynecology Cancer Society, Austin, TX, USA. 5. NRG Oncology, Philadelphia, PA, USA. 6. Department of Data Science, Dana-Farber Cancer Institute, Boston, MA, USA. 7. Medical Sciences Program, Indiana University School of Medicine-Bloomington, Bloomington, IN, USA. 8. Women's Health Integrated Research Center at Inova Health System, Women's Service Line, Inova Health System, Falls Church, VA, USA. 9. Department of Gynecological Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. 10. Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA. 11. Stephenson Cancer Center, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK, USA. 12. Gynecologic Oncology, University of Washington Medical Center, Seattle, WA, USA. 13. Gynecologic Oncology, Abington-Jefferson Health, Abington, PA, USA. 14. University of Alabama Highlands, Birmingham, AL, USA. 15. Women's Cancer Center of Nevada, Las Vegas, NV, USA. 16. Memorial Sloan Kettering Cancer and Weill Cornell Medical Center, New York, NY, USA. 17. Gynecologic Oncology, Mayo Clinic, Owatonna, MN, USA. 18. AMITA Health Physicians, Hinsdale, IL, USA. 19. Department of Obstetrics, Gynecology and Reproductive Services, Yale University School of Medicine, New Haven, CT, USA. 20. Minneapolis Radiation Oncology and Metro-Minnesota Community Oncology Research Consortium, St. Louis Park, MN, USA. 21. Genentech, Oceanside, CA, USA. 22. Division of Gynecologic Oncology, Arizona Oncology (US Oncology Network), University of Arizona College of Medicine, Phoenix, AZ, USA. 23. Winthrop P. Rockefeller Cancer Institute University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Abstract
BACKGROUND: There is a critical need to identify patient characteristics associated with long-term ovarian cancer survival. METHODS: Quality of life (QOL), measured by the Functional Assessment of Cancer Therapy-Ovarian-Trial Outcome Index (FACT-O-TOI), including physical, functional, and ovarian-specific subscales, was compared between long-term survivors (LTS) (8+ years) and short-term survivors (STS) (<5 years) of GOG 218 at baseline; before cycles 4, 7, 13, 21; and 6 months post-treatment using linear and longitudinal mixed models adjusted for covariates. Adverse events (AEs) were compared between survivor groups at each assessment using generalized linear models. All P values are 2-sided. RESULTS: QOL differed statistically significantly between STS (N = 1115) and LTS (N = 260) (P < .001). Baseline FACT-O-TOI and FACT-O-TOI change were independently associated with long-term survival (odds ratio = 1.05, 95% confidence interval = 1.03 to 1.06 and odds ratio = 1.06, 95% confidence interval = 1.05 to 1.07, respectively). A 7-point increase in baseline QOL was associated with a 38.0% increase in probability of LTS, and a 9-point increase in QOL change was associated with a 67.0% increase in odds for LTS. QOL decreased statistically significantly with increasing AE quartiles (cycle 4 quartiles: 0-5 vs 6-8 vs 9-11 vs ≥12 AEs, P = .01; cycle 21 quartiles: 0-2 vs 3 vs 4-5 vs ≥6 AEs, P = .001). Further, LTS reported statistically significantly better QOL compared with STS (P = .03 and P = .01, cycles 4 and 21, respectively), with similar findings across higher AE grades. CONCLUSIONS: Baseline and longitudinal QOL change scores distinguished LTS vs STS and are robust prognosticators for long-term survival. Results have trial design and supportive care implications, providing meaningful prognostic value in this understudied population.
BACKGROUND: There is a critical need to identify patient characteristics associated with long-term ovarian cancer survival. METHODS: Quality of life (QOL), measured by the Functional Assessment of Cancer Therapy-Ovarian-Trial Outcome Index (FACT-O-TOI), including physical, functional, and ovarian-specific subscales, was compared between long-term survivors (LTS) (8+ years) and short-term survivors (STS) (<5 years) of GOG 218 at baseline; before cycles 4, 7, 13, 21; and 6 months post-treatment using linear and longitudinal mixed models adjusted for covariates. Adverse events (AEs) were compared between survivor groups at each assessment using generalized linear models. All P values are 2-sided. RESULTS: QOL differed statistically significantly between STS (N = 1115) and LTS (N = 260) (P < .001). Baseline FACT-O-TOI and FACT-O-TOI change were independently associated with long-term survival (odds ratio = 1.05, 95% confidence interval = 1.03 to 1.06 and odds ratio = 1.06, 95% confidence interval = 1.05 to 1.07, respectively). A 7-point increase in baseline QOL was associated with a 38.0% increase in probability of LTS, and a 9-point increase in QOL change was associated with a 67.0% increase in odds for LTS. QOL decreased statistically significantly with increasing AE quartiles (cycle 4 quartiles: 0-5 vs 6-8 vs 9-11 vs ≥12 AEs, P = .01; cycle 21 quartiles: 0-2 vs 3 vs 4-5 vs ≥6 AEs, P = .001). Further, LTS reported statistically significantly better QOL compared with STS (P = .03 and P = .01, cycles 4 and 21, respectively), with similar findings across higher AE grades. CONCLUSIONS: Baseline and longitudinal QOL change scores distinguished LTS vs STS and are robust prognosticators for long-term survival. Results have trial design and supportive care implications, providing meaningful prognostic value in this understudied population.
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