Drug toxicity is often judged based on high-grade (grades 3-4) adverse events; however, many patients experience quality of life issues from lower-grade adverse effects. A recent study published in Cancer Management and Research suggests that assessment of cumulative drug toxicities, including adverse events of grades 1 and 2, may aid in predicting a patient’s quality of life.

The study included 105 adult patients in The Netherlands who received first-line chemotherapy for metastatic colorectal cancer and who completed the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30). Patients were drawn from 2 hospitals between August 2013 and through October 2016.

The patients completed the questionnaire at the start of treatment and 10 weeks later, and results were evaluated by multivariate linear regression analysis for the relationship between quality of life and cumulative toxicity. Cumulative toxicity was determined by each of: total numbers of high-grade (grades 3-4) adverse events, total number of all adverse events, and number of adverse events multiplied by grade. Results included a combination of questionnaire responses and electronic health records.

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The researchers hypothesized that all-grade toxicity would be more predictive of quality of life than high-grade toxicity is, and they found that for physical quality of life, this was the case (P =.002 for all-grade, P =.243 for high-grade toxicities, and P =.004 scored by severity). Global quality of life was not as easily predicted by cumulative toxicity (P =.720 for all-grade, P =.237 for high-grade toxicities, and P =.703 scored by severity).

These results indicate that prediction of patient physical quality of life with first-line chemotherapy for metastatic colorectal cancer is best considered using cumulative all-grade toxicity rather than just grade 3-4 toxicities.


Schuurhuizen CSEW, Verheul HMW, Braamse AMJ, et al. The predictive value of cumulative toxicity for quality of life in patients with metastatic colorectal cancer during first-line palliative chemotherapy. Cancer Manag Res. 2018;10:3015-3021.