Quality-of-Life Targeted Therapies

Andrew L. Pecora, MD

Editor-in-Chief Chief Innovations Officer, Professor, and Vice President of Cancer Services John Theurer Cancer Center at Hackensack University Medical Center

Time is a funny thing to think about. It is finite when it comes to living beings, yet seemingly infinite when it comes to the universe we live in. In the context of caring for cancer patients, all physicians and nurses trained in oncology receive education in quality-of-life issues; however, prolonging quantity of life remains our ultimate goal. In many situations, we are not yet able to prolong quantity of life, but can profoundly affect the quality of life of the patients we treat. People and societies have long accepted the paradox of spending a very brief period of time alive relative to time itself. Until recently, cancer care specialists were not primarily focused on quality-of-life issues; we accepted toxicities of therapy in exchange for prolongation of survival. By adapting the life-prolonging skills they have acquired over the years, oncologists are now conducting research to improve quality of life even when quantity of life is brief and unalterable.

Palesh and colleagues¹ conducted a study of 823 patients receiving chemotherapy and found that 37% had insomnia and an additional 43% had difficulty falling asleep. Surprisingly, the researchers found that younger patients (aged <55 y) were more likely to have insomnia. In addition, breast cancer and lung cancer patients had the greatest incidence of insomnia, which was highly correlated with depression and fatigue. Thus, the vast majority of patients treated with chemotherapy experience difficulty sleeping and many develop corresponding depression. Similar to new molecular-targeted therapies, efforts are now underway to intervene early with quality-of-life targeted therapies for patients with cancer, particularly if they have incurable disease.

The power of these quality-of-life initiatives was underscored when oncologists added palliative care to patients with lung cancer before they received chemotherapy. In a study of lung cancer patients receiving chemotherapy, 151 patients were randomized to receive chemotherapy with or without palliative supportive care, including pain management.² Those receiving the palliative intervention not only had better quality-of-life scores, but surprisingly better overall survival (11.6 mo vs 8.9 mo). Only 16% of patients receiving palliative care with chemotherapy had reported depression compared to 38% who had chemotherapy alone.

Yoga is another example of a targeted quality-of-life intervention that is getting increased attention due to recent study results. Researchers assessed the benefit of yoga for 410 cancer survivors who reported sleeping problems between 2 and 22 months after completing chemotherapy. Patients received routine medical management for sleep disorder either with or without yoga. Patients receiving yoga had greater improvement in quality of sleep, greater reductions in sleep medication use, and most striking, a 42% reduction in fatigue.³

There is little doubt that we are highly unlikely to change the time paradox anytime soon. Our profession continues to make great strides in preventing premature death and prolonging the lives of our patients. Knowing that death is inevitable, trying simply to prevent it would seem shortsighted and incomplete. As studies indicate, we can provide our patients with great benefit even if we cannot prolong life, through greater application of quality-of-life targeted therapies.

References

1. Palesh OG, Roscoe JA, Mustian KM, et al. Prevalence, demographics, and psychological associations of sleep disruption in patients with cancer: University of Rochester Cancer Center-Community Clinical Oncology Program. J Clin Oncol. 2010;28(2):292-298.
2. Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733-742.
3. Mustian KM, Sprod L, Peppone LJ, et al. Effect of YOCAS yoga on circadian rhythm, anxiety, and mood: A URCC CCOP randomized, controlled clinical trial among 410 cancer survivors. J Clin Oncol. 2011;29(suppl; abstr 9034).