Determinants of quality of life in patients with advanced cancer.
OBJECTIVE
Improving health-related quality of life (HRQL) is the main goal of palliative care and an important outcome for oncology trials. This study examines medical and sociodemographic determinants of HRQL in outpatients with advanced cancer.


METHODS
Patients with metastatic gastrointestinal, genitourinary, breast, lung or gynecological cancer, ECOG 0-2, and clinical prognosis of 6 months to 2 years were recruited from outpatient medical oncology clinics. HRQL was measured using the FACT-G questionnaire and the FACIT-Sp meaning and peace (existential) subscale. The influence of demographic and medical characteristics on HRQL was determined using t tests and analysis of variance, with Tukey's correction for multiple comparisons. Multivariate linear regression was used to determine independent predictors.


RESULTS
Of 285 patients, 57% were female and the median age was 61 years; 44% were alive at latest follow-up; and of those deceased, the mean survival time was 10 months. The strongest determinants of overall HRQL were increased age (p < 0.001), good performance status (PS; p < 0.001) and survival time >6 months (p = 0.001). Compared to patients receiving cancer treatment, those awaiting new treatment had worse emotional well-being (p < 0.001), while those on surveillance or whose treatment had been stopped had worse existential well-being (p = 0.03). Male gender predicted better emotional and physical well-being and lower income predicted worse social well-being.


CONCLUSIONS
Age, PS, survival time, and treatment status are important determinants of HRQL in patients with advanced cancer. Decision aids, open communication, and involvement of supportive care specialists may improve emotional and existential distress associated with changing or stopping cancer treatment.
Zimmermann
Camilla
C
Division of Medical Oncology and Hematology, Department of Medicine, Toronto, Canada. camilla.zimmermann@uhn.on.ca
Burman
Debika
D
Swami
Nadia
N
Krzyzanowska
Monika K
MK
Leighl
Natasha
N
Moore
Malcolm
M
Rodin
Gary
G
Tannock
Ian
I
D000367:Age Factors; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D009369:Neoplasms / Q000503:physiopathology* / Q000523:psychology / Q000628:therapy; D010166:Palliative Care / Q000379:methods*; D011379:Prognosis; D011788:Quality of Life; D012737:Sex Factors; D011795:Surveys and Questionnaires; D015996:Survival Rate