Abstract
BackgroundHealth-related quality of life and survival are two important outcome measures in cancer research and practice. The aim of this paper is to examine the relationship between quality of life data and survival time in cancer patients.MethodsA review was undertaken of all the full publications in the English language biomedical journals between 1982 and 2008. The search was limited to cancer, and included the combination of keywords 'quality of life', 'patient reported-outcomes' 'prognostic', 'predictor', 'predictive' and 'survival' that appeared in the titles of the publications. In addition, each study was examined to ensure that it used multivariate analysis. Purely psychological studies were excluded. A manual search was also performed to include additional papers of potential interest.ResultsA total of 451 citations were identified in this rapid and systematic review of the literature. Of these, 104 citations on the relationship between quality of life and survival were found to be relevant and were further examined. The findings are summarized under different headings: heterogeneous samples of cancer patients, lung cancer, breast cancer, gastro-oesophageal cancers, colorectal cancer, head and neck cancer, melanoma and other cancers. With few exceptions, the findings showed that quality of life data or some aspects of quality of life measures were significant independent predictors of survival duration. Global quality of life, functioning domains and symptom scores - such as appetite loss, fatigue and pain - were the most important indicators, individually or in combination, for predicting survival times in cancer patients after adjusting for one or more demographic and known clinical prognostic factors.ConclusionThis review provides evidence for a positive relationship between quality of life data or some quality of life measures and the survival duration of cancer patients. Pre-treatment (baseline) quality of life data appeared to provide the most reliable information for helping clinicians to establish prognostic criteria for treating their cancer patients. It is recommended that future studies should use valid instruments, apply sound methodological approaches and adequate multivariate statistical analyses adjusted for socio-demographic characteristics and known clinical prognostic factors with a satisfactory validation strategy. This strategy is likely to yield more accurate and specific quality of life-related prognostic variables for specific cancers.
Highlights
Health-related quality of life and survival are two important outcome measures in cancer research and practice
In 1985, Cassileth et al studied 359 cancer patients and found no association between social and psychological factors and duration of survival or time to relapse. They did not collect data on health-related quality of life but concluded that, these factors may contribute to the initiation of morbidity, the biology of the disease appears to predominate, overriding the potential influence of life-style and psychosocial variables once the disease process has been established [12]
The findings indicated that changes in the quality of life index, measured by a series of Linear Analog Self Assessment (LASA) scales for physical wellbeing, mood, pain and appetite, were independent prognostic indicators of subsequent survival [13]
Summary
Health-related quality of life and survival are two important outcome measures in cancer research and practice. Patientreported outcome is an 'umbrella term' encompassing any outcome reported by a patient himself or herself based on perception of a disease and its treatment, such as healthrelated quality of life, functional well-being and satisfaction [8]. This approach is currently receiving more attention and many believe it could help both physicians and patients, and even family carers to achieve a better understanding of the treatment outcomes of cancer patients and make appropriate decisions
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