Background
Methods
Search engines and time period
Definitions
-
Health-related quality of life was defined as an individual's perceived physical, mental and social health status affected by cancer diagnosis or treatment. This article uses the terms 'health-related quality of life' and 'quality of life' interchangeably.
-
Health-related quality of life measures (instruments, questionnaires) were defined as well-established questionnaires that measure individuals' perceptions of their own physical, mental and social health status, or some aspects of their health status resulting from cancer and its treatment.
-
Health-related quality of life data were defined as the data collected using valid generic or specific health-related quality of life measures.
-
Predictive or prognostic indicators were defined as any independent variables (e.g. health-related quality of life parameters) that can be used to estimate the chance of a given outcome (e.g. survival duration).
Search strategy
Inclusion and exclusion criteria
Data synthesis
Results
Statistics
Early pivotal publications [1982-1989]
Heterogeneous sample of cancer patients
Author(s) | Year | Sample | HRQOL measure(s) | Results* |
---|---|---|---|---|
Degner and Sloan [15] | 1995 | 435 ambulatory heterogeneous sample of cancer patients (including 82 lung cancer) | SDS | The single measure of symptom distress was a significant predictor of survival in lung cancer. |
Ringdal et al. [16] | 1996 | 253 heterogeneous sample of cancer patients | Physical functioning + psychosocial variables | Physical functioning was prognostic factor of survival but psychosocial covariates were not. |
Tamburini et al. [17] | 1996 | 100 terminal cancer patients | TIQ | Confusion, cognitive status and global health status were independent prognostic of survival. |
Coates et al. [18] | 1997 | 735 advanced malignancies | EORTC QLQ-C30 | Global QOL and social functioning were significantly predictive of survival among solid tumor patients, metastatic site. |
Dancey et al. [19] | 1997 | 474 heterogeneous population of cancer patients | EORTC QLQ-C30 | Global QOL was significantly associated with survival. |
Chang et al. [20] | 1998 | 218 cancers patients (colon, breast, ovary or prostate) | MSAS | Physical symptom subscale score significantly predicted survival. |
Lam et al. [21] | 2007 | 170 advanced cancer | HDS + ESAS + McGill QOL | ESAS score was independent prognostic factor for survival. |
Lung cancer
Author(s) | Year | Sample | HRQOL measure(s) | Results* |
---|---|---|---|---|
Pater and Loeb [11] | 1982 | 651 bronchogenic carcinoma | Symptomatic history, performance status, weight loss and age | Weight loss and performance status were significantly affected survival. |
Kaasa et al. [14] | 1989 | 102 inoperable non-small-cell, limited disease | Psychological well-being + disease-related symptoms + personal functioning + everyday activity | General symptoms and psychological well-being were the best predictive value for survival. |
Ganz et al. [22] | 1991 | 40 advanced metastatic lung cancer | FLI-C | A statistically significant relationship was observed between initial patient-rated QOL and subsequent survival. |
Ruckdeschel et al. [23] | 1994 | 438 lung cancer | FLI-C | Total FLI-C score was significant predictor of survival. |
Loprinzi et al. [24] | 1994 | 1,115 advanced colorectal or lung cancers | A designed patient-completed questionnaire | Patients' assessment of their own performance status and nutritional factors such as appetite, caloric intake, or overall food intake were prognostic of survival. |
Buccheri et al. [25] | 1995 | 128 Lung cancer | TIQ | The self-estimated difficulty at work and doing housework were significant independent prognostic determinants of survival. |
