Relationship between changes in hemoglobin level and quality of life during chemotherapy in anemic cancer patients receiving epoetin alfa therapy
Relationship between changes in hemoglobin level and quality of life during chemotherapy in anemic cancer patients receiving epoetin alfa therapy
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DOI：
10.1002/cncr.10763
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发表时间：
2002-08-15
期刊：
影响因子：
6.2
通讯作者：
Glaspy, JA
中科院分区：
文献类型：
--
作者：
Crawford, J;Cella, D;Glaspy, JA
背景血红蛋白升高与接受依泊苷α治疗的贫血癌症患者的生活质量（QOL）改善相关，但干预通常保留用于症状性贫血或血红蛋白<10 g/dL。血红蛋白、功能状态和患者报告的生活质量之间的关系尚未得到很好的表征。方法。来自两项开放标签、以社区为基础的试验的数据纳入了4382例接受化疗的贫血癌症患者，用于评价血红蛋白变化与QOL变化之间的关系。作者使用线性模拟量表评估（LASA）和更详细的疾病特异性癌症治疗功能评估-贫血（FACT-An）工具测量QOL。进行分析以确定与血红蛋白增加相关的QOL的增量变化（1 g/dL增量）。横断面分析显示，高血红蛋白水平与高LASA和FACT-An评分之间存在非线性关系和显著正相关（r分别为0.25和0.29，P <0.01）。血红蛋白升高> 2 g/dL的患者报告了5个FACT-A项目的统计学显著性改善，这些项目是先验选择的，专门用于反映功能能力。增量分析使用回归方法来确定血红蛋白增量变化与QOL评分之间的纵向关系。发现这种关系是非线性的，最大QOL增益发生在血红蛋白水平为12 g/dL（范围，11 - 13 g/dL）时。基线QOL评分低和基线与最终QOL评估之间时间较长的患者总体QCL增加显著（P <0.05）。基线时疾病进展、从基线到研究结束疾病状态的变化以及自我报告的疼痛或恶心的增加都对QOL评分有显著的负面影响（P <0.05）。在8 - 14 g/dL的临床相关血红蛋白范围内，依泊苷α治疗期间血红蛋白升高与接受化疗的癌症患者的相应QOL改善之间存在直接关系。这些数据表明，当血红蛋白在11 - 13 g/dL范围内时，QOL的增量最大。(C)2002年美国癌症协会。
BACKGROUND. Hemoglobin increases have been associated with quality of life (QOL) improvements in anemic cancer patients treated with epoetin alfa, but intervention generally has been reserved for symptomatic anemia or hemoglobin < 10 g/dL. Relationships among hemoglobin, functional status, and patient reported QOL have not been well characterized.METHODS. Data from two open-label, community-based trials of epoetin alfa therapy that enrolled 4382 anemic cancer patients undergoing chemotherapy were used to evaluate the relationship between hemoglobin changes and QOL changes. The authors measured QOL using the Linear Analog Scale Assessment (LASA) and the more detailed, disease-specific Functional Assessment of Cancer Therapy-Anemia (FACT-An) instrument. Analyses were performed to determine the incremental change in QOL associated with hemoglobin increases (I g/dL increments).RESULTS. Cross-sectional analyses showed a nonlinear relationship and significant positive correlation between high hemoglobin levels and high LASA and FACT-An scores (r = 0.25 and 0.29, respectively, P < 0.01). Patients with hemoglobin increases of : 2 g/dL reported statistically significant improvements in five FACT-An items selected a priori specifically to reflect functional capacity. An incremental analysis used regression methods to identify the longitudinal relationship between incremental changes in hemoglobin and QOL scores. This relationship was found to be nonlinear, with the maximum QOL gain occurring at a hemoglobin level of 12 g/dL (range, 11-13 g/dL). Patients with low baseline QOL scores and longer time periods between baseline and final QOL assessments experienced significantly (P < 0.05) greater increases in overall QCL. Progressive disease at baseline, change in disease status from baseline to end of study, and increase in self-reported pain or nausea all had significant (P < 0.05) negative effects on QOL scores.CONCLUSIONS. A direct relationship exists between hemoglobin increases during epoetin alfa therapy and corresponding QOL improvements in cancer patients receiving chemotherapy across the clinically relevant hemoglobin range of 8-14 g/dL. These data suggest that the maximal incremental gain in QOL occurs when hemoglobin is in the range of 11-13 g/dL. (C) 2002 American Cancer Society.