Pretreatment Quality of Life Is an Independent Prognostic Factor for Overall Survival in Patients with Advanced Stage Non-small Cell Lung Cancer

Abstract

Hypothesis We conducted this pooled analysis to assess the prognostic value of pretreatment Quality of Life (QOL) assessments on overall survival (OS) in advanced non-small cell lung cancer (NSCLC). Methods Four hundred twenty patients with advanced NSCLC (stages IIIB with pleural effusion and IV) from six North Central Cancer Treatment Group trials were included in this study. QOL assessments included the single-item Uniscale (355 patients), Lung Cancer Symptom Scale (217 patients), and Functional Assessment of Cancer Therapy-Lung (197 patients). QOL scores were transformed to a 0 to 100 scale with higher scores representing better status and categorized using the sample median or clinically deficient score (CDS, ≤50 versus >50). Cox proportional hazards models stratified by study were used to evaluate the prognostic importance of QOL on OS alone and in the presence of other prognostic factors such as performance status, age, gender, body mass index, and laboratory parameters. Results Pretreatment QOL accessed by Uniscale was significantly associated with OS univariately (p < 0.0001). Uniscale (p < 0.0001; hazard ratio = 1.6 for the sample median and 2.0 for the CDS categorization) and body mass index were the only significant predictors of OS multivariately. The median survival of patients who had a Uniscale score less than or equal to the CDS (≤50) was 5.7 versus 11.1 months for the >50 group; and 7.8 versus 13 months for the less than or equal to sample median (≤83) group and >83 group, respectively. The Lung Cancer Symptom Scale and the Functional Assessment of Cancer Therapy-Lung total scores were not significant predictors of OS. Conclusions Pretreatment QOL measured by Uniscale is a significant and an independent prognostic factor for OS, and QOL should be routinely integrated as a stratification factor in advanced NSCLC trials.

Comparing Effectiveness with Efficacy: Outcomes of Palliative Chemotherapy for Non-Small-Cell Lung Cancer in Routine Practice

“…Survival duration was significantly shorter for patients with the poorest well-being before treatment than for those with the best well-being (poorest: 22 weeks; 95% ci: 18 weeks to 27 weeks; best: 37 weeks; 95% ci: 31 weeks to 44 weeks). That observation is consistent with the results of previous studies that have shown the prognostic value of pretreatment qol 31 .…”

Do age and quality of life of patients with cancer influence quality of life of the caregiver?

“…Patients were categorized according to LASA overall QOL scores (≤50 vs >50). Previous research has indicated that this cutoff, as measured by the visual analog Spritzer Uniscale, is a prognostic factor (27). As the linear analog scale has been shown to be comparable to the visual analog scale, this categorization is valid in this study (28).…”

Health-related quality of life and cancer clinical trials

“…Baseline global QOL was a strong independent predictor of survival in patients with advanced CRC in one study [Maisey et al 2002], while in another study, the patient's score on the social functioning scale translated into a 9% decrease in the patient's hazard of death for any 10-point increase in the score (0 to 100 scale) [Efficace et al 2008[Efficace et al , 2006a. A correlation between various pretreatment PRO domain scores, including overall quality of life [Qi et al 2009], global quality of life [Movsas et al 2009 [Roychowdhury et al 2003] and total quality of life score in metastatic HRPC [Sullivan et al 2006] and in localized prostate cancer [Sadetsky et al 2009] have been associated with survival.…”