ESMO 2017: Association between biopsychosocial distress and overall survival in patients with metastatic renal cell carcinoma

Madrid, Spain ( Dr. Bergerot and colleagues presented their study assessing biopsychosocial distress and overall survival (OS) among patients with metastatic renal cell carcinoma (mRCC). Previous studies have found that depressive symptoms are associated with poorer OS in patients with mRCC [1]. In other malignancies, biopsychosocial distress has also been linked to poorer OS, but in mRCC, this association is unclear. The objective of this study was to perform a single institutional assessment of rates and types of distress and evaluating the association between distress and OS.

Clinicopathologic information from patients with mRCC diagnosed between 2001 and 2016 were collected. Corresponding data from an electronic survey tool was obtained, comprised of 22 core items spanning physical, practical, functional and emotional domains. Each item was self-assessed by the patient on a 5-point Likert scale. The cumulative score was used to characterize biopsychosocial distress as either low biopsychosocial distress (not a problem/mild) vs high biopsychosocial distress (moderate/severe/very severe). Associations between biopsychosocial distress level and clinicopathologic criteria (e.g. Heng risk) were interrogated, and OS was compared between patients characterized with low biopsychosocial distress vs high biopsychosocial distress.

A total of 102 patients (28.4% F/71.6% M) were assessed with a median age of 63 (range 24-80) years. 73.4% and 26.6% patients were characterized as having good/intermediate and poor risk by Heng criteria, respectively. Additionally, 79.3% and 20.7% patients were characterized as having low and high biopsychosocial distress, respectively. No association was found between biopsychosocial distress and age or gender, however married patients had longer survival (49 vs 35 months, p=0.07). Patients with poor risk mRCC were noted to have a higher biopsychosocial distress as compared to patients with mild biopsychosocial distress (75% vs 25%, p=0.22). Median OS in the overall cohort was 44.2 months. Although not statistically significant, a trend towards prolonged OS in patients with low biopsychosocial distress vs high biopsychosocial distress was observed (46 vs 36 months, p=0.09).

The authors concluded that their results suggest a potential link between Heng risk and biopsychosocial distress, with a compelling trend towards poorer OS in patients with higher biopsychosocial distress. These results warrant confirmation using multivariable adjusted models and in larger series. Targeted interventions to address elements related to biopsychosocial distress have the potential to improve patient outcomes and should be developed.

Speaker: Cristiane D. Bergerot, City of Hope Comprehensive Cancer Center, Duarte, United States of America

Co-Authors: K. L. Clark (Duarte, United States of America) K. T. Ashing (Duarte, United States of America) L. Almeida (Duarte, United States of America) P. G. Bergerot (Duarte, United States of America) R. Obenchain (Duarte, United States of America) N. Dizman (Duarte, United States of America) J. Hsu (Duarte, United States of America) M. C. Maia (Duarte, United States of America) E. Philip (Notre Dame, United States of America) M. Loscalzo (Duarte, United States of America) S. K. Pal (Duarte, United States of America)

Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, Twitter: @zklaassen_md at the European Society for Medical Oncology Annual Congress - September 8 - 12, 2017 - Madrid, Spain


Prinsloo S, Wei Q, Scott SM, et al. Psychological states, serum markers and survival: Associations of predictors of survival in patients with renal cell carcinoma. J Behav Med 2015;38(1):48-56.