Abstract
Background: Our purpose was to evaluate associations between health-related quality of life (HRQoL) and overall survival (OS) in a population-based sample of kidney cancer (KC) patients in the US. Methods: We analyzed a longitudinal cohort (n = 188) using the Surveillance, Epidemiology, and End Results (SEER) database linked with the Medicare Health Outcomes Survey (MHOS; 1998–2014). We included KC patients aged ≥65 years, with a completed MHOS during baseline (pre-diagnosis) and another during follow-up (post-diagnosis). We reported HRQoL as physical component summary (PCS) and mental component summary (MCS) scores and OS as number of months from diagnosis to death/end-of-follow-up. Findings were reported as adjusted hazard ratios (aHRs (95% CI)) from Cox Proportional Hazard models. Results: The aHRs associated with a 3-point lower average (baseline and follow-up) or a 3-point within-patient decline (change) in HRQoL with OS were: (a) baseline: PCS (1.08 (1.01–1.16)) and MCS (1.09 (1.01–1.18)); (b) follow-up: PCS (1.21 (1.12–1.31)) and MCS (1.11 (1.04–1.19)); and (c) change: PCS (1.10 (1.02–1.18)) and MCS (1.02 (0.95–1.10)). Conclusions: Reduced HRQoL was associated with worse OS and this association was strongest for post-diagnosis PCS, followed by change in PCS and pre-diagnosis PCS. Findings highlight the prognostic value of HRQoL on OS, emphasize the importance of monitoring PCS in evaluating KC prognosis, and contribute additional evidence to support the implementation of patient-reported outcomes in clinical settings.
Highlights
IntroductionHealth-related quality of life (HRQoL), a multidimensional concept representing individuals’ subjective assessment of overall wellbeing [1] is becoming a commonly measured patient-reported outcome (PRO) in oncology clinical trials [2,3,4,5]
This study examined the association of health-related quality of life (HRQoL) with overall survival in older kidney cancer patients aged ≥65 in the United States (US)
The lower average HRQoL pre-diagnosis and post-diagnosis of kidney cancer and a greater decline in physical component summary (PCS) from pre- to post-diagnosis of KC were associated with increased hazard of death
Summary
Health-related quality of life (HRQoL), a multidimensional concept representing individuals’ subjective assessment of overall wellbeing [1] is becoming a commonly measured patient-reported outcome (PRO) in oncology clinical trials [2,3,4,5]. Research in the United States (US), suggests that older kidney cancer patients experience poorer physical HRQoL versus those without cancer, while there is no difference in their mental. Kidney cancer is commonly diagnosed in older individuals (≥60 years) [10], who frequently present with several age-related comorbidities. This may result in decreased functional ability, which affects HRQoL and complicates healthcare management [11]
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