title: Health-related quality of life supersedes other psychosocial predictors of long-term survival in cancer patients undergoing radiotherapy.
abstract: BACKGROUND
  To investigate the prognostic value of several psychosocial factors for long-term survival in cancer patients.
  
  
  METHODS
  Baseline data were gathered in routine radiotherapy practice during 44 months. The analysis is based on 938 patients for whom follow-up data were available. Baseline psychosocial distress, depression, health-related quality of life (HRQOL), and life satisfaction were assessed using Questionnaire on Stress in Cancer Patients (QSC-R23), Self-Rating Depression Scale (SDS), Functional Assessment of Therapy - General (FACT-G) questionnaire, and Questions on Life Satisfaction (FLZ(M)). Patients were followed up for 7 to 10 years. Kaplan-Meier plots and Cox proportional hazards models were used to investigate associations between sociodemographic, clinical, psychosocial factors and overall survival (OS).
  
  
  RESULTS
  Patients' median survival time was 35 months (95% CI 28.9-41.1). Significant multivariate predictors of OS were age, health insurance type, Karnofsky performance status, cancer site, and cancer stage. Controlling for these variables, HRQOL was the only psychosocial predictor of survival (hazard ratio 0.988, 95% CI 0.979-0.997, p =0.009). The physical well-being and the functional well-being subscales of the FACT-G emerged as the relevant HRQOL facets predictive of survival.
  
  
  CONCLUSIONS
  HRQOL has incremental predictive value for long-term survival in cancer patients.
authors.affiliation: Department of Radiotherapy and Radiooncology, Klinikum Großhadern, Ludwig-Maximilians-Universität München, Munich, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Sehlen
authors.forename: Birgitt
authors.initials: B
authors.lastname: Marten-Mittag
authors.forename: Peter
authors.initials: P
authors.lastname: Herschbach
authors.forename: Monika
authors.initials: M
authors.lastname: Schweden
authors.forename: Katrin
authors.initials: K
authors.lastname: Book
authors.forename: Gerhard
authors.initials: G
authors.lastname: Henrich
authors.forename: Eckhard
authors.initials: E
authors.lastname: Dühmke
authors.forename: Andreas
authors.initials: A
authors.lastname: Dinkel
mesh_terms: D000328:Adult; D000368:Aged; D004522:Educational Status; D005260:Female; D006304:Health Status; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D009369:Neoplasms / Q000401:mortality* / Q000473:pathology / Q000523:psychology / Q000532:radiotherapy*; D016017:Odds Ratio; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011788:Quality of Life; D013315:Stress, Psychological / Q000209:etiology*