Buccheri et al. [26] | 1998 | 133 Lung cancer | SDS | Depression was associated with survival. Diverse SDS subscales were associated with survival. |
Herndon et al. [27] | 1999 | 206 advanced non-small-cell lung cancer | EORTC QLQ-C30 + Duke-UNC Social Support Scale | Pain was a significant predictor of survival but overall QOL was not. |
Langendijk et al. [28] | 2000 | 198 inoperable non-small-cell lung cancer | EORTC QLQ-C30 | Global QOL was a strong prognostic factor of survival. |
Burrows et al. [29] | 2000 | 85 recurrent symptomatic malignant pleural effusions | KPS | Only the KPS score (score ≥ 70) at the time of thoracoscopy was predictive of survival. Pleural fluid pH, pleural fluid glucose, and EPC scores were not as reliable as initially reported. |
Montazeri et al. [30] | 2001 | 129 lung cancer (small and non-small-cell) | NHP + EORTC QLQ-C30 + EORTC QLQ-LC13 | Baseline global QOL was most significant predictor of the length of survival. |
Auchter et al. [31] | 2001 | 30 non-small cell lung cancer | FACT-L (TOI) | The change in TOI score was not associated with survival. A trend was noted for shorter survival with the largest negative change in TOI score. |
Moinpour et al. [32] | 2002 | 222 advanced non-small-cell | FACT-L | Total FACT-L score was predictor of survival. |
Nakahara et al. [33] | 2002 | 179 advanced small- and non-small cell lung cancer | Tokyo University Egogram (measure for mental state) | Mental state was prognostic of survival. |
Naughton et al. [34] | 2002 | 70 small-cell lung cancer | EORTC QLQ-C30 + CES-D + MOS Social Support Questionnaire + a sleep quality scale | Higher depressive symptoms were borderline significant in predicting decreased survival. |
Eton et al. [35] | 2003 | 573 advanced non-small-cell lung cancer | FACT-L + TOI | Baseline physical well-being and TOI scores predicted either survival duration or disease progression respectively. |
Dharma-Wardene et al. [36] | 2004 | 44 advanced lung cancer | FACT-G | Baseline FACT-G total score was significantly associated with survival. |
Nowak et al. [37] | 2004 | 53 pleural mesothelomia | EORTC QLQ-C30 + EORTC QLQ-LC13 | Functional domains and symptom scales (fatigue and pain) demonstrated predictive validity for survival. |
Maione et al. [38] | 2005 | 566 advanced non-small-cell lung cancer | ADL + IADL + EORTC QOL-C30 (global QOL) | Baseline global QOL and IADL were significant prognostic factors for overall survival. |
Brown et al. [39] | 2005 | 273 non-small-cell lung cancer | EORTC QLQ-C30 + EORTC QLQ-LC17 + DDC | Global QOL, role functioning, fatigue, appetite loss and constipation were prognostic indicators of survival. |
Martins et al. [40] | 2005 | 41 locally advanced or metastatic lung cancer | LCSS | Patients' scores on the LCSS appetite and fatigue subscales were independent predictors of survival. |
Efficace et al. [41] | 2006 | 391 advanced non-small-cell lung cancer | EORTC QLQ-C30 + EORTC QLQ-LC13 | Pain, and dysphagia were significant prognostic factors for survival. |
Sundstrom et al. [42] | 2006 | 301 stag III non-small-cell lung cancer | EORTC QLQ-C30 | Appetite loss was the most significant prognostic factor of survival. |
Bottomley et al. [43] | 2007 | 250 malignant pleural mesothelioma | EORTC QLQ-C30 + EORTC QLQ-LC13 | Pain, and appetite loss were independent prognostic indicators of survival. |
Fielding and Wong [44] | 2007 | 534 liver and lung cancers | FACT-G | Global QOL scores did not predict survival in liver and lung cancer. Physical well-being and appetite predicted survival in lung cancer. |
Jacot et al. [45] | 2008 | 301 non-small-cell lung cancer | LCSS | Pretreatment LCSS global symptoms score was independent determinant of overall survival. |
Breast cancer
Author(s) | Year | Sample | HRQOL measure(s)* | Results* |
