The Importance of Reducing Patients' Symptom Burden in Cancer

Patients May Achieve a Clinical Benefit With Treatment, Despite a Limited Tumor Response

Maurie Markman, MD


July 18, 2014

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Hello. I am Dr. Maurie Markman, from Cancer Treatment Centers of America in Philadelphia, Pennsylvania. I want to briefly discuss a very interesting -- and, I would suggest, very important -- paper that recently appeared in the International Journal of Gynecological Cancer, "Symptom Burden and Outcomes of Patients With Platinum Resistant/Refractory Recurrent Ovarian Cancer: A Reality Check: Results of Stage 1 of the Gynecologic Cancer Intergroup Symptom Benefit Study."[1]

This study prospectively followed a group of 126 women with platinum-resistant ovarian cancer. The investigators looked at objective response rates and toxicities, but they also used a variety of tools to look at symptom burden and response of individual patients to the treatment plan. The study demonstrates, perhaps not surprisingly, that the majority of patients in this setting have symptoms; 70% had more than 9 symptoms. The objective response rate to therapy in this study was as anticipated, and at 8.5%, unfortunately low. Perhaps most interesting, however, was that 40% of patients reported clinical benefit to the treatment program even though they also reported toxicity, and 50% of symptomatic patients reported symptom improvement.

Tumor Response Rate vs Symptom Response

Of course, the data need to be confirmed, but I believe that one of the most important outcomes of this study is that it objectively demonstrates that despite a low response rate, defined by RECIST, or shrinkage of the tumor masses, patients do achieve clinical benefit. For example, ascites may be reduced and the patient will be able to eat, even though that would not meet RECIST criteria. Or, for example, pressure on a pelvic mass may be decreased. Again, a decrease in the measurable tumor mass may not be demonstrated, but the patient's pain may recede.

This study also leads to the important question of whether improvement in symptoms, objectively quantified by validated symptom assessment tools, should be used as an indication of clinical benefit. Perhaps this would even be preferable to looking at shrinkage of a tumor mass, which is not associated with any evidence of clinical benefit.

This is an important paper. I hope we will see more such papers in the future that truly assess what patients feel and how they benefit, rather than simply looking at shrinkage of a tumor mass in a patient with an advanced cancer.

Thank you for your attention. I encourage you to read this interesting paper.


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