title: Health-related quality of life as a survival predictor for patients with localized head and neck cancer treated with radiation therapy.
abstract: OBJECTIVE
  To assess the added prognostic value for overall survival (OS) of baseline health-related quality of life (HRQOL) and of early changes in HRQOL among patients with localized head and neck cancer (HNC) treated with radiation therapy.
  
  
  METHODS
  All 540 patients with HNC who participated in a randomized trial completed two HRQOL instruments before radiation therapy: the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) and the Head and Neck Radiotherapy Questionnaire. Six months after the end of radiation therapy, 497 trial participants again completed the two HRQOL instruments. During the follow-up, 179 deaths were observed. Multivariate Cox proportional hazards models were used to test whether HRQOL variables, baseline and change, provided additional prognostic value beyond recognized prognostic factors.
  
  
  RESULTS
  The baseline EORTC QLQ-C30 physical functioning (PF) score was an independent predictor of OS. The hazard ratio (HR) associated with a 10-point increment in baseline PF was 0.87 (95% CI, 0.81 to 0.94). In multivariate models, the change in HRQOL was significantly associated with OS for most HRQOL dimensions. Among these, PF change was the strongest predictor. The magnitude of the association between PF change and survival decreased over time. At 1 year, the HR associated with a positive PF change of 10 points was 0.75 (95% CI, 0.68 to 0.83). After PF is taken into account, no other HRQOL variable was associated with survival.
  
  
  CONCLUSIONS
  Our findings indicate that both baseline PF and PF change provide added prognostic value for OS beyond established predictors in patients with HNC. Assessing HRQOL could help better predict survival of cancer patients.
authors.affiliation: Laval University Cancer Research Center, CHUQ-HDQ, Québec, Canada. francois.meyer@chuq.qc.ca
authors.forename: François
authors.initials: F
authors.lastname: Meyer
authors.forename: André
authors.initials: A
authors.lastname: Fortin
authors.forename: Michel
authors.initials: M
authors.lastname: Gélinas
authors.forename: Abdenour
authors.initials: A
authors.lastname: Nabid
authors.forename: François
authors.initials: F
authors.lastname: Brochet
authors.forename: Bernard
authors.initials: B
authors.lastname: Têtu
authors.forename: Isabelle
authors.initials: I
authors.lastname: Bairati
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000532:radiotherapy*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D011795:Surveys and Questionnaires