Journal of Clinical Oncology, Vol 15, 2022-2029, Copyright © 1997 by American Society of Clinical Oncology
Effect of regional and systemic fluorinated pyrimidine chemotherapy on quality of life in colorectal liver metastasis patients
S Earlam, C Glover, M Davies, C Fordy and TG Allen-Mersh
Department of Surgery, Charing Cross and Westminster Medical School, Chelsea and Westminster Hospital, London, United Kingdom.
PURPOSE: Since systemic and regional (HAI) fluorinated pyrimidine
chemotherapies offer similar survival benefit in treatment of colorectal
liver metastases (CLM), we sought to identify their impact on quality of
life (QoL), which might be a useful indicator of treatment preference.
METHODS: We compared QoL in 135 CLM patients managed by symptom control (n
= 49 patients), systemic fluorouracil (5FU)/folinic acid (n = 35), or
hepatic arterial floxuridine (FUDR) (n = 51). Full blood count and liver
function tests, World Health Organization (WHO) toxicity criteria, and QoL
(Rotterdam Symptom Checklist [RSC], the Sickness Impact Profile [SIP], and
the Hospital Anxiety and Depression scale [HAD]) were measured monthly in
all patients. RESULTS: The HAD anxiety score was significantly increased in
symptom control compared with chemotherapy patients 1 month after
randomization. There was a significant increase in RSC physical score
(repeated measures, P = .05), and in scores for sore mouth (P < .01),
dry mouth (P < .01), and tingling hands and feet (P < .01) in
systemic chemotherapy compared with symptom control patients. Significant
QoL differences (repeated measures and Mann-Whitney U [MWU]) between HAI
and symptom control patients were not detected. Systemic chemotherapy
patients lived for significantly longer (log-rank test, P < or = .0001)
with abnormal HAD anxiety, RSC psychosocial, or RSC sore mouth scores
compared with HAI patients, but there were no overall survival differences.
CONCLUSION: Randomization to symptom control only was associated with
increased anxiety. QoL with systemic chemotherapy was impaired by side
effects. HAI was associated with similar survival to systemic chemotherapy
but with better sustained QoL.
