INITIAL PROGNOSTIC FACTORS IN SMALL-CELL LUNG-CANCER PATIENTS PREDICTING QUALITY-OF-LIFE DURING CHEMOTHERAPY

The question of whether initial prognostic factors in small-cell lung cancer patients have a predictive value for patients' quality of life (QL) during chemotherapy is addressed in the context of a randomised c linical trial comparing early and late alternating chemotherapy (SAKK protocol 15/84). The relative impact of initial tumour stage and perfo rmance status, previous weight loss, sex and age on patient-rated QL w as analysed over six chemotherapy cycles in 124-130 patients (accordin g to available QL data) with more than 400 questionnaires. Fatigue/mal aise, personal functioning, emotional and general well-being were pros pectively selected as QL indicators. Predefined summary measures (aver age QL score over chemotherapy cycles,'minimum', 'maximum' and 'final' improvement) were analysed separately by scale in various patient gro ups. General linear models adjusted for treatment arm and response wer e used to confirm the univariate findings. Within the overall sample, the average QL scores over six cycles were predicted by initial progno stic factors. Patients with poor prognostic factors reported worse QL. Within a limited sample (with baseline QL), patients with poor progno stic factors reported worse QL at baseline and greater improvement und er treatment. Graphical comparison of QL patterns over cycles showed p ermanent discrimination by levels of prognostic factors. The impact of initial prognostic factors was consistently confirmed in the three an alyses. Levels of performance status and weight loss best discriminate d QL. Initial tumour stage, performance status and previous weight los s can predict QL in small-cell lung cancer during chemotherapy, even a fter controlling for response to treatment. Our results may contribute to clinical decision-making with regard to the intensity of chemother apy and QL outcome, especially in patients with extensive disease.