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Z Gastroenterol 2013; 51(8): 733-739
DOI: 10.1055/s-0033-1335064
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Treatment of Metastatic Colorectal Cancer with Cetuximab: Influence on the Quality of Life.

Therapie des metastasierten kolorektalen Karzinoms mit Cetuximab: Einfluss auf die Lebensqualität.
K. Unger
,
U. Niehammer
,
A. Hahn
,
S. Goerdt
,
M. Schumann
,
S. Thum
,
W. Schepp
Further Information

Publication History

26 October 2012

30 January 2013

Publication Date:
16 August 2013 (online)

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Abstract

Background: Epidermal Growth Factor Receptor (EGFR) antibodies are innovative anti-cancer drugs prolonging survival in metastatic colocrectal cancer. However, due to adverse drug reactions, patients develop acneform skin toxicities. We hypothesized that the skin reaction leads to a decline in general (QOL) and dermatological health related quality of life (HQOL). Furthermore, we aimed at evaluating predictors for QOL and HQOL to improve individual adjustment of therapy.

Methods: 40 outpatients with metastatic colocrectal cancer were involved in this study. According to their KRAS status, patients were allocated to 2 groups: The CTCX group (n = 20; KRAS wild-type) was treated with the EGFR-antibody Cetuximab plus chemotherapy, the CT group (n = 20; KRAS mutation) was receiving chemotherapy only. Psychological assessment consisted of questionaires to evaluate QOL and HQOL, depression, coping-styles, health beliefs and the patient´s personality.

Results: Between the two groups, no significanct difference in QOL was found, QOL remained stable over the course of treatment. Yet, the severity of the skin reactions had a significant influence on HQOL. Internal health beliefs and high compliance were found to be protective factors, while passive coping strategies, depression and the personality trait neuroticism were identified as risk factors.

Discussion: Interdisciplinary cooperation between medical professionals and psycho-oncologists is strongly recommended to encourage patients to embark on and to retain EGFR-antibody therapy. If risk factors are present, psycho-oncological therapy should focus on the minimization of depression and on the development of active coping strategies.

Zusammenfassung

Hintergrund: Epidermal-Growth-Factor-Receptor(EGFR)-Antikörper sind innovative Medikamente in der Krebsbehandlung. Sie führen zu verlängertem Überleben bei metastasiertem kolorektalen Karzinom. Aufgrund der Nebenwirkungen entwickeln die Patienten allerdings akneartige Hautausschläge. Für vorliegende Arbeit wurde die Hypothese aufgestellt, dass der Hautausschlag zu zeiner Verschlechterung der allgemeinen (QOL) und hautausschlagbezogenen Lebensqualität (HQOL) führt. Außerdem sollten mögliche Prädiktoren für QOL und HQOL identifiziert werden, um eine individuelle Therapieanpassung zu ermöglichen.

Methodik: In die Studie wurden 40 ambulante Patienten mit metastasiertem kolorektalen Karzinom eingeschlossen. Entsprechend ihrem KRAS-Status wurden sie in 2 Gruppen eingeteilt: Die CTCX-Gruppe (n = 20; KRAS Wildtyp) wurde mit dem EGFR-Antikörper Cetuximab und Chemotherapie behandelt, die CT-Gruppe (n = 20; KRAS-Mutation) erhielt nur Chemotherapie. Die psychologische Testung beinhaltete Fragebögen zur Erhebung von QOL und HQOL, Depression, Coping-Mechanismen, Kontrollüberzeugungen und Persönlichkeitsvariablen.

Resultate: Zwischen den beiden Gruppen zeigte sich kein signifikanter Unterschied hinsichtlich der QOL, im Verlauf der Behandlung blieb die QOL stabil. Die Intensität des Hautausschlags hatte einen signifikanten Einfluss auf die HQOL. Internale Kontrollüberzeugungen und eine hohe Patientencompliance erwiesen sich als protektive Faktoren, passive Coping-Mechanismen. Depression und das Persönlichkeitsmerkmal Neurotizismus stellen Risikofaktoren dar.

Diskussion: Enge Zusammenarbeit zwischen Ärzten und Psychoonkologen ist erforderlich, um Patienten erfolgreich zur Aufnahme und Beibehaltung der EGFR-Antikörper-Therapie zu ermutigen. Falls Risikofaktoren vorliegen, sollte sich die psychoonkologische Behandlung auf die Verbesserung der depressiven Symptomatik sowie auf die Ausbildung von aktiven Coping-Mechanismen konzentrieren.

