J Clin Outcomes Manage
Using the quality of life index as a prognostic stratification tool in advanced cancer
Lis CG, Gupta D, Grutsch JF
Abstract Objective: To use continuous quality of life (QOL) data to categorize patients into distinct prognostic groups using survival analysis. Design: Case series. Patients and setting: QOL data were collected from 954 cancer patients treated at Cancer Treatment Centers of America Midwestern comprehensive cancer center between April 2001 and November 2004. Measurements: Ferrans and Powers Quality of Life Index (QLI) was used to evaluate patient QOL. We used half a standard deviation difference to sequentially stratify QLI subscale scores into 2 mutually exclusive categories. Kaplan-Meier survival analysis was used to calculate survival. The log-rank statistic derived from survival analyses was plotted as a function of the cutpoints to identify which cutpoints maximized the difference in survival between the 2 groups. Results: Of 954 patients, 579 were female and 375 male, with a median age of 56 years (range, 20–90 years). 66% had failed prior treatment. The most common cancers were breast (26%), colorectal (19%), and lung (16%). We found a statistically significant difference in survival among patients with health and function scores ? 17.4 and > 17.4, with the median survival being 9.5 and 23.2 months, respectively (p < 0.001). For the family subscale, the median survival was 8.0 and 15.9 months (p < 0.001) for the ? 19.6 and > 19.6 categories. For the psychological and spiritual subscale, the median survival was 8.4 and 16.9 months (p < 0.001) for the ? 14.8 and > 14.8 categories. For the QLI overall score, the median survival was 8.1 and 17.5 months (p < 0.001) for the ? 16 and > 16 categories. Conclusion: It is possible to convert continuous QLI scores into nonoverlapping survival outcome categories. These data suggest that QOL scores can be used to help physicians evaluate their patients’ prognosis and to facilitate treatment planning.
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