Quality of life assessment in clinical oncology: Implications for prognosis in advanced colorectal cancer

Abstract

3699 Background: Quality of Life (QoL) assessment is important to evaluate the impact of disease and treatment in patients with advanced cancer. Recently, it has been hypothesized that QoL may also have a prognostic role in cancer, however, there is little evidence in the literature to support this view. To further investigate this issue, we evaluated the prognostic significance of baseline QoL in patients with advanced colorectal cancer. Methods: We examined a case series of 31 histologically confirmed stages III and IV colorectal cancer patients treated at Cancer Treatment Centers of America at Midwestern Regional Medical Center between March 2001 and January 2003. Two fundamentally different QoL tools were utilized in this study. The EORTC QLQ-C30 (EORTC) emphasizes the patient's capacity to fulfill the activities of daily living, while the Ferrans and Powers Quality of Life Index (QLI) highlights the level of patient satisfaction with life. Study patients were dichotomized into two groups based on the median scores for all QoL domains for both the EORTC and QLI. Kaplan Meier method was used to calculate survival. Log-Rank test was used to study the equality of survival distributions. Results: Patients with high global health EORTC scores had a median survival of 21.2 months while those with low scores 13.6 months (p = 0.08). Additional EORTC QoL domains significantly associated with survival included role function (median survival of 13.6 months for low vs. 23.9 for high scores) and social function (median survival of 13.6 months for low vs. 23.9 for high scores), p = 0.09 and 0.06 respectively. For QLI, only health and physical functioning was significantly associated with survival (p = 0.09), with the median survival for low scores being 13.6 months and 21.3 months for high scores. Conclusions: This study suggests that baseline QoL assessment provides useful prognostic information in patients with advanced colorectal cancer. Similar studies in other cancer types with larger sample sizes are needed to further validate the prognostic significance of QoL in advanced cancer. No significant financial relationships to disclose.