Abstract
Purpose
Health-related quality of life (HRQOL) after cancer diagnosis is prognostic for overall survival (OS). However, no studies have assessed if HRQOL before diagnosis is predictive for OS. The objective of this study was to determine the association between pre-lung cancer diagnosis HRQOL and OS.
Methods
Our prospective cohort study used surveillance, epidemiology, and end results linked to the Medicare Health Outcomes Survey. We included 6290 individuals 65 years or older diagnosed with incident lung cancer from 1998 to 2013. We assessed the prognostic value of (1) short-form 36 summary component and domain-specific scores, (2) activities of daily living (ADL), and (3) two global HRQOL questions. Cox-proportional hazards models were used to examine associations between HRQOL and OS, adjusting for demographics, comorbid conditions, and clinical characteristics.
Results
Worse pre-diagnosis HRQOL was significantly associated with greater risk of death across HRQOL measures. An above average physical or mental component summary score was associated with 16 and 24% decreases in the hazard of death, respectively (p < 0.0001). Being unable to perform ADLs, such as bathing oneself, was associated with an 89% increased hazard of death (p < 0.0001). Reporting “poor” versus “excellent” health was associated with a 74% increase in the hazard of death (p < 0.0001).
Conclusion
This population-based study reinforces the importance of self-reported health status as a predictor for OS. Routine HRQOL screening may identify patients who could benefit from early interventions to improve HRQOL. Future studies should explore associations between changes in HRQOL before and after cancer diagnosis and OS.
Similar content being viewed by others
References
Ferlay, J., Shin, H. R., Bray, F., Forman, D., Mathers, C., & Parkin, D. M. (2010). Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. International Journal of Cancer Journal International du Cancer, 127(12), 2893–2917. doi:10.1002/ijc.25516.
Claassens, L., van Meerbeeck, J., Coens, C., Quinten, C., Ghislain, I., Sloan, E. K., Wang, X. S., Velikova, G., & Bottomley, A. (2011). Health-related quality of life in non-small-cell lung cancer: an update of a systematic review on methodologic issues in randomized controlled trials. Journal of Clinical Oncology, 29(15), 2104–2120. doi:10.1200/jco.2010.32.3683.
Akin, S., Can, G., Aydiner, A., Ozdilli, K., & Durna, Z. (2010). Quality of life, symptom experience and distress of lung cancer patients undergoing chemotherapy. European Journal of Oncology Nursing, 14(5), 400–409. doi:10.1016/j.ejon.2010.01.003.
Ediebah, D. E., Coens, C., Zikos, E., Quinten, C., Ringash, J., King, M. T., Schmucker von Koch, J., Gotay, C., Greimel, E., Flechtner, H., Weis, J., Reeve, B. B., Smit, E. F., Taphoorn, M. J., & Bottomley, A. (2014). Does change in health-related quality of life score predict survival? Analysis of EORTC 08975 lung cancer trial. British Journal of Cancer, 110(10), 2427–2433. doi:10.1038/bjc.2014.208.
Hennessy CH, Moriarty DG, Zack MM, Scherr PA, Brackbill R (1994) Measuring health-related quality of life for public health surveillance. Public health reports (Washington, DC, 1974) 109(5):665–672.
Lopez-Class, M., Perret-Gentil, M., Kreling, B., Caicedo, L., Mandelblatt, J., & Graves, K. D. (2011). Quality of life among immigrant Latina breast cancer survivors: realities of culture and enhancing cancer care. Journal of Cancer Education, 26(4), 724–733. doi:10.1007/s13187-011-0249-4.
Donovan, K., Sanson-Fisher, R. W., & Redman, S. (1989). Measuring quality of life in cancer patients. Journal of Clinical Oncology, 7(7), 959–968. doi:10.1200/jco.1989.7.7.959.
Gotay, C. C., Kawamoto, C. T., Bottomley, A., & Efficace, F. (2008). The prognostic significance of patient-reported outcomes in cancer clinical trials. Journal of Clinical Oncology, 26(8), 1355–1363. doi:10.1200/jco.2007.13.3439.
Singh, J. A., Nelson, D. B., Fink, H. A., & Nichol, K. L. (2005). Health-related quality of life predicts future health care utilization and mortality in veterans with self-reported physician-diagnosed arthritis: the veterans arthritis quality of life study. Seminars in Arthritis and Rheumatism, 34(5), 755–765. doi:10.1016/j.semarthrit.2004.08.001.
