Quality of life (QOL) as a predictor of survival in aggressive non-Hodgkin lymphoma (NHL).

Abstract

8059 Background: QOL is predictive of survival in some malignancies. We sought to examine the relationship between QOL and survival in a cohort of newly diagnosed patients with aggressive NHL. Methods: Newly diagnosed lymphoma patients were prospectively enrolled within 9 months of diagnosis in the University of Iowa/Mayo Clinic SPORE Molecular Epidemiology Resource. Patients with aggressive NHL were included in this analysis. Baseline QOL was measured with the Functional Assessment of Cancer Treatment-General scale (FACT-G), which measures 4 QOL domains: physical, social/family, emotional, and functional well-being (WB); a single item Linear Analogue Self Assessment (LASA) for measuring overall QOL; and a LASA measuring spiritual WB. Clinical data were abstracted and patients were systematically followed for overall survival (OS). Cox proportional hazards models were used to evaluate the association between QOL and OS. Results: 169 patients with aggressive NHL and pre-treatment QOL questionnaire were enrolled between 9/02-2/08. Subtype was 52% diffuse large B-cell, 19% mantle cell, 13% T-cell, and 16% other NHL. Median age was 63 years and 53% were male. At a median follow-up of 40 months (range 1-75), 62 patients (37%) had an event and 39 patients (23%) died. In univariate analysis, lower scores for physical WB (HR=0.52, 95% CI 0.32-0.86), functional WB (HR=0.47, 95% CI 0.29-0.76), total FACT-G (HR=0.75, 95% CI 0.62-0.91), spiritual WB LASA (HR=0.85, 95% CI 0.73-0.99), and overall QOL LASA (HR=0.83, 95% CI 0.72-0.96) were associated with inferior OS. After adjusting for the International Prognostic Index (IPI) and subtype in multivariate analysis, only lower total FACT-G and functional WB scores still showed a trend towards an association with inferior OS (FACT-G HR=0.81, 95% CI 0.65-1.01, functional HR=0.58, 95% CI 0.33-1.01). Conclusions: We found evidence that overall and functional QOL measured pre-treatment is predictive of OS in patients with aggressive NHL, although results attenuated after adjustment for IPI. If the association is confirmed, underlying mechanisms need to be identified and whether interventions to increase QOL will also increase OS in patients with aggressive NHL.