What clinical, functional, and psychological factors before treatment are predictors of poor quality of life in cancer patients at the end of chemotherapy?

Mangia, Ariella Sebastião; Coqueiro, Nara Lisiane de Oliveira; Azevedo, Fernanda Cabral; Araujo, Hiago Tomaz da Silva; Amorim, Elizandra de Oliveira; Alves, Cibelli Navarro Rodrigues; Camargo, Calvino; Fonseca, Allex Jardim da

doi:10.1590/1806-9282.63.11.978

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Revista da Associação Médica Brasileira

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ORIGINAL ARTICLE • Rev. Assoc. Med. Bras. 63 (11) • Nov 2017 • https://doi.org/10.1590/1806-9282.63.11.978 copy

What clinical, functional, and psychological factors before treatment are predictors of poor quality of life in cancer patients at the end of chemotherapy?

Que fatores clínicos, funcionais e psíquicos antes do tratamento são preditores de baixa qualidade de vida em pacientes oncológicos ao término da quimioterapia?

Authorship SCIMAGO INSTITUTIONS RANKINGS

Summary

Objective:

To correlate physical activity level (PAL), functional capacity and psychological state with quality of life (QoL) in cancer patients undergoing chemotherapy (CT).

Method:

Observational cohort study. Patients (n=121) with any primary cancer site with indications of chemotherapy with palliative or curative intent were evaluated at three moments: 1) patient admission (week 0), before chemotherapy; 2) week 8; 3) end of CT. Data were collected regarding QoL, PAL, clinical data, functional capacity (short walking distance test, sitting-rising test, isometric manual gripping force), and anxiety and depression tests.

Results:

There was significant improvement at the end of CT for: level of physical activity; walk test (> 500 meters); sitting-rising test (> 20x). There was a significant reduction in the prevalence of moderate/severe depression. The prevalence of high QoL showed a significant increase in evaluation 3 (42.4% vs. 40.0% vs. 59.2%, p=0.02). Education up to high school level, low PAL, walking < 300 meters, sitting and rising < 20 times, having depression (moderate to severe) and QoL that was not high at the start of treatment (week 0) all proved to be risk factors for low quality of life at week 16. Conversely, early staging, curative intent chemotherapy and low-grade symptoms were shown to be protective factors.

Conclusion:

Performing less than 20 movements in the sitting-rising test and low PAL at the start of chemotherapy represent independent risk factors for low quality of life at the end of chemotherapy.

Keywords:
neoplasms; antineoplastic agents; drug therapy; quality of life; exercise; physical and rehabilitation medicine

Explanatory variable (week 0)	Incidence of low quality of life at week 16	p-value	Relative risk (95CI)
Age over 50 years Age up to 50 years	52.2% 46.8%	ns	1.08 (0.74-3.99) 1
Age over 60 years Age up to 60 years	49.2% 54.7%	ns	0.78 (0.35-1.86) 1
Female Male	48.2% 54.4%	ns	0.95 (0.50-1.57) 1
Married/Common-law Single/Widow(er)/Divorced	52.2% 41.7%	ns	1.30 (0.59-1.86) 1
Education up to high school Higher education	58.2% 23.2%	0.02	2.27 (1.15-5.53) 1
Early staging Late staging	10.3% 58,8%	0.008	0.21 (0.08-0.78) 1
Curative chemotherapy Palliative chemotherapy	30.6% 65.4%	0.01	0.45 (0.22-0.90) 1
ECOG performance status 0, 1 or 2 3 or 4	40.6% 50.2%	ns	0.85 (0.25-3.25) 1
Body mass index Less than 20 Less than 25 Less than 3 Greater than 30	52.0% 50.2% 48.6% 40.6%	ns ns ns	1.18 (0.25-4.87) 1.15 (0.28-3.21) 1.04 (0.32-3.22) 1
Manual grip strength, right Less than 30 kg.force Greater than 30 kg.force	55.6% 50.2%	ns	1.12 (0.35-2.84) 1
Manual grip strength, left Less than 30 kg.force Greater than 30 kg.force	47.2% 51.4%	ns	0.95 (0.52-2.61) 1
Baseline level of physical activity Low Moderate/High	62.2% 25.6%	0.008	2.22 (1.33-6.82) 1
Walk test Less than 300 m Less than 400 m Less than 500 m More than 500 m	78.8% 48.2% 47.6% 43.2%	0.018 ns ns	1.82 (1.16-5.88) 1.12 (0.62-2.34) 1.10 (0.60-2.23) 1
Sitting-rising test Less than 20 times More than 20 times	78.0% 30.2%	<0.001	2.58 (1.25-4.90) 1
Anxiety test Moderate/Severe Minimal/Mild	68.2% 45.2%	ns	1.58 (0.66-3.24) 1

	Adjusted relative risk (95% confidence interval) for low quality of life (week 16). Stratification based on the variables below (week 0) Mantel-Haenszel method.
Explanatory variables related to physical activity (week 0)	Depressed mood (moderate/severe vs. mild/mininal)	Baseline quality of life (cut-off = 80)	Functional scale (cut-off = 80)	Symptom scale (cut-off = 30)
Baseline level of physical activity Low Moderate/High Adjusted p-value	2.24 (1.05-6.3) 1 0.032	2.16 (1.12-4.8) 1 0.022	2.40 (1.07-5.9) 1 0.030	2.23 (1.06-6.0) 1 0.031
Walk test Less than 300 m More than 300 m Adjusted p-value	1.83 (1.11-5.2) 1 0.024	1.20 (0.82-3.2) 1 ns	1.21 (0.78-3.4) 1 ns	1.31 (0.68-4.0) 1 ns
Sitting-rising test Less than 20 times More than 20 times Adjusted p-value	2.25 (1.15-4.8) 1 0.002	2.01 (1.13-3.0) 1 0.020	2.02 (1.14-3.2) 1 0.018	2.24 (1.16-4.7) 1 0.002

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