Abstract
This study examines the prognostic value of clinical assessments, including a 3-fold classification of cancer patients by treatment intention. It is based upon a sample of 253 patients with different cancer diagnoses who filled out a 108-item questionnaire. Cox regression analysis (the proportional hazards model) was used to analyse the relationship of the three groups of covariates (clinical, demographic and psychosocial) with survival. The univariate analysis showed that several clinical, demographic and psychosocial covariates are significantly related to survival. The study located two main prognostic factors: the 3-fold classification by treatment intention being the most important one, followed by physical functioning which may be seen as a proxy for performance status. Several additional covariates including psychosocial ones were related to survival when considered separately. However, their effects disappeared when controlling for treatment intention and physical functioning. Thus, the additional psychosocial covariates did no add to the prognostic value of the model.
Highlights
Many cancer treatments used today are unpleasant and the burden they place on the patients may not be compensated for by a longer survival time (Baum et al, 1990). Kaasa (1993) reports for instance, that it is not unusual to offer curative treatment to patients with inoperable non-small-cell lung cancer, for which the 5 year survival is 1-2% independent of treatment modality
The classification most closely associated with prognosis is, according to Hermanek et al (1990), the anatomical extent or stage of disease, which is defined according to the T(umour) N(odes) M(etastasis) Classification of Cancer (UICC, 1992)
The main purpose of this paper is to evaluate the prognostic value of a 3-fold classification of cancer patients by treatment intention compared with a number of other clinical, demographic and psychosocial factors
Summary
Many cancer treatments used today are unpleasant and the burden they place on the patients may not be compensated for by a longer survival time (Baum et al, 1990). Kaasa (1993) reports for instance, that it is not unusual to offer curative treatment to patients with inoperable non-small-cell lung cancer, for which the 5 year survival is 1-2% independent of treatment modality. No agreement exists on a definition of curable or non-curable cancer diseases or how to treat the different patient groups (Kaasa, 1993). The main purpose of this paper is to evaluate the prognostic value of a 3-fold classification of cancer patients by treatment intention compared with a number of other clinical, demographic and psychosocial factors. The following research questions will be pursued: Is the classification into three groups by treatment intention significantly related to survival of cancer patients? Are other clinical factors such as treatment modality significantly related to survival of cancer patients? Are demographic factors such as age, marital status and having children significantly related to the survival of cancer patients? Are psychosocial factors such as general quality of life, anxiety and depression, hopelessness and religiosity significantly related to the survival of cancer patients? The following research questions will be pursued: Is the classification into three groups by treatment intention significantly related to survival of cancer patients? Are other clinical factors such as treatment modality significantly related to survival of cancer patients? Are demographic factors such as age, marital status and having children significantly related to the survival of cancer patients? Are psychosocial factors such as general quality of life, anxiety and depression, hopelessness and religiosity significantly related to the survival of cancer patients?
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