Quality of Life Plays Role in Cancer Outcomes

[CaroleHammett]

Those of you who know me also know that I believe strongly that Quality of Life is not only the most important factor in my decision-making regarding the rest of my life, but also that it can improve survival rates drastically. The following article (along with many others) confirms my opinions and I do plan (sometime in the near future) to post a series of past articles and studies on this subject. In the meantime:

http://www.oncologystat.com/home/news/T ... es_GL.html

Two Meta-analyses Show That Quality of Life Plays Role in Cancer Outcomes

Elsevier Global Medical News. 2008 Jun 17, K Wachter

CHICAGO (EGMN) - Feeling better overall translates to better survival for cancer patients, based on the results of two studies presented at the annual meeting of the American Society of Clinical Oncology and involving more than 10,000 cancer patients.

Researchers in the United States and Europe concluded that baseline quality of life (QoL) is an important predictor of outcome for cancer patients.

In a meta-analysis of 24 trials involving 3,704 patients, the median survival for patients with an overall QoL score of 50 or less (on a 0-100 scale) was 9.2 months, compared with 16.8 months for patients with scores greater than 50 (P = .0001), reported Jeff A. Sloan, Ph.D., a professor of oncology and biostatistics at the Mayo Clinic in Rochester, Minnesota.

In the second study of 7,417 cancer patients, adding baseline QoL data to clinical data in Cox hazard models improved predictive accuracy from 68% to 72%, reported Chantal Quinten, a researcher with the quality of life department of the European Organization for Research and Treatment of Cancer (EORTC) in Brussels.

"These large investigations confirm the relationship between quality of life and survival, and I think it's imperative that all of us who work in the clinical trials arena push for quality of life as a stratification factor," said Dr. Jamie H. Von Roenn, a professor of medicine in the division of hematology/oncology at Northwestern University, Chicago, who discussed the two studies.

For the first study, Dr. Sloan and his colleagues gathered data from the large Mayo Clinic and U.S.-based North Central Cancer Treatment Group (NCCTG) clinical trials treatment and cancer control study databases. Studies included gastrointestinal cancer treatment studies, cancer control studies, lung cancer treatment studies, and QoL assessment studies. The analysis was stratified by study type and patient population.

Overall QoL was assessed at baseline using a 0-100 scale. Overall survival - for the whole study group and by study - was tested for association with overall QoL. Scores were divided into two ranges: clinically deficient (0-50) and not clinically deficient (51-100). Cox proportional hazards models were adjusted for performance score, race, study site, age, and gender.

Most of the patients (91%) were white. The median age was 63 years, and two-thirds were men. Most patients (76%) had performance scores of 0-1. The most common major tumor site was gastrointestinal (62%), followed by lung (16%), breast (7%), and genitourinary (5%). The remainder was other or unknown. Most patients (86%) rated their overall QoL in the 51-100 range. The median score was 83.

Only 5% of 506 patients with scores between 0-50 lived beyond 3 years, compared with 10% of the 3,198 patients in the higher QoL group. Likewise, just 12% of those in the lower QoL group lived beyond 2 years, compared with 24% of those in the higher QoL group. "Results for GI, GU, lung, and breast cancer patients all indicated survival deficits among patients who reported clinically-deficient baseline quality of life," said Dr. Sloan, who presented the study for Angelina Tan of the biostatistics department at the Mayo Clinic.

A QoL score of 50 or less resulted in a hazard ratio of 1.56 (P less than .001), after controlling for performance score, age, race, and tumor type. A performance score of 1-2 (compared with a score of 0) resulted in a hazard ratio of 1.77 (P less than .001).

"Even after controlling for all these other factors, the indication of a clinically deficient baseline quality of life score contributed significantly to the prediction of patient survival," said Dr. Sloan. "As a screening tool in clinical practice or a stratification variable in clinical trials, the single-item assessment can be the trigger that launches a further and more comprehensive investigation to uncover the specific quality of life deficit and/or [to initiate] appropriate clinical intervention."

The study authors reported that they have no conflicts of interest.

In the second study, Ms. Quinten and her colleagues pooled data from 29 EORTC trials, involving more than 10,108 patients. Full baseline QoL data were available for 7,417 patients.

The EORTC QLQ-C30 questionnaire was used in these studies to assess quality of life. The questionnaire is a multidimensional, symptom-based tool, consisting of 30 items that the patient assesses on a scale of 1-4. These data were transformed to 15 QoL parameters with continuous scales of 0-100. The parameters include fatigue, pain, nausea/vomiting, dyspnoea, appetite loss, constipation, diarrhea, financial difficulties, insomnia, physical functioning, role functioning, cognitive functioning, emotional functioning, social functioning, and global health status. A 10-point difference is considered to be a clinically important difference.

The researchers also considered the prognostic value of some clinical characteristics, including performance status, age, gender, and the presence of distant metastases. The researchers used three models: clinical variables only, clinical and QoL variables, and a frailty analysis

Looking at clinical variables alone, investigators found that patients who had a World Health Organization performance score of 2-3, age greater than 60 years, metastases, and male gender had a greater risk of dying. In the second model (clinical and QoL variables), the QoL parameters of physical functioning, pain, and appetite loss also provided prognostic value. Notably, performance status was no longer prognostic in this model. In the frailty model that included clinical and QoL data, the parameters of physical functioning, pain, and appetite loss were still prognostic.

"The model, which includes clinical data and quality of life data, is better able to predict survival of cancer patients," said Ms. Quinten. "The quality of life parameters [of pain, physical functioning, and appetite loss] provide prognostic information beyond clinical measures."

Ms. Quinten reported that she had no relevant financial relationships.

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Carole