title: Can changes in health related quality of life scores predict survival in stages III and IV colorectal cancer?
abstract: BACKGROUND
  Several studies have demonstrated the predictive significance on survival of baseline quality of life (QoL) in colorectal cancer (CRC) with little information on the impact of changes in QoL scores on prognosis in CRC. We investigated whether changes in QoL during treatment could predict survival in CRC.
  
  
  METHODS
  We evaluated 396 stages III-IV CRC patients available for a minimum follow-up of 3 months. QoL was evaluated at baseline and after 3 months of treatment using EORTC QLQ-C30. Cox regression evaluated the prognostic significance of baseline, 3-month and changes in QoL scores after adjusting for age, gender and stage at diagnosis.
  
  
  RESULTS
  After adjusting for covariates, every 10-point increase in both baseline appetite loss and global QoL score was associated with a 7% increased risk of death with HR = 1.07 (95% CI, 1.01-1.14; P = 0.02) and (HR = 0.93 (95% CI, 0.87-0.98; P = 0.01) respectively. A lower risk of death was associated with a 10-point improvement in physical function at 3 months (HR, 0.86; 95% CI, 0.78-0.94; P = 0.001). Surprisingly, a higher risk of death was associated with a 10-point improvement in social function at 3 months (HR, 1.08; 95% CI, 1.02-1.13; P = 0.008).
  
  
  CONCLUSIONS
  This study provides preliminary evidence to indicate that CRC patients whose physical function improves within 3 months of treatment have a significantly increased probability of survival. These findings should be used in clinical practice to systematically address QoL-related problems of CRC patients throughout their treatment course.
authors.affiliation: Office of Clinical Research, Cancer Treatment Centers of America® (CTCA) at Midwestern Regional Medical Center, 2520 Elisha Ave,, Zion, IL 60099, USA.
authors.forename: Donald P
authors.initials: DP
authors.lastname: Braun
authors.forename: Digant
authors.initials: D
authors.lastname: Gupta
authors.forename: James F
authors.initials: JF
authors.lastname: Grutsch
authors.forename: Edgar D
authors.initials: ED
authors.lastname: Staren
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011379:Prognosis; D011788:Quality of Life; D018434:Sickness Impact Profile; D016019:Survival Analysis; D014481:United States; D055815:Young Adult