Key words

colorectal cancer - palliative treatment - Epidermal Growth Factor Receptor Inhibitor - skin toxicities - psycho-oncology - quality of life

Schlüsselwörter

kolorektalen Karzinom - Palliativtherapie - Epidermal-Growth-Factor-Receptor(EGFR)-Antikörper - Hauttoxizität - Psychoonkologie - allgemeine Lebensqualität (QOL)
 

  • References

  • 1 Parkin DM, Bray F, Ferlay J et al. Global Cancer Statistics, 2002. CA: A Cancer Journal for Clinicians 2005; 55: 74-108
    CrossrefPubMedSearch in Google Scholar
  • 2 Karapetis C, Khambata-Ford S, Jonker D et al. K-ras mutations and benefit from betuximab in bdvanced colorectal caner. New Engl J Med 2008; 359: 1757-1765
    CrossrefPubMedSearch in Google Scholar
  • 3 Au HJ, Karapetis C, Callaghan O et al. Health-related quality of life in patients with advanced colorectal cancer treated with cetuximab: Overall and KRSA-specific results of the NCIC CTG and AGITG CO.17 trial. J Clin Oncol 2009; 27: 1822-1828
    CrossrefPubMedSearch in Google Scholar
  • 4 Andreis F, Rizzi A, Mosconi P et al. Quality of life in colon cancer patients with skin side effects: preliminary results from a monocentric cross sectional study. Health Qual Life Outcomes 2010; 8: 40-47
    CrossrefPubMedSearch in Google Scholar
  • 5 Tol J, Koopman M, Cats A. Supplement to: chemotherapy, bevacizumab, and cetuximab in metastatic colorectal cancer. New Engl J Med 2009A 360: 563-572
    PubMed
  • 6 Zabora J, Brintzenhofeszoc K, Kurbow B et al. The prevalence of psychological distress by cancer site. Psycho-Oncology 2001; 10: 19-28
    CrossrefPubMedSearch in Google Scholar
  • 7 Merckaert I, Libert Y, Messin S et al. Cancer patients’ desire for psychological support: prevalance and implications for screening patients’ psychological needs. Psycho-Oncology 2010; 19: 141-149
    PubMedSearch in Google Scholar
  • 8 Romito F, Giuliani F, Cormio C et al. Psychological effects of cetuximab-induced cutaneous rash in advanced colorectal cancer patients. Supportive Care Cancer 2009; 18: 329-334
    PubMedSearch in Google Scholar
  • 9 Rehse B, Pukrop R. Effects of psychosocial interventions on quality of life in adult cancer patients: meta-analysis of 37 published controlled outcome studies. Patient Educ Counseling 2003; 50: 179-186
    CrossrefPubMedSearch in Google Scholar
  • 10 World Health Organization. WHOQOL. Measuring quality of life. Geneva: World Health Organization; 1997
    PubMedSearch in Google Scholar
  • 11 Velikova G, Awad N, Coles-Gay R et al. The clinical value of quality of life assessments in oncology practice- a qualitative study of patient and physician views. Psycho-Oncology 2008; 17: 690-698
    PubMedSearch in Google Scholar
  • 12 Gordon H, Guyatt MD, Sander JO et al. Measuring quality of life in clinical trials. A taxonomy and review. Can Med Assoc J 1989; 140: 1441-1448
    PubMedSearch in Google Scholar
  • 13 Tol J, Koopman M, Cats A et al. Chemotherapy, bevacizumab, and cetuximab in metastatic colorectal cancer. New Engl J Med 2009B 360: 563-572
    PubMed
  • 14 Lacouture ME, Mitchell EP, Piperdi B et al. Skin toxitiy evaluation protocol with Panitumumab (STEPP), a phase II, open-label, randomized trial evaluation the impact of a pre-emptive skin treatment regimen on skin toxicities and quality of life in patients with metastatic colocrectal cancer. J Clin Oncol 2010; 28: 1351-1357
    CrossrefPubMedSearch in Google Scholar
  • 15 Härtl K, Engel J, Herschbach P et al. Personality traits and psychological stress: quality of life over 2 years following breast cancer diagnosis and psychological impact factors. Psycho-Oncoloy 2010; 19: 160-169
    PubMedSearch in Google Scholar
  • 16 Oken MM, Creech RH, Tormey DC et al. Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clin Oncol 1982; 5: 649-655
    CrossrefPubMedSearch in Google Scholar
  • 17 Knight L, Mussell M, Brandl T et al. Development and psychometric evaluation of the Basic Documentation for Psycho-Oncoloy (PO-Bado), a tool for standardized assessment of cancer patients. J Psychosom Res 2005; 64: 373-381
    PubMedSearch in Google Scholar
  • 18 Fahrenberg J, Myrtek M, Schumacher J et al. Fragebogen zur Lebenszufriedenheit (FLZ). Handanweisung. Göttingen: Hogrefe; 2001
