Affiliation:
1. Department of Internal Medicine SSM St Mary's Hospital St. Louis Missouri USA
2. Department of Biostatistics and Bioinformatics Duke University Durham North Carolina USA
3. Department of Medicine University of Minnesota Medical School Minneapolis Minnesota USA
4. Department of Urology Cleveland Clinic Cleveland Ohio USA
5. Department of Medicine, Lank Center for Genitourinary Oncology Dana‐Farber Cancer Institute Boston Massachusetts USA
6. Prostate Cancer Foundation Santa Monica California USA
7. Division of Hematology, Oncology and Transplantation University of Minnesota Medical School Minneapolis Minnesota USA
8. University of Minnesota Masonic Cancer Center Minneapolis Minnesota USA
Abstract
AbstractBackgroundA prognostic risk score (Halabi score) in metastatic castration‐resistant prostate cancer (mCRPC) accurately predicts overall survival, but its association with quality of life (QOL) has not been defined. We hypothesize that a higher pretreatment Halabi score is associated with worse QOL outcomes over time in mCRPC patients.MethodsPatient‐level data from the docetaxel plus prednisone control arm of Mainsail, a Phase 3 clinical trial in mCRPC were accessed via ProjectDataSphere. Pretreatment Halabi score included disease‐related factors: metastatic site, opioid use, Eastern Cooperative Oncology Group performance status (ECOG‐PS), alkaline phosphatase, albumin, hemoglobin, lactic acid dehydrogenase, and PSA, with higher score indicating worse survival. Three QOL scales were created: Functional Assessment of Cancer Therapy‐Prostate (FACT‐P, higher score = better QOL), Brief Pain Inventory‐Short Form Severity score (BPI‐SFSS, higher score = higher pain severity), and BPI‐SF Interference score (BPI‐SFIS, higher score = greater pain interference). Mixed linear model was used to estimate the associations between Halabi score and QOL scores assessed at different time points (baseline, 2 months, and 6 months).ResultsThis analysis included 412 mCRPC patients (median age = 68 years, 82% white, 5% Black, median log PSA = 4.4 ng/mL). After multivariable adjustment, Halabi score was significantly associated with QOL scores at all time points. At 6 months, multivariable adjusted FACT‐P decreased by 10.0 points (worsening), BPI‐SFSS increased by 0.8 points (worsening), and BPI‐SFIS increased by 0.9 points (worsening) for each unit increase in Halabi risk score. In multivariable analysis of individual components, ECOG‐PS, site of metastasis, and opioid use were significantly associated with worse QOL scores at baseline.ConclusionsChemotherapy‐naïve mCRPC patients with poorer Halabi prognostic risk scores have poorer QOL and greater pain intensity and interference at baseline and during follow‐up.