TY - JOUR
T1 - Baseline quality of life as a prognostic indicator of survival
T2 - a meta-analysis of individual patient data from EORTC clinical trials
AU - Quinten, Chantal
AU - Coens, Corneel
AU - Mauer, Murielle
AU - Comte, Sylvie
AU - Sprangers, Mirjam AG
AU - Cleeland, Charles
AU - Osoba, David
AU - Bjordal, Kristin
AU - Bottomley, Andrew
N1 - Funding Information:
This study was funded by an unrestricted academic grant from Merck KGaA and partly by the EORTC Charitable Trust and National Cancer Institute grants 2U10CA11488-36 . We thank all the EORTC clinical groups, their clinical investigators, and all the patients who participated in these closed EORTC trials; and Sheila Scott-Sanderson, John Maringwa, and Francesca Martinelli for critically reading and editing the report.
PY - 2009/9
Y1 - 2009/9
N2 - Background: Although individual studies show that baseline health-related quality of life (HRQOL) is a prognostic factor for survival, contradictory results have been published and very few meta-analyses have confirmed the finding. We examined whether HRQOL scores are associated with survival when pooled across a large sample of patients with different disease sites. Methods: We selected 30 randomised controlled trials from the European Organisation for Research and Treatment of Cancer (EORTC) started between 1986 and 2004, which included survival data for 10 108 patients with 11 different cancer sites. Patients were eligible for inclusion if they had completed a baseline HRQOL assessment with the EORTC core quality of life questionnaire (QLQ-C30; n=7417). Sociodemographic variables were age (≤60 vs >60 years) and sex (men vs women), and clinical variables were WHO performance status (0-1 vs 2-3), distant metastases (no vs yes), and cancer site. We assessed prognostic significance of sociodemographic and clinical variables and the 15 QLQ-C30 scales with Cox proportional hazard models. Findings: In the stratified multivariate model including sociodemographic, clinical, and HRQOL data, the HRQOL parameters of physical functioning (hazard ratio 0·94, 95% CI 0·92-0·96; p<0·0001), pain (1·04, 1·02-1·06; p<0·0001), and appetite loss (1·05, 1·03-1·06; p<0·0001) provided significant prognostic information in addition to the parameters age (1·17, 1·06-1·28; p=0·0001), sex (0·74, 0·67-0·82; p<0·0001), and distant metastases (1·70, 1·49-1·93; p<0·0001), but not for WHO performance status (1·07, 0·97-1·19; p=0·11). Consideration of the three HRQOL parameters and sociodemographic and clinical data increased the predictive accuracy of prognosis of overall survival by 6% relative to sociodemographic and clinical characteristics alone (C statistic for concordance between predicted and observed overall survival 0·68 for sociodemographic and clinical variables, and 0·72 for sociodemographic, clinical, and HRQOL variables). Interpretation: The results suggest that HRQOL scales provide prognostic information in addition to that of sociodemographic and clinical measures. This study shows that HRQOL data can help to predict survival in patients with cancer. Funding: Merck KGaA, EORTC Charitable Trust, and National Cancer Institute.
AB - Background: Although individual studies show that baseline health-related quality of life (HRQOL) is a prognostic factor for survival, contradictory results have been published and very few meta-analyses have confirmed the finding. We examined whether HRQOL scores are associated with survival when pooled across a large sample of patients with different disease sites. Methods: We selected 30 randomised controlled trials from the European Organisation for Research and Treatment of Cancer (EORTC) started between 1986 and 2004, which included survival data for 10 108 patients with 11 different cancer sites. Patients were eligible for inclusion if they had completed a baseline HRQOL assessment with the EORTC core quality of life questionnaire (QLQ-C30; n=7417). Sociodemographic variables were age (≤60 vs >60 years) and sex (men vs women), and clinical variables were WHO performance status (0-1 vs 2-3), distant metastases (no vs yes), and cancer site. We assessed prognostic significance of sociodemographic and clinical variables and the 15 QLQ-C30 scales with Cox proportional hazard models. Findings: In the stratified multivariate model including sociodemographic, clinical, and HRQOL data, the HRQOL parameters of physical functioning (hazard ratio 0·94, 95% CI 0·92-0·96; p<0·0001), pain (1·04, 1·02-1·06; p<0·0001), and appetite loss (1·05, 1·03-1·06; p<0·0001) provided significant prognostic information in addition to the parameters age (1·17, 1·06-1·28; p=0·0001), sex (0·74, 0·67-0·82; p<0·0001), and distant metastases (1·70, 1·49-1·93; p<0·0001), but not for WHO performance status (1·07, 0·97-1·19; p=0·11). Consideration of the three HRQOL parameters and sociodemographic and clinical data increased the predictive accuracy of prognosis of overall survival by 6% relative to sociodemographic and clinical characteristics alone (C statistic for concordance between predicted and observed overall survival 0·68 for sociodemographic and clinical variables, and 0·72 for sociodemographic, clinical, and HRQOL variables). Interpretation: The results suggest that HRQOL scales provide prognostic information in addition to that of sociodemographic and clinical measures. This study shows that HRQOL data can help to predict survival in patients with cancer. Funding: Merck KGaA, EORTC Charitable Trust, and National Cancer Institute.
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U2 - 10.1016/S1470-2045(09)70200-1
DO - 10.1016/S1470-2045(09)70200-1
M3 - Article
C2 - 19695956
AN - SCOPUS:69149100083
SN - 1470-2045
VL - 10
SP - 865
EP - 871
JO - The lancet oncology
JF - The lancet oncology
IS - 9
ER -