    PubMedSearch in Google Scholar
  • 19 Hautzinger M, Bailer M, Worall H et al. Beck-Depressions-Inventar (BDI). Bern: Hans Huber; 1995
    PubMedSearch in Google Scholar
  • 20 Borkenau P, Ostendorf F. NEO-Fünf-Faktoren Inventar nach Costa und McCrae (NEO-FFI). Manual. Göttingen: Hogrefe; 2005
    PubMedSearch in Google Scholar
  • 21 Lohaus A, Schmitt GM. Fragebogen zur Erhebung von Kontrollüberzeugungen zu Krankheit und Gesundheit (KKG). Göttingen: Hogrefe; 1998
    Search in Google Scholar
  • 22 Muthny FA. Freiburger Fragebogen zur Krankheitsverarbeitung. Göttingen: Hogrefe; 1989
    Search in Google Scholar
  • 23 National Cancer Institute (NCI). Common toxicity criteria. Bethesda, Maryland (USA): Division of Cancer Treatment, National Cancer Institute; 1988
    PubMedSearch in Google Scholar
  • 24 Schäfer T, Staudt A, Ring J. German instrument fort the assessment of quality of life in skin deseases (DIELH). Internal consistency, reliability, convergent and discriminant validity and responsiveness. Der Hautarzt 2001; 52: 624-628
    CrossrefPubMedSearch in Google Scholar
  • 25 Fawzy IF. Psychosocial interventions for patients with cancer: what works and what doesn`t. Eur J Cancer 1999; 35: 1559-1564
    CrossrefPubMedSearch in Google Scholar
  • 26 Livneh H. Psychological adaption to cancer: the role of coping strategies. The J Rehabil 2000; 66: 43-51
    PubMedSearch in Google Scholar
  • 27 Herschbach P. The "well-being paradox" in quality-of-life research. Psychother Psychosom Med Psychol 2002; 52: 141-150
    Thieme ConnectPubMedSearch in Google Scholar
  • 28 Sprangers MAG, Moinpur CM, Moynihan TJ et al. Assessing meaningful change in quality of life over time: A user´s guide for clinicians. Mayo Clin Proc 2002; 77: 561-571
    CrossrefPubMedSearch in Google Scholar
  • 29 Rapkin BD, Schwartz CE. Toward a theoretical model of quality-of-life appraisal: implications of findings from studies of response shift. Health Qual Life Outcomes 2004; 2: 14-18
    CrossrefPubMedSearch in Google Scholar
  • 30 Saif MW, Longo W, Israel G. Correlation between rash and a positive drug response associated with cetuximab in a patient with advanced colorectal cancer. Clin Colorect Cancer 2008; 7: 144-148
    PubMedSearch in Google Scholar
  • 31 Gotlib V, Khaled S, Lapko I et al. Skin rash secondary to cetuximab in patient with advances colorectal cancer and relation to response. Anticancer Drugs 2006; 17: 1227-1229
    CrossrefPubMedSearch in Google Scholar
  • 32 Thompson AGH, Sunol R. Expectations as determinants of patient satisfaction: concepts, theory and evidence. Int J Qual Health Care 1995; 7: 127-141
    CrossrefPubMedSearch in Google Scholar
  • 33 Carr AJ, Gibson B, Robinson PG. Is quality of life determined by expectations or experience?. Br Med J 2001; 322: 1240-1243
    CrossrefPubMedSearch in Google Scholar
  • 34 Bandura A. Self-efficacy: Toward a unifying theory of behavioral change. Psychol Rev 1977; 84: 191-215
    CrossrefPubMedSearch in Google Scholar
  • 35 Allison PJ, Locker D, Feine JS. Quality of life: A dynamic construct. Social Sci Med 1997; 45: 221-230
    CrossrefPubMedSearch in Google Scholar
  • 36 Spencer SM, Carver CS, Price AA. Psychological and social factors in adaptation. In J.C Holland, (Ed) Psychooncology. (pp 211-222) New York: Oxford Press; 1998
    Search in Google Scholar
  • 37 Bech P. Quality of life measurements in major depression. Eur Psychiatry 1996; 11: 123-126
    CrossrefPubMedSearch in Google Scholar
  • 38 Lazarus RS, Folkman S. Stress, appraisal, and coping. New York: Springer; 1984
    Search in Google Scholar
  • 39 Magnus K, Diener E, Fujita F et al. Extraversion and neuroticism as predictors for objective life-events. A longitudinal analysis. J Personality Social Psychol 1993; 65: 1046-1053
    CrossrefPubMedSearch in Google Scholar
  • 40 Diener E, Suh E, Lucas RE et al. Subjective well-being: Three decades of progress. Psychol Bull 1999; 125: 276-302
    CrossrefPubMedSearch in Google Scholar
  • 41 Matthews G, Deary IJ. Personality traits. Cambridge, UK: Cambridge University Press; 1998
    Search in Google Scholar