---|---|---|---|---|
Coates et al. [13] | 1987 | 226 advanced breast cancer | LASA scores for physical well-being + mood, pain, and appetite (as QOL index) | Changes in QOL scores were independent prognostic of survival. |
Coates et al. [46] | 1992 | 226 advanced breast cancer | LASA scores for physical well-being + mood, nausea, vomiting, and appetite (as QOL index) | Both QOL index and physical well-being were independent prognostic factors of survival. |
Fraser et al. [47] | 1993 | 60 advanced breast cancer | DDC + LASA + NHP | The DDC provided accurate prognostic data regarding subsequent response and survival. |
Seidman et al. [48] | 1995 | 40 advanced breast cancer | MSAS + MSAS-GDI + FLI-C + RMHI + BPI + MPAC | Baseline global QOL and distress index scores independently predicted the overall survival. |
Tross et al. [49] | 1996 | 280 early stage breast cancer | SCL-90-R | No significant predictive effect of the level of depression on length of disease-free and overall survival observed. |
Watson et al. [50] | 1999 | 578 early stage breast cancer | MAC + CECS + HADS | Depression score of the HADS and helplessness and hopelessness category of the MAC had determinant effect on survival. |
Coats et al. [51] | 2000 | 227 metastatic and early stage breast cancer | Physical well-being + mood, appetite, and coping (as QOL index) | Disease-free survival was not significantly predicted by QOL scores at baseline or by changes in QOL scores. After relapse QOL scores were predictive for subsequent survival. |
Kramer et al. [52] | 2000 | 187 advanced breast cancer | EORTC QLQ-C30 | Pain was prognostic for survival. However, fatigue and emotional functioning were significant in backward selection model. |
Shimozuma et al. [53] | 2000 | 47 advanced or end stage breast cancer | QOL-ACD | Physical aspects of QOL were significantly related to survival. The change in scores of both overall QOL and the physical aspects of QOL were also significant predictors of survival. |
Butow et al. [54] | 2000 | 99 metastatic breast cancer | Cognitive appraisal of threat + coping + psychological adjustment + perceived aim of treatment + social support + QOL | Minimization was associated with longer survival while a better appetite predicted shorter duration of survival. |
Luoma et al. [55] | 2003 | 279 advanced breast cancer | EORTC QLQ-C30 | Baseline severe pain was predictive for a shorter overall survival. QOL scores had no great importance in predicting primary clinical endpoints such as time to progression or overall survival. |
Winer et al. [56] | 2004 | 474 metastatic breast cancer | FLI-C + SDS | Global QOL and symptom distress scores were prognostic for survival. |
Efficace et al. [57] | 2004 | 448 nonmetastatic breast cancer | EORTC QLQ-C30 | Baseline QOL had no prognostic value in nonmetastatic breast cancer. |
Efficace et al. [58] | 2004 | 275 matastatic breast cancer | EORTC QLQ-C30 + QLQ-BR23 | Loss of appetite was a significant prognostic factor for survival. |
Goodwin et al. [59] | 2004 | 397 early stage breast cancer | EORTC QLQ-C30 + POMS + PAIS + IES + MACS +ACS + CECS | QOL and psychological status at diagnosis and 1 year later were not associated with medical outcome. |
Watson et al. [60] | 2005 | 578 early stage breast cancer | MAC + HADS | Helplessness/hopelessness was a significant predictor of disease-free survival but depression was not. |
Lehto et al. [61] | 2006 | 72 localized breast cancer | Coping + emotional expression + perceived support + life stresses + QOL | Longer survival was predicted by a minimizing-related coping while shorter survival was predicted by anti-emotionality, escape coping, and high level of perceived support. |