Cunningham, W. E., Crystal, S., Bozzette, S., & Hays, R. D. (2005). The association of health-related quality of life with survival among persons with HIV infection in the United States. Journal of General Internal Medicine, 20(1), 21–27. doi:10.1111/j.1525-1497.2005.30402.x.
Sloan, J. A., Zhao, X., Novotny, P. J., Wampfler, J., Garces, Y., Clark, M. M., & Yang, P. (2012). Relationship between deficits in overall quality of life and non-small-cell lung cancer survival. Journal of Clinical Oncology, 30(13), 1498–1504. doi:10.1200/jco.2010.33.4631.
Cooley, M. E. (2000). Symptoms in adults with lung cancer. A systematic research review. Journal of Pain and Symptom Management, 19(2), 137–153.
Ganz, P. A., Lee, J. J., & Siau, J. (1991). Quality of life assessment. An independent prognostic variable for survival in lung cancer. Cancer, 67(12), 3131–3135.
Eton, D. T., Fairclough, D. L., Cella, D., Yount, S. E., Bonomi, P., & Johnson, D. H. (2003). Early change in patient-reported health during lung cancer chemotherapy predicts clinical outcomes beyond those predicted by baseline report: results from Eastern Cooperative Oncology Group Study 5592. Journal of Clinical Oncology, 21(8), 1536–1543. doi:10.1200/jco.2003.07.128.
Efficace, F., Bottomley, A., Smit, E. F., Lianes, P., Legrand, C., Debruyne, C., Schramel, F., Smit, H. J., Gaafar, R., Biesma, B., Manegold, C., Coens, C., Giaccone, G., & Van Meerbeeck, J. (2006). Is a patient’s self-reported health-related quality of life a prognostic factor for survival in non-small-cell lung cancer patients? A multivariate analysis of prognostic factors of EORTC study 08975. Annals of Oncology, 17(11), 1698–1704. doi:10.1093/annonc/mdl183.
Maione, P., Perrone, F., Gallo, C., Manzione, L., Piantedosi, F., Barbera, S., Cigolari, S., Rosetti, F., Piazza, E., Robbiati, S. F., Bertetto, O., Novello, S., Migliorino, M. R., Favaretto, A., Spatafora, M., Ferrau, F., Frontini, L., Bearz, A., Repetto, L., Gridelli, C., Barletta, E., Barzelloni, M. L., Iaffaioli, R. V., De Maio, E., Di Maio, M., De Feo, G., Sigoriello, G., Chiodini, P., Cioffi, A., Guardasole, V., Angelini, V., Rossi, A., Bilancia, D., Germano, D., Lamberti, A., Pontillo, V., Brancaccio, L., Renda, F., Romano, F., Esani, G., Gambaro, A., Vinante, O., Azzarello, G., Clerici, M., Bollina, R., Belloni, P., Sannicolo, M., Ciuffreda, L., Parello, G., Cabiddu, M., Sacco, C., Sibau, A., Porcile, G., Castiglione, F., Ostellino, O., Monfardini, S., Stefani, M., Scagliotti, G., Selvaggi, G., De Marinis, F., Martelli, O., Gasparini, G., Morabito, A., Gattuso, D., Colucci, G., Galetta, D., Giotta, F., Gebbia, V., Borsellino, N., Testa, A., Malaponte, E., Capuano, M. A., Angiolillo, M., Sollitto, F., Tirelli, U., Spazzapan, S., Adamo, V., Altavilla, G., Scimone, A., Hopps, M. R., Tartamella, F., Ianniello, G. P., Tinessa, V., Failla, G., Bordonaro, R., Gebbia, N., Valerio, M. R., D’Aprile, M., Veltri, E., Tonato, M., Darwish, S., Romito, S., Carrozza, F., Barni, S., Ardizzoia, A., Corradini, G. M., Pavia, G., Belli, M., Colantuoni, G., Galligioni, E., Caffo, O., Labianca, R., Quadri, A., Cortesi, E., D’Auria, G., Fava, S., Calcagno, A., Luporini, G., Locatelli, M. C., Di Costanzo, F., Gasperoni, S., Isa, L., Candido, P., Gaion, F., Palazzolo, G., Nettis, G., Annamaria, A., Rinaldi, M., Lopez, M., Felletti, R., Di Negro, G. B., Rossi, N., Calandriello, A., Maiorino, L., Mattioli, R., Celano, A., Schiavon, S., Illiano, A., Raucci, C. A., Caruso, M., Foa, P., Tonini, G., Curcio, C., & Cazzaniga, M. (2005). Pretreatment quality of life and functional status assessment significantly predict survival of elderly patients with advanced non-small-cell lung cancer receiving chemotherapy: a prognostic analysis of the multicenter Italian lung cancer in the elderly study. Journal of Clinical Oncology, 23(28), 6865–6872. doi:10.1200/jco.2005.02.527.
