title: Determinants of global quality of life before and after major cancer surgery: an exploratory study.
abstract: OBJECTIVE
  To explore whether determinants of global quality of life (QOL) change before and after major cancer surgery.
  
  
  METHODS
  Consecutive patients (n = 145) undergoing surgery for upper gastrointestinal cancer were prospectively studied and asked to complete the EORTC QLQ-C30 before and after 6 months. Excluded were patients found to be inoperable (n = 12) and those with missing second questionnaires (because of death n = 20, poor health (n = 10), administrative failure (n = 7) or patient refusal (n = 4)). Multivariable linear regression models investigated associations between global QOL and other scales and items of QOL adjusting for clinical variables.
  
  
  RESULTS
  Some 87 patients completed both questionnaires. Before surgery the main predictors of global QOL were physical and emotional function, with adjusted increases in global QOL of 0.55 (95% CI 0.26-0.84; P < 0.001) and 0.30 (95% CI 0.14-0.45; P < 0.001) per unit increase of physical and emotional function, respectively. Six months after surgery, however, fatigue and dyspnea most strongly predicted global QOL, with adjusted differences in global QOL of -0.24 (95% CI -0.44 to -0.04; P = 0.02) per unit increase of fatigue and -6.28 (95% CI -12.64 to 0.07; P = 0.05) for those experiencing any symptoms of dyspnea.
  
  
  CONCLUSIONS
  Further work is needed to test these findings, but the results suggest that the global QOL scale in the QLQ-C30 is difficult to interpret and it should be considered within the context of other clinical and patient reported outcomes.
authors.affiliation: Department of Molecular Medicine and Surgery, Karolinska Institutet, Unit of Esophageal and Gastric Research (ESOGAR), Stockholm, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Rutegård
authors.forename: Rachael
authors.initials: R
authors.lastname: Hughes
authors.forename: Pernilla
authors.initials: P
authors.lastname: Lagergren
authors.forename: Jane M
authors.initials: JM
authors.lastname: Blazeby
mesh_terms: D000368:Aged; D016629:Esophagectomy / Q000523:psychology*; D005260:Female; D005743:Gastrectomy / Q000523:psychology*; D014943:Global Health; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery*; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires