Simple Symptom Questionnaires Could Help Predict Leukemia Survival, Study Finds

Patients' answers to questions routinely asked by oncologists may offer important clues about their chances of survival from chronic lymphocytic leukemia (CLL), a slow-growing blood cancer, according to a new study published in the journal Therapeutic Advances in Hematology. The research suggests that systematically evaluating what patients say about their symptoms and daily functioning can help predict outcomes and identify people at higher risk.

The study pooled individual patient data from 1,238 people with CLL enrolled in three major international randomized clinical trials, reanalyzing outcomes from ibrutinib-based treatment strategies. Before treatment, participants completed a widely used cancer quality-of-life questionnaire covering physical functioning, fatigue, pain, shortness of breath and social functioning. Rather than simply labelling answers "high" or "low," the researchers applied internationally recognized thresholds to identify problems severe enough to be clinically meaningful.

About three out of four patients reported at least one area of poor functioning or symptom burden before starting therapy, the authors found, and those with five or more impaired areas had a higher chance of severe side effects and shorter overall survival. Poor physical functioning emerged as the strongest predictor of adverse outcomes. "A large proportion of patients entering clinical trials had meaningful functional or symptom burdens that could be identified simply by asking them directly," said Dr. Ahmad Y. Abuhelwa, associate professor of pharmacotherapeutics at the University of Sharjah and the study's lead author.

In 2021, more than 721,000 people were living with CLL worldwide, and deaths attributed to the disease rose from 29,278 in 1990 to 45,573 in 2021. The study, an international collaboration involving Harvard Medical School, the University of South Florida, Jordan University of Science and Technology, Flinders University and institutions in Qatar and the United Arab Emirates, describes itself as the first comprehensive evaluation of clinically important patient-reported outcomes in CLL, using thresholds derived from a widely used cancer quality-of-life questionnaire.

Abuhelwa said a short patient questionnaire before treatment could help clinicians identify vulnerable patients who may need closer monitoring or more individualized care, but cautioned that treatment decisions should not currently be made solely on questionnaire scores. "The results require prospective validation before a specific patient-reported outcome threshold can be considered a stand-alone clinical decision-making tool," he said.