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

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)

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