The prognostic role of quality-of-life assessment in lung cancer.

Abstract

9096 Background: There is accumulating evidence that various quality of life (QoL) domains provide information on patient longevity independent of known prognostic factors. We investigated whether QoL functional domains and symptom items could identify lung cancer patients at high or low risk of treatment failure. Methods: 1,194 lung cancer patients treated at two single-system cancer centers between Jan 2001 and Dec 2008. QoL was evaluated prior to initiation of treatment using EORTC-QLQ-C30 which incorporates a global, 5 functional and 9 symptom scales. Univariate and multivariate Cox regression analyses evaluated survival. Results: Mean age at presentation was 58.3 years. There were 605 analytic (newly diagnosed) and 589 non-analytic patients (recurrent disease); 601 males and 593 females. Stage of disease at diagnosis was I, 100; II, 63; III, 348; IV, 656; and 27 indeterminate. Median overall survival was 8.8 months (95% CI: 8.0-9.5). Mean global QoL score was 53.8 and 53.1 for locoregional and metastatic disease (p=0.63) and 56.1 and 50.9 for analytic and non-analytic disease (p=0.001). On univariate analysis, QoL scales predictive of survival were physical (p<0.001), role (p<0.001), emotional (p=0.04), cognitive (p=0.003), social (p<0.001), fatigue (p<0.001), nausea/vomiting (p=0.001), pain (p<0.001), dyspnea (p<0.001), loss of appetite (p<0.001), constipation (p=0.001) and diarrhea (p=0.02). Upon multivariate analyses, only physical function (p<0.001), pain (p=0.05) and insomnia (p=0.03) were predictive of survival independent of other QoL scales, age, gender, stage, and treatment history. Higher stage of disease, prior treatment history and male gender predicted worse survival (p <0.001 for all). Physical function, nausea/vomiting, insomnia, and diarrhea (p<0.05 for all) in analytic patients while only physical function (p<0.001) in nonanalytic patients were independently predictive of survival. Conclusions: In newly diagnosed patients, a cluster of symptoms—insomnia, nausea/vomiting and diarrhea—identified patients at high risk for treatment failure. While this symptom cluster was uninformative in patients with recurrent disease, low physical function identified patients at high risk of treatment failure. No significant financial relationships to disclose.