Gupta et al. [62] | 2007 | 251 breast carcinoma | Ferrans and Powers QLI | Baseline patient satisfaction with health and physical functioning and overall HRQOL were significant prognostic of survival. |
Groenvold et al. [63] | 2007 | 1588 breast cancer | EORTC QLQ-C30 + HADS | Emotional functioning was predicted overall survival and fatigue was independent predictor of recurrence-free survival. |
Gastro-oesophageal cancers
Author(s) | Year | Sample | HRQOL measure(s) | Results* |
---|---|---|---|---|
Blazeby et al. [64] | 2000 | 89 oesophageal cancer | EORTC QLQ-C30 + Dysphagia scale of QLQ-OES24 | Physical functioning at baseline was significantly associated with survival. |
Blazeby et al. [65] | 2001 | 89 oesophageal cancer | EORTC QLQ-C30 + Dysphagia scale of QLQ-OES24 | Physical functioning at baseline was significantly associated with survival. After treatment, improved emotional functioning was significantly related to longer survival. |
Fang et al. [66] | 2004 | 110 oesophageal squamous cell cancer | EORTC QLQ-C30 | Pretreatment physical functioning was the most significant survival predictor while QOL scores during treatment were not. After treatment dysphagia was the most significant predictor. |
Chau et al. [67] | 2004 | 1080 locally advanced or metastatic oesophago-gastric cancer | EORTC QLQ-C30 | Pretreatment physical and role functioning and global QOL predicted survival. |
Park et al. [68] | 2008 | 164 advanced gastric cancer | EORTC QLQ-C30 | Social functioning was significant prognostic factor for survival. |
Bergquist et al. [69] | 2008 | 96 advanced oesophageal cancer | EORTC QLQ-C30 + QLQ-OES18 | Physical functioning, fatigue and reflux were significant prognostic of survival. |
McKernan et al. [70] | 2008 | 152 gastric or oesophageal cancer | EORTC QLQ-C30 | Appetite loss was significantly independent predictor of survival. |
Healy et al. [71] | 2008 | 185 localized oesophageal cancer | EORTC QLQ-C30 | Fatigue score was predictive of 1-year survival but global QOL data were not. |
Colorectal cancer
Author(s) | Year | Sample | HRQOL measure(s) | Results* |
---|---|---|---|---|
Loprinzi et al. [24] | 1994 | 1115 advanced colorectal or lung | A designed questionnaire | Patients' assessment of their own performance status and nutritional factors such as appetite, caloric intake, or overall food intake were prognostic of survival. |
Earlam et al. [72] | 1996 | 50 colorectal with liver metastases | RSCL + HADS + SIP | Diarrhea, eating, restlessness, and ability to work and sleep were predictors of survival. |
Maisey et al. [73] | 2002 | 501 locally advanced and metastatic colorectal | EORTC QLQ-C30 | Baseline physical, role, social, emotional functioning, global QOL and pain, nausea, dyspnea, and sleep difficulties were strong independent predictors of survival. |
Lis et al. [74] | 2006 | 177 colorectal | Ferrans and Powers QLI | Health and physical subscale was predictive of survival. |
Efficace et al. [75] | 2006 | 299 metastatic colorectal | EORTC QLQ-C30 | Social functioning was a prognostic measure of survival beyond a number of previously known biomedical parameters. |
Efficace et al. [76] | 2008 | 564 metastatic colorectal | EORTC QLQ-C30 | Social functioning was prognostic factor for survival. |
Head and neck cancer
Author(s) | Year | Sample | HRQOL measure(s) | Results* |
---|---|---|---|---|
De Boer [77] | 1998 | 133 head and neck | Self-reported psychosocial and physical functioning | Patients with higher perceived physical abilities were likely to survive more and less likely to develop a recurrence. |
de Graeff et al. [78] | 2001 | 208 head and neck | EORTC QLQ-C30 + QLQ-H&N35 + CES-D | Cognitive functioning was predictor of survival while physical functioning; mood and global QOL were not. |
