Division of General Internal Medicine, Department of Medicine, Weill Cornell Medicine, 525 East 68th Street, Box 331, New York, NY, 10065, USA.
Center for Health Measurement, Population Health Sciences, Duke University School of Medicine, Durham, NC, 27710, USA.
Support Care Cancer. 2018 Nov;26(11):3925-3932. doi: 10.1007/s00520-018-4265-3. Epub 2018 May 18.
Health-related quality of life (HRQOL) is an important predictor for overall survival (OS). To date, no studies compared associations between HRQOL assessed before and after a cancer diagnosis for OS. Our objectives were to (1) investigate associations between HRQOL changes and OS and (2) identify the best HRQOL assessment time point to predict OS.
We used the Surveillance, Epidemiology and End Results linked with the Medicare Health Outcomes Survey data. Medicare Advantage beneficiaries with SEER-confirmed, incident lung cancer between 1998 and 2013 were included. We only included individuals who completed pre- and post-diagnosis assessments. HRQOL was captured using the Short-Form (SF-36) and Katz's Activities of Daily Living (ADL). Cox Proportional Hazards models examined associations between HRQOL and OS, adjusting for potential confounders. AICs compared model fit.
Five hundred thirty-five adults with mean age of 75 years at diagnosis were included. We observed 300 deaths. Poor HRQOL was associated with greater risk of death across HRQOL assessments. SF-36 before diagnosis, after diagnosis, and change over time had AHRs of 1.01-1.08, 1.10-1.20, and 1.06-1.12, respectively. Pre-diagnosis, post-diagnosis, and changes in ADLs had AHRs of 0.90-2.06, 1.72-2.56, and 1.66-2.21, respectively. Post-diagnosis HRQOL and HRQOL change models had the smallest AICs and largest AHRs, suggesting they were most associated with OS.
This is the first study to compare the prognostic ability of pre-diagnosis, post-diagnosis, and HRQOL changes for OS. The prognostic value of HRQOL at distinct points in the cancer continuum underscores the importance of routine HRQOL monitoring as part of patient-centered cancer care.
健康相关生活质量（HRQOL）是总生存（OS）的重要预测因素。迄今为止，尚无研究比较癌症诊断前后 HRQOL 评估与 OS 之间的相关性。我们的目标是：（1）研究 HRQOL 变化与 OS 之间的相关性；（2）确定预测 OS 的最佳 HRQOL 评估时间点。
我们使用监测、流行病学和结果（SEER）与医疗保险健康结果调查（Medicare Health Outcomes Survey）数据进行关联。纳入 1998 年至 2013 年间 SEER 确诊的、偶发性肺癌的医疗保险优势受益人的数据。我们只纳入了完成了诊断前和诊断后评估的个体。HRQOL 使用简明健康状况调查问卷（SF-36）和 Katz 日常生活活动（ADL）量表进行评估。Cox 比例风险模型调整潜在混杂因素后，检验了 HRQOL 与 OS 之间的相关性。AIC 比较模型拟合情况。
纳入了 535 名平均年龄为 75 岁的成年人，诊断时年龄为 75 岁。我们观察到 300 例死亡。在所有 HRQOL 评估中，HRQOL 较差与死亡风险增加相关。诊断前、诊断后和随时间变化的 SF-36 的 AHR 分别为 1.01-1.08、1.10-1.20 和 1.06-1.12。诊断前、诊断后和 ADL 变化的 AHR 分别为 0.90-2.06、1.72-2.56 和 1.66-2.21。诊断后 HRQOL 和 HRQOL 变化模型的 AIC 最小，AHR 最大，提示其与 OS 相关性最强。
这是第一项比较癌症连续体中不同时间点的诊断前、诊断后和 HRQOL 变化与 OS 之间相关性的研究。HRQOL 在癌症连续体中的不同时间点的预后价值突显了作为以患者为中心的癌症护理的一部分，常规进行 HRQOL 监测的重要性。
