The prognostic association of health-related quality of life scores with survival in breast cancer

Goals of work: There is extensive data showing that health-related quality of life (HRQOL) tools measuring the activities of daily life provide prognostic information in cancer. However, similar information on HRQOL tools measuring patient satisfaction with their life is sparse. The Ferrans and Powers quality of life index (QLI) is one such instrument. This study evaluated the association between HRQOL, as measured by the QLI, and survival in breast cancer. Materials and methods: We examined a consecutive case series of 251 histologically confirmed breast cancer patients treated at Cancer Treatment Centers of Arnerica (R) between April 2001 and November 2004. QLI measures overall HRQOL and the HRQOL in four major subscales: health and physical functioning, social and economic, psychological and spiritual, and family. All scores range from 0 to 30 with higher scores indicating a better HRQOL. Study patients were dichotomized into two groups based on the median scores for all QLI subscales. Kaplan-Meier method was used to calculate survival. Log-rank test was used to study the equality of survival distributions. Multivariate Cox regression analyses were then performed to evaluate the joint prognostic significance of HRQOL and clinical factors. Results: Patient satisfaction with health and physical subscale was significantly associated with survival (p = 0.0006), with the median survival for low and high scores being 17.8 and 35.3 months, respectively. Similarly, patient satisfaction with overall HRQOL was significantly associated with survival (p = 0.0006), with the median survival for low and high scores being 17.8 and 34.6 months, respectively. Patient satisfaction with health and physical subscale and overall HRQOL were found to be predictive of survival independent of the effects of stage at presentation. Conclusions: This study suggests that baseline patient satisfaction with health and physical functioning and overall HRQOL, as measured by QLI, provides useful prognostic information in patients with breast cancer independent of stage at presentation.