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Is quality of life predictive of the survival of patients with advanced nonsmall cell lung carcinoma?
Author(s) -
Herndon James E.,
Fleishman Stewart,
Kornblith Alice B.,
Kosty Michael,
Green Mark R.,
Holland Jimmie
Publication year - 1999
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/(sici)1097-0142(19990115)85:2<333::aid-cncr10>3.0.co;2-q
Subject(s) - medicine , quality of life (healthcare) , lung cancer , proportional hazards model , performance status , oncology , multivariate analysis , carcinoma , hazard ratio , clinical trial , univariate analysis , cancer , confidence interval , nursing
BACKGROUND Several studies have recently reported on the importance of quality of life (QOL) in predicting the survival of patients with lung carcinoma. To confirm these reports, the relationship between survival and QOL, as measured by the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire and Duke‐UNC Social Support Scale, was examined within a group of 206 patients with advanced nonsmall cell lung carcinoma treated in a randomized clinical trial conducted by the Cancer and Leukemia Group B (CALGB 8931). METHODS Patients completed the EORTC instrument and the Duke‐UNC Social Support Scale at baseline in the clinic. The Cox proportional hazards model was used to determine the incremental contribution QOL provided in predicting survival beyond the effect of known clinical prognostic variables. RESULTS Clinical factors that were jointly predictive of poorer survival included low performance status, nonadenocarcinoma histology, presence of dyspnea, weight loss greater than 5%, albumin level less than 3.5 mg/dL, and adrenal metastases. Univariate analyses showed that patient‐reported EORTC subscales describing increased pain, appetite loss, fatigue, lung carcinoma symptoms, poorer overall QOL, and poorer physical functioning predicted significantly poorer survival. Multivariate analyses showed that, after adjustment for clinical factors, overall QOL was not a significant predictor of survival. Rather, the only EORTC subscale of prognostic importance was the pain subscale, in which a 40‐point increase was associated with a 27% increase in the hazard rate. CONCLUSIONS This study did not confirm the prognostic importance of overall QOL. Rather, after adjustment for significant clinical factors, a patient‐provided pain report had the greatest prognostic importance. Cancer 1999;85:333–40. © 1999 American Cancer Society.