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Support Care Cancer. 2018 Nov;26(11):3941-3949. doi: 10.1007/s00520-018-4273-3. Epub 2018 May 29.

Do drugs offering only PFS maintain quality of life sufficiently from a patient's perspective? Results from AVALPROFS (Assessing the 'VALue' to patients of PROgression Free Survival) study.

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Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School (BSMS), University of Sussex, Falmer, Brighton, BN1 9RX, UK.
MRC Biostatistics Unit, University of Cambridge, School of Clinical Medicine, Robinson Way, Cambridge, CB2 0SR, UK.
Sussex Health Outcomes Research & Education in Cancer (SHORE-C), Brighton & Sussex Medical School (BSMS), University of Sussex, Falmer, Brighton, BN1 9RX, UK.
Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, Middlesex, HA6 2RN, UK.
Sussex Cancer Centre, Brighton & Sussex University Hospitals, Brighton, BN2 5DA, UK.



Trials of novel drugs used in advanced disease often show only progression-free survival or modest overall survival benefits. Hypothetical studies suggest that stabilisation of metastatic disease and/or symptom burden are worth treatment-related side effects. We examined this premise contemporaneously using qualitative and quantitative methods.


Patients with metastatic cancers expected to live > 6 months and prescribed drugs aimed at cancer control were interviewed: at baseline, at 6 weeks, at progression, and if treatment was stopped for toxicity. They also completed Functional Assessment of Cancer Therapy (FACT-G) plus Anti-Angiogenesis (AA) subscale questionnaires at baseline then monthly for 6 months.


Ninety out of 120 (75%) eligible patients participated: 41 (45%) remained on study for 6 months, 36 progressed or died, 4 had treatment breaks, and 9 withdrew due to toxicity. By 6 weeks, 66/69 (96%) patients were experiencing side effects which impacted their activities. Low QoL scores at baseline did not predict a higher risk of death or dropout. At 6-week interviews, as the side effect severity increased, patients were significantly less inclined to view the benefit of cancer control as worthwhile (X2 = 50.7, P < 0.001). Emotional well-being initially improved from baseline by 10 weeks, then gradually returned to baseline levels.


Maintaining QoL is vital to most patients with advanced cancer so minimising treatment-related side effects is essential. As side effect severity increased, drugs that controlled cancer for short periods were not viewed as worthwhile. Patients need to have the therapeutic aims of further anti-cancer treatment explained honestly and sensitively.


Patients’ views; Progression-free survival; Quality of life; Side effects

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