title: Prognostic value of changes in health-related quality of life scores during curative treatment for esophagogastric cancer.
abstract: OBJECTIVE
  Accumulating evidence suggests that health-related quality of life (HRQL) data before treatment predict survival, but the prognostic value of changes in HRQL scores after treatment is unknown. The aim of this study was to explore whether changes in HRQL scores in esophagogastric cancer predict survival.
  
  
  METHODS
  Consecutive patients undergoing curative treatment completed HRQL questionnaires (EORTC QLQ-C30) at baseline and after six months and were followed up for at least five years. Cox proportional hazard models with adjustments assessed associations between baseline HRQL and survival and between changes in HRQL before and after treatment and survival.
  
  
  RESULTS
  Overall, 216 patients initiated curative therapy, of whom 169 completed treatment and survived 6 months. Of these, 132 (7%) had two complete HRQL assessments. Analyses adjusted for age, sex, performance status, tumor stage, and disease site revealed that a 10-point poorer dyspnea score at baseline was significantly associated with an 18% higher risk of death. Additional analyses to adjust for baseline HRQL and treatment showed that a 10-point change in physical function (hazard ratio [HR], 0.85; 95% CI, 0.76 to 0.96; P = .007), pain (HR, 1.20; 95% CI, 1.09 to 1.33; P < .001), and fatigue (HR, 1.16; 95% CI, 1.04 to 1.30; P = .009) scores was associated with better survival.
  
  
  CONCLUSIONS
  This exploratory study found longer survival beyond the 6 months after starting treatment to be associated with fewer problems with dyspnea before treatment and better recovery of physical function, pain, and fatigue after treatment. More research to confirm these findings and understand the results is needed.
authors.affiliation: Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Therese
authors.initials: T
authors.lastname: Djärv
authors.forename: Chris
authors.initials: C
authors.lastname: Metcalfe
authors.forename: Kerry N L
authors.initials: KN
authors.lastname: Avery
authors.forename: Pernilla
authors.initials: P
authors.lastname: Lagergren
authors.forename: Jane M
authors.initials: JM
authors.lastname: Blazeby
mesh_terms: D000368:Aged; D004938:Esophageal Neoplasms / Q000401:mortality / Q000523:psychology* / Q000628:therapy; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D013274:Stomach Neoplasms / Q000401:mortality / Q000523:psychology* / Q000628:therapy; D011795:Surveys and Questionnaires