Clinical & Nutritional Determinants of Quality of Life in Patients with Incurable Cancer

Background: Optimising quality of life (QoL) remains the central tenet of care in patients with incurable cancer, however determinants of this are not clear. Methods: Multi-centre study conducted across 18 sites in Ireland and United Kingdom over a period of 5 years (2011-2016). Data collected included: patient demographics, Performance Status (ECOG-PS), weight loss (%WL) and skeletal muscle index (SMI) and skeletal muscle attenuation (MA) assessed by CT images, inflammatory markers [modified Glasgow Prognostic score (mGPS)] and QoL data (EORTC QLQ-30). The relationship between clinical and nutritional parameters with QoL was assessed using the Spearman rank correlation coefficient & multivariate binary logistic regression. Results: Data were available on 1027 patients, of which 51% were male and the median age was 66 (IQR 57-74) years. Gastrointestinal cancer was most prevalent (40%) and 87% of patients had metastatic disease. %WL, ECOG-PS and mGPS were significantly correlated with deteriorating QoL functional & symptom scales (all p < 0.001). On multivariate regression analysis, >10% WL (OR 2.69 [95% CI: 1.63-4.42]), ECOG-PS 3-4 (OR 14.33 [95% CI: 6.76- 30.37]) and mGPS score 2 (OR 1.58 [95% CI: 1.09- 2.29]) were independently associated with poorer summary QoL score. WL & mGPS were also independently associated with poor physical function, fatigue and appetite loss (all p < 0.05). Low MA was independently associated with poor physical function (OR 1.67 [95% CI: 1.09-2.56]), but not with fatigue, appetite or QoL summary score. Conclusions: The findings indicate that QoL is determined in part by WL, ECOG-PS and systemic inflammation in patients with advanced cancer. Although muscle parameters were associated with some QoL domains, no significant independent association with fatigue, appetite loss or QoL summary score was observed. Identifying early predictors of poor QoL may allow the identification of patients who may benefit from early referral to palliative care, which has been shown to improve QoL