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Abstract
BackgroundWe aimed to evaluate the prognostic value of quality of life (QOL) for predicting survival among disease-free survivors of surgically-treated lung cancer after the completion of cancer treatment.MethodsWe administered the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30), the Quality of Life Questionnaire Lung Cancer Module (QLQ-LC13), Hospital Anxiety and Depression Scale (HADS), and Posttraumatic Growth Inventory (PTGI) to 809 survivors who were surgically-treated for lung cancer at two hospitals from 2001 through 2006. We gathered mortality data by linkage to the National Statistical Office through December 2011. We used Cox proportional hazard models to compute adjusted hazard ratios (aHRs) and 95 % confidence intervals (CIs) to estimate the relationship between QOL and survival.ResultsAnalyses of QOL items adjusted for age, sex, stage, body mass index, and physical activity showed that scores for poor physical functioning, dyspnea, anorexia, diarrhea, cough, personal strength, anxiety, and depression were associated with poor survival. With adjustment for the independent indicators of survival, final multiple proportional hazard regression analyses of QOL show that physical functioning (aHR, 2.39; 95 % CI, 1.13–5.07), dyspnea (aHR, 1.56; 95 % CI, 1.01–2.40), personal strength (aHR, 2.36; 95 % CI, 1.31–4.27), and anxiety (aHR, 2.13; 95 % CI, 1.38–3.30) retained their independent prognostic power of survival.ConclusionThis study suggests that patient-reported QOL outcomes in disease-free survivors of surgically-treated lung cancer after the completion of active treatment has independent prognostic value for long-term survival.
Highlights
We aimed to evaluate the prognostic value of quality of life (QOL) for predicting survival among disease-free survivors of surgically-treated lung cancer after the completion of cancer treatment
Univariate analyses and adjusted proportional hazard regression analyses of QOL, Posttraumatic Growth Inventory (PTGI), and Hospital Anxiety and Depression Scale (HADS) Table 2 summarizes the multiple proportional hazard regression analyses using a backward feature selection method with variables that were significant in the univariate analyses showing that age, sex, stage of cancer, monthly income, alcohol drinking (BMI) of overweight indicator, and physical activity (PA) showed that the scores of physical functioning, dyspnea, anorexia, diarrhea, and cough for the problematic group were associated with poor survival
Final multiple proportional hazard regression analyses of QOL adjusted for independent demographic and clinical indicators of survival After adjustment for independent demographic and clinical indicators of survival, the final multiple proportional hazard regression analyses of QOL showed that physical functioning and dyspnea from the EORTC QLQC30, personal strength from the PTGI, and anxiety
Summary
We aimed to evaluate the prognostic value of quality of life (QOL) for predicting survival among disease-free survivors of surgically-treated lung cancer after the completion of cancer treatment. Studies regarding the prognostic value of QOL have primarily focused on QOL at the time of the diagnosis or treatment at baseline [13,14,15,16,17,18,19]. Prior analyses have shown that QOL is an important prognostic factor in patients with advanced lung cancer [12, 20,21,22,23,24]. Measured QOL at the time of the diagnosis or clinical treatment trials, and no published studies have focused on the predictive value of QOL for long-term survival in disease-free lung cancer survivors after the completion of cancer treatment. The identification of prognostic factors might help clinicians to correctly survey individuals at highest risk for
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