Fang et al. [79] | 2004 | 102 advanced head and neck | EORTC QLQ-C30 + EORTC QLQ-H&N35 | Baseline fatigue was predictive of survival while changes in QOL scores during treatment was not. |
Mehanna and Morton [80] | 2006 | 200 head and neck | AQLQ + LSS + GHQ | QOL at diagnosis was not significant predictor of survival. One year after diagnosis poor life satisfaction score and pain were significant predictors of survival. |
Nordgren et al. [81] | 2006 | 89 head and neck | EORTC QLQ-C30 | Physical functioning was significant predictor of survival. |
Coyne et al. [82] | 2007 | 1093 locally advanced head and neck cancer | Emotional well-being (FACT-G) | Emotional functioning was not an independent predictor of survival. |
Siddiqui et al. [83] | 2008 | 1093 locally advanced head and neck cancer | FACT-H&N | The FACT-H&N score was independently predictive of loco-regional control but not overall survival. |
Karvonen-Gutierrez et al. [84] | 2008 | 495 head and neck cancer | SF-36, HNQOL | The SF-36 physical component summary score and three domains of the HNQOL (pain, eating and speech) were associated with survival. |
Melanoma
Author(s) | Year | Sample | HRQOL measure(s) | Results* |
---|---|---|---|---|
1985 and 1988 | 359 unresectable cancers or early stage melanoma or breast cancer | Social and psychological factors | Social and psychological factors individually or in combined did not influence the length of survival. | |
Coates et al. [87] | 1993 | 152 metastatic melanoma | LASA scales + Spitzer QLI | QLI and LASA scores for mood, appetite, and overall QOL were significant predictors of survival. |
Butow et al. [88] | 1999 | 125 metastatic melanoma | Cognitive appraisal of threat + coping + psychological adjustment + perceived aim of treatment + social support + QOL | Perceived aim of treatment, minimization, anger and better QOL were independently predictive of longer survival. |
Brown et al. [89] | 2000 | 426 early stage melanoma | 3 single-item LASA scales measuring physical well-being, mood and perceived effort to cope | Shorter survival duration was associated with a positive mood (On average patients who relapsed or died reported using more active, distraction or avoidant styles of coping). |
Chiarion-Sileni et al. [90] | 2003 | 140 advanced melanoma | RSCL | Baseline overall QOL and the physical symptom distress scores were significant independent prognostic factors for survival. |
Lehto et al. [91] | 2007 | 59 localized melanoma | Coping with cancer + anger expression + perceived social support + life stresses + domains of QOL | Anger non-expression, hopelessness, over-positive reporting of QOL reduced survival while denial/minimizing response to the diagnosis as such predicted longer survival. |
Other cancers
Author(s) | Year | Sample | HRQOL measure(s) | Results* |
---|---|---|---|---|
Andrykowski et al. [92] | 1994 | 42 leukemia | Depressed mood + Functional QOL + MAC | Anxious preoccupation and functional QOL were independent predictors of survival. |
Tannock et al. [93] | 1996 | 161 symptomatic hormone-resistant prostate | EORTC QLQ-C30 + QLQ-PR25 + PROSQOLI | Appetite loss, pain, and physical functioning were associated with survival. |
Wisloff and Hjorth [94] | 1997 | 468 multiple myeloma | EORTC QLQ-C30 | Physical functioning was independent prognostic factor of survival. |
Meyers et al. [95] | 2000 | 80 brain (recurrent glioblastoma multiforme or anaplastic astrocytoma) | FACT-Br + ADL | Measures of QOL and ADL were not independently related to survival. |
Jerkeman et al. [96] | 2001 | 95 aggressive lymphoma | EORTC QLQ-C30 | Pretreatment global QOL was an independent prognostic marker of overall survival. |
Roychowdury et al. [97] | 2003 | 364 locally advanced and metastatic bladder | EORTC QLQ-C30 | Longer survival was associated with high physical functioning, low role functioning and no anorexia. |
