Patient-Reported Quality of Life Predicts Long-Term Lung Cancer Survival

Patient-reported quality of life (QOL) may have prognostic value for long-term survival in disease-free survivors of surgically treated lung cancer who have completed active treatment, according to research published in BMC Cancer

QOL has been reported as a critical, independent prognostic factor for predicting survival in patients with cancer; however, these studies have often focused on assessing the prognostic value of QOL at the time of diagnosis or treatment baseline, not on its predictive value for long-term survival in disease-free cancer survivors. 

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Thus, researchers led by Young Ho Yun, MD, PhD, Seoul National University (Seoul, South Korea), used data they had previously collected for a 2007 study on patient-reported QOL to evaluate the prognostic value of the measure among patients with lung cancer after treatment completion.  

In that 2007 study, researchers had participants complete a questionnaire about important survivorship factors, including anxiety, depression, and posttraumatic growth. In the current study, they then reviewed the data to investigate how different patient scores correlated with 5-year survival. 

Among the 809 participants included in the study, 96 deaths (11.9%) were reported. The median time from diagnosis to survey completion was 6.0 (±1.24) years, and median survival time was 8.3 (±2.01) years. Researchers then used statistical techniques to construct a model assessing the prognostic strength of QOL scores on long-term survival. 

After adjusting for age, sex, stage, body mass index, and physical activity, researchers found that scores for poor physical functioning, dyspnea, anorexia, diarrhea, cough, personal strength, anxiety, and depression were all associated with diminished lengths of survival. When a final adjustment for the independent indicators of survival was performed, multiple proportional hazard regression analyses of QOL showed that physical functioning (aHR, 2.39; 95% CI, 1.13–5.07), dyspnea (aHR, 1.56; 95% CI, 1.01–2.40), personal strength (aHR, 2.36; 95% CI, 1.31–4.27), and anxiety (aHR, 2.13; 95% CI, 1.38–3.30) each retained its independent prognostic power.

“To the best of our knowledge, this is the first study to report on the prognostic value of QOL scores using a large sample of disease-free survivors with lung cancer after the completion of lung cancer treatment,” authors of the study wrote. “Our findings are consistent with those of other studies that investigated the importance of pretreatment QOL assessment in patients with non-small cell lung cancer.”

They concluded that patient-reported QOL outcomes after treatment completion for lung cancer may have prognostic value for long-term survival and that assessments of QOL should be incorporated into routine oncology clinical practice. 

The study was limited in regards to the interpretation and generalization of data. Only disease-free patients who survived at least 1 year after surgery were selected for study inclusion, which means that the study cohort may not represent the general population of lung cancer survivors. Additionally, any changes in QOL over time were not recorded and could have affected survival. Lastly, the study only addressed overall mortality, not cancer-specific mortality. Future studies should look to include cancer-specific mortality and non-cancer mortality to better show the prognostic value of QOL in lung cancer.—Sean McGuire

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Yun YH, Kim YA, Sim JA, et al. Prognostic value of quality of life score in disease-free survivors of surgically-treated lung cancer. BMC
Cancer
. 2015;16:505. doi: 10.1186/s12885-016-2504-x.