Reeve, B. B., Potosky, A. L., Smith, A. W., Han, P. K., Hays, R. D., Davis, W. W., Arora, N. K., Haffer, S. C., & Clauser, S. B. (2009). Impact of cancer on health-related quality of life of older Americans. Journal of the National Cancer Institute, 101(12), 860–868. doi:10.1093/jnci/djp123.
Ambs, A., Warren, J. L., Bellizzi, K. M., Topor, M., Haffer, S. C., & Clauser, S. B. (2008). Overview of the SEER–Medicare Health Outcomes Survey linked dataset. Health Care Financing Review, 29(4), 5–21.
Ware, J. E. Jr., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30(6), 473–483.
Fleishman, J. A., Selim, A. J., & Kazis, L. E. (2010). Deriving SF-12v2 physical and mental health summary scores: a comparison of different scoring algorithms. Quality of Life Research, 19(2), 231–241. doi:10.1007/s11136-009-9582-z.
Selim AR, W; Qian, S; Rothendler, JA; Kent, EE; Kazis, LE. (2016) A new algorithm to build bridges between two patient-reported health outcome instruments: the MOS SF-36® and the VR-12 health survey. National Cancer Institute.
Pinheiro, L. C., Wheeler, S. B., Chen, R. C., Mayer, D. K., Lyons, J. C., & Reeve, B. B. (2015). The effects of cancer and racial disparities in health-related quality of life among older Americans: a case-control, population-based study. Cancer, 121(8), 1312–1320. doi:10.1002/cncr.29205.
Angst, F., Aeschlimann, A., & Stucki, G. (2001). Smallest detectable and minimal clinically important differences of rehabilitation intervention with their implications for required sample sizes using WOMAC and SF-36 quality of life measurement instruments in patients with osteoarthritis of the lower extremities. Arthritis and Rheumatism, 45(4), 384–391. doi:10.1002/1529-0131(200108)45:4<384::aid-art352>3.0.co;2-0.
Swigris, J. J., Brown, K. K., Behr, J., du Bois, R. M., King, T. E., Raghu, G., & Wamboldt, F. S. (2010). The SF-36 and SGRQ: validity and first look at minimum important differences in IPF. Respiratory Medicine, 104(2), 296–304. doi:10.1016/j.rmed.2009.09.006.
Bjorner, J. B., Wallenstein, G. V., Martin, M. C., Lin, P., Blaisdell-Gross, B., Tak Piech, C., & Mody, S. H. (2007). Interpreting score differences in the SF-36 Vitality scale: using clinical conditions and functional outcomes to define the minimally important difference. Current Medical Research and Opinion, 23(4), 731–739. doi:10.1185/030079907x178757.
Cohen, J. (1965). Some statistical issues in psychological research. In Handbook of clinical psychology (pp. 95–121). New York: McGraw-Hill.
Pompili, C., Salati, M., Refai, M., Berardi, R., Onofri, A., Mazzanti, P., & Brunelli, A. (2013). Preoperative quality of life predicts survival following pulmonary resection in stage I non-small-cell lung cancer. European Journal of Cardio-thoracic Surgery, 43(5), 905–910. doi:10.1093/ejcts/ezs532.
Moller, A., & Sartipy, U. (2012). Quality of life six months after lung cancer surgery is associated with long-term survival. Acta Oncologica (Stockholm, Sweden), 51(8), 1029–1035. doi:10.3109/0284186x.2012.689112.
