title: Patients' perspectives on palliative chemotherapy of colorectal and non--colorectal cancer: a prospective study in a chemotherapy- experienced population.
abstract: BACKGROUND
  A better understanding of patients' views on the benefit and burden obtained from palliative chemotherapy would facilitate shared decision making. We evaluated palliative cancer patients' reported outcomes (PROs) for toxicity and investigated the survival threshold for which they would repeat chemotherapy (CTx).
  
  
  METHODS
  Patients who had received a minimum of three months of palliative CTx for advanced colorectal (CRC) or non-colorectal (non-CRC: upper gastrointestinal, lung and head-and-neck) cancer were assessed by questionnaire. Patients were questioned about PROs for toxicity, subjective burden from side effects, and were asked for the survival threshold necessary for them to repeat CTx. Expected survival (sum of indicated survival threshold and median survival time with best supportive care) was compared to the patients' actual survival.
  
  
  RESULTS
  One hundred and thirty-four patients (CRC: 58; non-CRC: 76) were surveyed. The most frequent PRO- grade 3/4 toxicities were acne (12.8%), fatigue (9.0%), and diarrhea (8.5%). The symptom causing the highest subjective burden was fatigue and was worse than expected in 29.9% of the patients. The median survival threshold for which patients would repeat CTx was significantly longer in CRC than in non-CRC patients (p=0.01). Median expected survival was significantly longer than actual median survival (CRC: 44.0 months [22.0-65.9] compared with 30.0 months of actual survival [20.9-39.1]; non-CRC: 22.0 months [15.3-28.6] compared with 19.0 months of actual survival [15.1-22.9], p=0.03).
  
  
  CONCLUSIONS
  Fatigue deserves more attention when toxicity of treatment and symptoms of disease are explained to patients. Patients' survival expectations from palliative chemotherapy are higher than previously described, exceed the median survival time known from phase III trials, and are significantly longer than their actual survival.
authors: Medical Department I, University Hospital Carl Gustav Carus, Fetscherstrasse 74, 01307, Dresden, Germany.
authors: Marika
authors: M
authors: Mende
authors: Karolin
authors: K
authors: Trautmann
authors: Anke
authors: A
authors: Rentsch
authors: Beate
authors: B
authors: Hornemann
authors: Ulrich S
authors: US
authors: Schuler
authors: Gerhard
authors: G
authors: Ehninger
authors: Gunnar
authors: G
authors: Folprecht
mesh_terms: D000152:Acne Vulgaris / Q000139:chemically induced / Q000523:psychology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects*; D015179:Colorectal Neoplasms / Q000188:drug therapy*; D003967:Diarrhea / Q000139:chemically induced / Q000523:psychology; D005221:Fatigue / Q000139:chemically induced / Q000523:psychology; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000188:drug therapy*; D006258:Head and Neck Neoplasms / Q000188:drug therapy*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000523:psychology; D057566:Self Report; D013534:Survival / Q000523:psychology
chemical_list: D000970:Antineoplastic Agents
references: Lancet. 2003 Aug 23;362(9384):640-50
references: 12944066
references: J Clin Oncol. 2008 Aug 10;26(23):3896-902
references: 18688058
references: J Clin Oncol. 2006 Jun 20;24(18):2903-9
references: 16782930
references: N Engl J Med. 2008 Sep 11;359(11):1116-27
references: 18784101
references: J Psychosom Res. 2002 Feb;52(2):69-77
references: 11832252
references: Clin Oncol (R Coll Radiol). 2001;13(3):204-8
references: 11527297
references: Arch Psychiatr Nurs. 2009 Apr;23(2):138-47
references: 19327556
references: Psychooncology. 2001 Sep-Oct;10(5):410-8
references: 11536419
references: BMJ. 1990 Jun 2;300(6737):1458-60
references: 2379006
references: J Clin Oncol. 1997 Jan;15(1):330-40
references: 8996160
references: J Clin Oncol. 2006 Nov 1;24(31):4991-7
references: 17075117
references: Psychosomatics. 2001 May-Jun;42(3):241-6
references: 11351113
references: N Engl J Med. 2006 Dec 14;355(24):2542-50
references: 17167137
references: Indian J Palliat Care. 2009 Jan;15(1):19-25
references: 20606851
references: Clin Otolaryngol Allied Sci. 1983 Feb;8(1):7-13
references: 6831756
references: N Engl J Med. 2012 Oct 25;367(17):1616-25
references: 23094723
references: BMJ. 1998 Sep 19;317(7161):771-5
references: 9740561
references: Acta Psychiatr Scand. 1983 Jun;67(6):361-70
references: 6880820
references: Lung Cancer. 2009 Nov;66(2):250-6
references: 19264374
references: J Clin Oncol. 1988 Apr;6(4):633-41
references: 2833577
references: Jpn J Clin Oncol. 2008 Jan;38(1):64-70
references: 18238880
references: N Engl J Med. 2011 May 26;364(21):2060-5
references: 21612477
references: Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2011 Jan;54(1):46-51
references: 21246328
references: J Clin Oncol. 2009 Aug 1;27(22):3677-83
references: 19470929
references: J Clin Oncol. 2006 Jul 20;24(21):3490-6
references: 16849766
references: N Engl J Med. 2009 Apr 2;360(14):1408-17
references: 19339720
references: Psychooncology. 2005 Jan;14(1):25-33
references: 15386792
references: N Engl J Med. 2008 Jan 3;358(1):36-46
references: 18172173
references: BMJ. 2000 Sep 2;321(7260):531-5
references: 10968812
references: Oncologist. 2000;5(5):353-60
references: 11040270
references: Pain. 1995 May;61(2):277-284
references: 7659438
references: Patient Educ Couns. 2001 Nov;45(2):149-57
references: 11687329
references: JAMA. 2008 Oct 8;300(14):1665-73
references: 18840840
references: Lancet. 2009 May 2;373(9674):1525-31
references: 19410716