Sehlen et al. [98] | 2003 | 153 brain tumors | FACT-G | The FACT-G sum score was a significant predictor of survival. |
Collette et al. [99] | 2004 | 391 symptomatic metastatic hormone-resistant prostate cancer | EORTC QLQ-C30 | Insomnia and appetite loss were significant independent predictors of survival. |
Monk et al. [100] | 2005 | 179 advanced cancer of cervix | FACT-G + Cervix subscale + FACT/GOG-Ntx+ BPI | Baseline FACT-Cx (FACT-G + Cervix subscale) scores was associated with survival. |
Brown et al. [101] | 2005 | 273 brain (high grade gloima) | LASA scales (to measure overall QOL)+ FACT-Br + Fatigue (SDS) + Sleep (ESS) + depression (POMS-SF)+ Mental health (MMSE) | Changes in QOL measures over time were not found to be associated with survival. |
Brown et al. [102] | 2006 | 194 brain (high grade glioma) | LASA scales (to measure overall QOL)+ FACT-Br + Fatigue (SDS) + Sleep (ESS) + depression (POMS-SF) + Mental health (MMSE) | Fatigue was significant independent predictor of survival. |
Yeo et al. [103] | 2006 | 233 unresectable hepatocellular | EORTC QLQ-C30 | Appetite loss, physical and role functioning scores were significant predictor of survival. |
Lis et al. [104] | 2006 | 55 pancreatic cancer | Ferrans and Powers QLI | Health and physical subscale was marginally significant predictor of survival. |
Dubois et al. [105] | 2006 | 202 refractory multiple myeloma | EORTC QLQ-C30 + QLQ-MY24 + FACIT-F + FACT/GOG-Ntx | Fatigue was significant predictor of survival. |
Sullivan et al. [106] | 2006 | 809 metastatic hormon-refractory prostate | EORTC QLQ-C30 + FACT-P | Baseline QOL scores (global QOL, physical, role, and social functioning and pain, fatigue and appetite loss) were significant predictors of survival. |
Mauer et al. [107] | 2007 | 247 brain (anaplastic oligodenroglimas) | EORTC QLQ-C30 + EORTC QLQ-BN20 | Emotional functioning, communication deficit, future uncertainty, and weakness of legs were significant prognostic of survival. Baseline QOL scores added little to clinical factors to predict survival. |
Mauer et al. [108] | 2007 | 490 brain (new diagnosed glioblastoma) | EORTC QLQ-C30 + QLQ-BN20 | Cognitive functioning, global health status, and social functioning were significant prognostic factors of survival. Baseline QOL scores added little to clinical factors to predict survival. |
Fielding and Wong [44] | 2007 | 358 liver and lung | FACT-G | Global QOL scores did not predict survival in liver and lung cancer. Physical well-being and appetite predicted survival in lung cancer. |
Viala et al. [109] | 2007 | 202 multiple myeloma | EORTC QLQ-C30, EORTC QLQ-MY24, FACIT-F, FACT/GOG-Ntx | 14 out of 21 patient-reported outcomes were significant predictors of mortality. Clinical plus PRO data increased the predictive power. |
Bonnetain et al. [110] | 2008 | 538 advanced hepatocellular carcinoma | Spitzer QLI | Baseline QOL was independent prognostic factor for survival. |
Carey et al. [111] | 2008 | 244 advanced ovarian cancer | EORTC QLQ-C30 | Performance status and global QOL scores at baseline were prognostic factors for both progression-free survival and overall survival. |
Gupta et al. [112] | 2008 | 90 ovarian cancer | Ferrans and Powers QLI | No statistically significant prognostic association of patient satisfaction with QOL was observed with survival. |
Robinson et al. [113] | 2008 | 86 pancreatic cancer | FACIT-F+ FAACT + BPI + SF-36 | Fatigue strongly predicted survival. |
Strasser-Weippl and Ludwig [114] | 2008 | 92 multiple myeloma | EORTC QLQ-C30 | Role, emotional, cognitive and social functioning but not physical functioning and global QOL were found to be independent prognostic factors of overall survival. |