ASPO Abstracts

Patient-Reported Symptom Outcomes and Microsatellite Instability in Patients with Metastatic Colorectal Cancer

Authors: Advani SM, Shi Ql Overman MJ; Loree JM; Lam M; Morris V; Shureiqi I; Kee B; Dasari A; Vilar E; Mehvarz Sarshekeh, A; LIN, HK; Manuel S; Hamilton S; Raghav K; Maru, D; Kopetz, S; Wang, XS

Category: Survivorship & Health Outcomes/Comparative Effectiveness Research
Conference Year: 2020

Abstract Body:
Purpose: Survival in metastatic CRC (mCRC) is influenced by genetic and epigenetic changes that might influence patient’s experience of symptom burden. Understanding the association of molecular changes with symptom burden can help clinicians gain insight into molecular basis of symptom burden and improve tolerance of treatments. To date, no studies have compared patient-reported symptom burden with these molecular subsets among mCRC patients. Methods: We recruited mCRC patients refractory to at least one line of therapy and enrolled in the Assessment of Targeted Therapies Against Colorectal Cancer (ATTACC) trial at The University of Texas MD Anderson Cancer Center. All patients completed a baseline gastrointestinal symptom inventory (MD Anderson Symptom Inventory-GI). Symptom burden across key demographics and molecular changes including CRC associated mutations, microsatellite instability (MSI) status, and the CpG island methylator phenotype (CIMP) were compared using chi-square tests. Association of symptom burden with overall survival was examined using Cox regression models. Results: Patients with MSI-High phenotype reported greater pain (OR:3.06[95% confidence interval:1.61,5.84]), fatigue (OR=2.78[95% CI=1.41,5.49]), sleep (OR=2.52 [95%CI=1.32, 4.08]); and drowsiness (OR=2.51 [95% CI=1.32,4.78]) compared to microsatellite stable (MSS) patients. Patients with MSI-H phenotype also reported higher odds of overall symptom burden (OR=2.48 [95% CI=1.29,4.74]) compared to MSS patients. CIMP-high patients reported higher odds of pain than CIMP-negative patients (OR=1.72 [95%CI=1.06, 2.80]). Higher overall symptom burden was associated with poor overall survival (hazard ratio: 1.42 [95% CI:0.98,2.06]), though not-significant(p=0.06). Conclusion: Correlation of MSI-H associated tumor features with symptom burden may help provide better understanding of underlying mechanisms associated with our findings

Keywords: Symptom burden, Colorectal, Patient reported outcomes, Microsatellite Instability; Epigenetics