Results of an European Organization for Research and Treatment of Cancer (EORTC) study, published online on 11 October 2013 in the journal Cancer, point out the prognostic value of baseline recorded health-related quality of life for survival in eleven types of cancer: brain, breast, colorectal, oesophageal, head and neck, lung, melanoma, ovarian, pancreatic, prostate, and testicular cancer. For each cancer type, at least one health-related, quality-of-life parameter provided additional prognostic information over and above the clinical and socio-demographic variables.
According to background information in the study article and Dr Andrew Bottomley, EORTC Headquarters Associate Director, this study utilised a single, standardised and validated patient self-assessment tool, the EORTC Core Quality of Life Questionnaire (QLQ-C30). The study investigators on behalf of Patient Reported Outcomes and Behavioral Evidence (PROBE) and the EORTC Clinical Groups, with Chantal Quinten, MSc as first author, selected thirty EORTC randomised, controlled trials which involved eleven different cancer types for this study. This effort included questionnaires completed by 7417 patients prior to their being randomised into one of these studies.
Parameters predictive for survival
The health-related, quality-of-life parameters that were found to be predictive for survival were:
- cognitive functioning for brain cancer
- physical functioning, emotional functioning, global health status, and nausea and vomiting for breast cancer
- physical functioning, nausea and vomiting, pain, and appetite loss for colorectal cancer
- physical functioning and social functioning for oesophageal cancer
- emotional functioning, nausea and vomiting, and dyspnoea for head and neck cancer
- physical functioning and pain for lung cancer
- physical functioning for melanoma
- nausea and vomiting for ovarian cancer
- global health status for pancreatic cancer
- role functioning and appetite loss for prostate cancer
- role functioning for testicular cancer
Models were adjusted for age, sex, and World Health Organization performance status, and were stratified by distant metastasis. The authors concluded that for each cancer type, univariate and multivariate Cox proportional hazards modelling was used to assess the prognostic value (p < 0.05) of 15 health-related, quality-of-life parameters for each cancer site.
The corresponding news that accompanied release of this article is written by John Bean, PhD, EORTC Medical Science Write.
This EORTC research was supported by an unrestricted grant from the Pfizer Foundation, the EORTC Charitable Trust, and by the United States of America National Cancer Institute. One of the authors, Divine E. Ediebah was supported by a Belgian Cancer Foundation Grant.
Quinten C, Martinelli F, Coens C, et al. A global analysis of multitrial data investigating quality of life and symptoms as prognostic factors for survival in different tumor sites. Cancer 2013 Oct 11. doi: 10.1002/cncr.28382. [Epub ahead of print].