Change in quality of life and psychological distress in patients with resected non-metastatic vs unresectable advanced cancer undergoing systemic treatment

Abstract Purpose: Cancer and its treatments changes patients’ quality of life. The aim was to analyze quality of life, psychological distress, and life satisfaction in patients with resected versus unresectable cancer.Methods: Two prospective, multicenter (15 medical oncology departments), studies with consecutive patient recluitment were conducted, NEOetic, in individuals with unresectable advanced disease (2020-2021) and NEOcoping, in subjects with resected non-metastatic cancer (2016-2018). Participants completed quality of life (EORTC QLQ-C30), emotional distress (Brief Symptom Inventory, BSI), and life satisfaction (Satisfaction with Life Scale, SWLS) questionnaires before systemic antineoplastic treatment and after treatment. A descriptive, bivariate chi-square analysis and t-tests were performed to ascertain the differences between localized and advanced cancer.Results: A total of 1450 patients were recruited, 941 (65%) with a resected cancer and 509 with unresectable advanced cancer with a mean age of 59.0 and 64.9 years, respectively. The most common cancers were colorectal (42%) and breast (34%) in resected group and bronchopulmonary (29%), colorectal (17%), and pancreatic (11%) in unresectable advanced cancer group. Subjects with advanced disease exhibited worse scores on functional scales (physical, cognitive, emotional, and social), and had more symptoms than those with resected disease prior to initiating systemic treatment. Individuals with advanced cancer displayed better functional status and fewer symptoms, but more fatigue and nausea and those with resected cancer presented worse physical and cognitive function, more psychological distress, and more symptoms post-treatment. Conclusion: This sample reveals how antineoplastic treatment can enhance quality of life for people with unresectable advanced disease and negatively affect individuals with resected, non-metastatic cancer.Structured Abstract: Our study shows the potential quality of life benefit of systemic antineoplastic treatment in patients with unresectable advanced cancer. In addition, it shows the deterioration of quality of life in patients with resected non-metastatic cancer after completion of adjuvant treatment.