Quality of Life in Vulnerable Older Patients with Metastatic Colorectal Cancer Receiving Palliative Chemotherapy: The Randomized NORDIC9-Study

Gabor Liposits, Henrik Rode Eshøj, Sören Möller, Stine Brændegaard Winther, Halla Skuladottir, Jesper Ryg, Eva Hofsli, Carl Henrik Shah, Laurids Østergaard Poulsen, Åke Berglund, Camilla Qvortrup, Pia Österlund, Bengt Glimelius, Halfdan Sorbye, Per Pfeiffer

Research output: Contribution to journalArticleScientificpeer-review


Quality of life data from randomized trials are lacking in older patients with metastatic colorectal cancer (mCRC). In the randomized NORDIC9-study, reduced-dose S1+oxaliplatin (SOx) showed superior efficacy compared to full-dose S1 monotherapy. We hypothesized that treatment with SOx does not result in inferior quality of life. Patients with mCRC aged ≥ 70 years and that were not a candidate for standard combination chemotherapy were included and randomly as-signed to receive either S1 or SOx. The EORTC QLQ-C30 questionnaire was completed at baseline, after 9, and 18 weeks. The primary endpoint was global Quality of Life (QoL) at 9 weeks. For statistical analysis, a non-inferiority design was chosen applying linear mixed effects models for repeated measurements. The results were interpreted according to statistical significance and anchor-based, clinically relevant between-group minimally important differences (MID). A total of 160 patients aged (median (Interquartile range (IQR))) 78 years (76–81) were included. The QLQ-C30 questionnaire was completed by 150, 100, and 60 patients at baseline, at 9, and 18 weeks, respectively. The difference at 9 weeks in global QoL was 6.85 (95%CI-1.94; 15.65) and 7.37 (0.70; 14.05) in the physical functioning domain in favor of SOx exceeding the threshold for MID. At 18 weeks, the between-group MID in physical functioning was preserved. Dose-reduced combination chemotherapy may be recommended in vulnerable older patients with mCRC, rather than full-dose monotherapy.

Original languageEnglish
Article number2604
Issue number11
Publication statusPublished - 2021
Publication typeA1 Journal article-refereed


  • Chemotherapy
  • Geriatric oncology
  • Metastatic colorectal cancer
  • Older adults
  • Physical functioning
  • Quality of life
  • Vulnerability

Publication forum classification

  • Publication forum level 1

ASJC Scopus subject areas

  • Oncology
  • Cancer Research


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