Skip to main content

Advertisement

SpringerLink
Log in

The prognostic value of pre-diagnosis health-related quality of life on survival: a prospective cohort study of older Americans with lung cancer

  • Published:
Quality of Life Research Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. 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.

    Article  CAS  PubMed  Google Scholar 

  2. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. 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.

    Article  PubMed  Google Scholar 

  4. 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.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. 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.

    CAS  Google Scholar 

  6. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  7. 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.

    Article  CAS  PubMed  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. 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.

    Article  PubMed  Google Scholar 

  10. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Cooley, M. E. (2000). Symptoms in adults with lung cancer. A systematic research review. Journal of Pain and Symptom Management, 19(2), 137–153.

    Article  CAS  PubMed  Google Scholar 

  13. 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.

    Article  CAS  PubMed  Google Scholar 

  14. 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.

    Article  PubMed  Google Scholar 

  15. 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.

    Article  CAS  PubMed  Google Scholar 

  16. 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.

    Article  PubMed  Google Scholar 

  17. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  18. 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.

    PubMed  PubMed Central  Google Scholar 

  19. 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.

    Article  PubMed  Google Scholar 

  20. 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.

    Article  PubMed  Google Scholar 

  21. 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.

  22. 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.

    Article  PubMed  Google Scholar 

  23. 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.

    Article  CAS  PubMed  Google Scholar 

  24. 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.

    Article  PubMed  Google Scholar 

  25. 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.

    Article  PubMed  Google Scholar 

  26. Cohen, J. (1965). Some statistical issues in psychological research. In Handbook of clinical psychology (pp. 95–121). New York: McGraw-Hill.

    Google Scholar 

  27. 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.

    Article  PubMed  Google Scholar 

  28. 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.

    Article  Google Scholar 

  29. 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.

    Article  CAS  PubMed  Google Scholar 

  30. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  31. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  32. 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.

    Article  CAS  PubMed  Google Scholar 

  33. 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.

    Article  CAS  PubMed  Google Scholar 

  34. Jensen, G. A., & Morrisey, M. A. (2004). Are healthier older adults choosing managed care? The Gerontologist, 44(1), 85–94.

    Article  PubMed  Google Scholar 

  35. 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.

    Article  CAS  PubMed  Google Scholar 

  36. 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.

    Article  PubMed  Google Scholar 

  37. 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.

    Article  PubMed  Google Scholar 

  38. 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.

    Article  PubMed  Google Scholar 

  39. 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.

    Article  PubMed  Google Scholar 

  40. 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.

    Article  CAS  PubMed  Google Scholar 

  41. 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.

    Article  CAS  PubMed  Google Scholar 

  42. 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.

    Article  CAS  PubMed  Google Scholar 

Download references

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

  1. Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Laura C. Pinheiro & Bryce B. Reeve

  2. Departments of Neurosurgery and Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, USA

    Timothy M. Zagar

  3. Department of Health Policy and Management, Gillings School of Global Public Health,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Bryce B. Reeve

Authors
  1. Laura C. Pinheiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Timothy M. Zagar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bryce B. Reeve
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Laura C. Pinheiro.

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

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

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

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-017-1515-7

Keywords

Search

Navigation