title: Determinants of quality of life in advanced cancer patients with bone metastases undergoing palliative radiation treatment.
abstract: OBJECTIVE
  Assessment of health-related quality of life (HRQOL) is critical to effective delivery of palliative care in patients with advanced cancer. The current study analyzes relationships between baseline social determinants of health and medical factors, and self-reported HRQOL in patients with bone metastases receiving palliative radiotherapy.
  
  
  METHODS
  Advanced cancer patients referred for radiotherapy treatment of bone metastases completed the EORTC QLQ-C30 questionnaire in multiple outpatient clinics internationally. Demographics and social determinants were collected as baseline information. Univariate and Bonferroni-adjusted multivariate linear regression analyses were used to detect significant correlations between baseline determinants and different HRQOL domains.
  
  
  RESULTS
  Karnofsky Performance Status (KPS) was correlated with better physical (p = 0.0002), role (p < 0.0001), emotional (p < 0.0001), and social (p < 0.0001) functioning, and global health scores (p = 0.0015) and predicted lower symptom scores for fatigue (p < 0.0001), pain (p < 0.0001), appetite loss (p < 0.0001), and constipation (p < 0.0001). Increased age was predictive of better social functioning (p < 0.0001) and less insomnia (p = 0.0036), higher education correlated with better global health status (p = 0.0043), and patients who were employed or retired had improved physical functioning (p = 0.0004 and p = 0.0030, respectively) and less financial challenges compared to patients who were unemployed (p = 0.0005).
  
  
  CONCLUSIONS
  Baseline KPS had the greatest influence on EORTC QLQ-C30 domain scores. Age, education level, and employment status had significant impacts, although on fewer domains. Further studies that investigate baseline determinants are worthwhile to clarify relationships in order to care for patients more effectively at the end of life.
authors.affiliation: Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada, M4N 3M5.
authors.forename: Kinsey
authors.initials: K
authors.lastname: Lam
authors.forename: Edward
authors.initials: E
authors.lastname: Chow
authors.forename: Liying
authors.initials: L
authors.lastname: Zhang
authors.forename: Erin
authors.initials: E
authors.lastname: Wong
authors.forename: Gillian
authors.initials: G
authors.lastname: Bedard
authors.forename: Alysa
authors.initials: A
authors.lastname: Fairchild
authors.forename: Vassilios
authors.initials: V
authors.lastname: Vassiliou
authors.forename: Mohamed
authors.initials: M
authors.lastname: Alm El-Din
authors.forename: Reynaldo
authors.initials: R
authors.lastname: Jesus-Garcia
authors.forename: Aswin
authors.initials: A
authors.lastname: Kumar
authors.forename: Fabien
authors.initials: F
authors.lastname: Forges
authors.forename: Ling-Ming
authors.initials: LM
authors.lastname: Tseng
authors.forename: Ming-Feng
authors.initials: MF
authors.lastname: Hou
authors.forename: Wei-Chu
authors.initials: WC
authors.lastname: Chie
authors.forename: Andrew
authors.initials: A
authors.lastname: Bottomley
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000523:psychology* / Q000532:radiotherapy* / Q000556:secondary; D001943:Breast Neoplasms / Q000473:pathology / Q000523:psychology; D005221:Fatigue; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D017567:Karnofsky Performance Status; D008175:Lung Neoplasms / Q000473:pathology / Q000523:psychology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010146:Pain / Q000523:psychology; D010166:Palliative Care / Q000379:methods* / Q000523:psychology*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000523:psychology; D011788:Quality of Life; D011795:Surveys and Questionnaires