Page 200 - Haematologica - Vol. 105 n. 6 - June 2020

L.K. Nielsen et al.
ilar global QoL in experimental versus control arms in patients with colorectal cancer, despite higher toxicity rates in the former. The authors question whether the global QoL assessment, using the very brief two-item global QoL scale, has sufficient measurement precision to detect a difference in global QoL over time. However, this has been challenged by others stating that QoL is a com- plex and multidimensional concept, not caused by side effects only.35 Importantly, both those in favor and those against the limitations of the global QoL scale indicate the need for development for more sensitive patient-reported QoL instruments.36 This is also supported by our data on peripheral neuropathy. We defined ‘tingling’ of hands or feet as peripheral neuropathy. Although this approach is not validated, we found a discrepancy between patient and physician-reported neuropathy in 13% of question- naires, the majority (76%) being explained by lower reporting by physicians, which has been reported previ- ously, both for neuropathy and other symptoms.37-39 The use of the EORTC QLQ-CIPN20 questionnaire might improve concordance between patients and physicians.40 The need for flexible and tailored patient reported out- come (PRO) measurements has recently also been advo- cated by Thanarajasingam and colleagues and these have
been developed by the EORTC.36,41 Furthermore, the PRO version of the Common Terminologies Criteria for Adverse Events (PRO-CTCAE) for self-reported toxicities developed by the National Institute of Health is another valuable tool.42,43
In conclusion, we found that the treatment with MPT-T and MPR-R improved HRQoL in elderly patients with NDMM and in general is clinically meaningful to the patients during maintenance therapy only. This supports the current paradigm of continuous treatment, not only improving survival, but also maintaining, and even improving, specific subscales of HRQoL. Although clini- cally relevant diarrhea developed in patients treated with lenalidomide, this did not negatively affect the global QoL during induction and maintenance. Moreover, currently it is known that bile acid malabsorption plays an important role, which can be treated with bile acid sequestrants.44 Clinically significant peripheral neuropathy precluded long term thalidomide treatment in the majority of patients and appeared not to improve HRQoL in those patients who continued therapy.
Funding
Dutch Cancer Society KWF VU-2008 4246, Celgene.
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