title: EORTC QLQ-C15-PAL quality of life score as a prognostic indicator of survival in patients with far advanced cancer.
abstract: OBJECTIVE
  Quality of life (QoL) and performance status predict survival in advanced cancer patients; these relationships have not been explored in the hospice palliative care setting. The aim of this study was to examine the survival predictability of patient-reported QoL using the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C15-PAL questionnaire in far advanced cancer inpatients at the very end of life.
  
  
  METHODS
  This is a retrospective cohort study. Patients reported QoL using the EORTC QLQ-C15-PAL. One hundred sixty-two inpatients in hospice palliative wards of six hospitals in South Korea were followed until death or the end of the study. Additional symptoms and performance status were assessed by the MD Anderson Symptom Inventory-Korean (MDASI-K), Palliative Performance Scale (PPS) and Eastern Cooperative Oncology Group (ECOG) performance status. Correlations between EORTC QLQ-C15-PAL, MDASI-K, PPS, and ECOG were assessed. Survival analyses were performed using Cox proportional hazard models.
  
  
  RESULTS
  Patients' median survival was less than 1 month. Physician-reported PPS significantly predicted survival (hazard ratio [HR] 0.493; p<0.001). From the EORTC QLQ-C15-PAL, patient-reported physical functioning predicted survival (HR=0.65; p<0.001). Other six domains of EORTC QLQ-C15-PAL were significantly related to survival after adjustment. Those domains were global health status, emotional functioning, fatigue, nausea/vomiting, appetite loss, and constipation.
  
  
  CONCLUSIONS
  EORTC QLQ-C15-PAL can be an independent prognostic factor in inpatients with far advanced cancer. Patient-reported physical functioning showed survival predictability as good as physician-reported performance status. It is notable that the QLQ instrument is useful even for patients in their final month of life. Cancer anorexia-cachexia syndrome-related symptoms may be independent prognostic symptoms. Prospective study is warranted.
authors.affiliation: College of Medicine, The Catholic University of Korea, Seoul, South Korea.
authors.forename: Yong Joo
authors.initials: YJ
authors.lastname: Lee
authors.forename: Sang-Yeon
authors.initials: SY
authors.lastname: Suh
authors.forename: Youn Seon
authors.initials: YS
authors.lastname: Choi
authors.forename: Jae Yong
authors.initials: JY
authors.lastname: Shim
authors.forename: Ah-Ram
authors.initials: AR
authors.lastname: Seo
authors.forename: Sung-Eun
authors.initials: SE
authors.lastname: Choi
authors.forename: Hong-Yup
authors.initials: HY
authors.lastname: Ahn
authors.forename: Eunji
authors.initials: E
authors.lastname: Yim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006304:Health Status; D017051:Hospice Care / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000503:physiopathology* / Q000523:psychology*; D010166:Palliative Care / Q000523:psychology; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D011795:Surveys and Questionnaires