Katz, S. (1983). Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. Journal of the American Geriatrics Society, 31(12), 721–727.
Reeve, B. B., Stover, A. M., Jensen, R. E., Chen, R. C., Taylor, K. L., Clauser, S. B., Collins, S. P., & Potosky, A. L. (2012). Impact of diagnosis and treatment of clinically localized prostate cancer on health-related quality of life for older Americans: a population-based study. Cancer, 118(22), 5679–5687. doi:10.1002/cncr.27578.
Stover, A. M., Mayer, D. K., Muss, H., Wheeler, S. B., Lyons, J. C., & Reeve, B. B. (2014). Quality of life changes during the pre- to postdiagnosis period and treatment-related recovery time in older women with breast cancer. Cancer, 120(12), 1881–1889. doi:10.1002/cncr.28649.
Concato, J., Peduzzi, P., Holford, T. R., & Feinstein, A. R. (1995). Importance of events per independent variable in proportional hazards analysis. I. Background, goals, and general strategy. Journal of Clinical Epidemiology, 48(12), 1495–1501.
Lawton, M. P., & Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist, 9(3), 179–186.
Jensen, G. A., & Morrisey, M. A. (2004). Are healthier older adults choosing managed care? The Gerontologist, 44(1), 85–94.
Morgan, R. O., Virnig, B. A., DeVito, C. A., & Persily, N. A. (1997). The Medicare-HMO revolving door–the healthy go in and the sick go out. The New England Journal of Medicine, 337(3), 169–175. doi:10.1056/nejm199707173370306.
Pourat, N., Kagawa-Singer, M., & Wallace, S. P. (2006). Are managed care Medicare beneficiaries with chronic conditions satisfied with their care? Journal of Aging and Health, 18(1), 70–90.
Jagsi, R., Abrahamse, P., Hawley, S. T., Graff, J. J., Hamilton, A. S., & Katz, S. J. (2012). Underascertainment of radiotherapy receipt in surveillance, epidemiology, and end results registry data. Cancer, 118(2), 333–341. doi:10.1002/cncr.26295.
Santana, M. J., & Feeny, D. H. (2009). Using the health utilities index in routine clinical care: process, feasibility, and acceptability: a randomized controlled trial. The patient, 2(3), 159–167. doi:10.2165/11313620-000000000-00000.
Detmar, S. B., Muller, M. J., Schornagel, J. H., Wever, L. D., & Aaronson, N. K. (2002). Health-related quality-of-life assessments and patient-physician communication: a randomized controlled trial. JAMA, 288(23), 3027–3034.
Taenzer, P., Bultz, B. D., Carlson, L. E., Speca, M., DeGagne, T., Olson, K., Doll, R., & Rosberger, Z. (2000). Impact of computerized quality of life screening on physician behaviour and patient satisfaction in lung cancer outpatients. Psycho-oncology, 9(3), 203–213.
Velikova, G., Wright, E. P., Smith, A. B., Cull, A., Gould, A., Forman, D., Perren, T., Stead, M., Brown, J., & Selby, P. J. (1999). Automated collection of quality-of-life data: a comparison of paper and computer touch-screen questionnaires. Journal of Clinical Oncology, 17(3), 998–1007.
Wagner, A. K., Ehrenberg, B. L., Tran, T. A., Bungay, K. M., Cynn, D. J., & Rogers, W. H. (1997). Patient-based health status measurement in clinical practice: a study of its impact on epilepsy patients’ care. Quality of Life Research, 6(4), 329–341.
Acknowledgements
This study was supported by the University Cancer Research Fund of North Carolina and the National Cancer Institute’s Research Supplement to Promote Diversity in Health Research.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All other authors (Dr. Pinheiro, Dr. Zagar, and Dr. Reeve) declare that they have no conflicts of interest to disclose.
Informed consent
Informed consent from study subjects was not needed as the University of North Carolina at Chapel Hill IRB granted this research exemption from review.
Rights and permissions
About this article
Cite this article
Pinheiro, L.C., Zagar, T.M. & Reeve, B.B. The prognostic value of pre-diagnosis health-related quality of life on survival: a prospective cohort study of older Americans with lung cancer. Qual Life Res 26, 1703–1712 (2017). https://doi.org/10.1007/s11136-017-1515-7
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11136-017-1515-7