title: Determinants of quality of life in patients with advanced cancer.
abstract: 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.
authors.affiliation: Division of Medical Oncology and Hematology, Department of Medicine, Toronto, Canada. camilla.zimmermann@uhn.on.ca
authors.forename: Camilla
authors.initials: C
authors.lastname: Zimmermann
authors.forename: Debika
authors.initials: D
authors.lastname: Burman
authors.forename: Nadia
authors.initials: N
authors.lastname: Swami
authors.forename: Monika K
authors.initials: MK
authors.lastname: Krzyzanowska
authors.forename: Natasha
authors.initials: N
authors.lastname: Leighl
authors.forename: Malcolm
authors.initials: M
authors.lastname: Moore
authors.forename: Gary
authors.initials: G
authors.lastname: Rodin
authors.forename: Ian
authors.initials: I
authors.lastname: Tannock
mesh_terms: 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