Quality of life most important for survival in advanced non-small cell lung patients

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Healthcare providers have observed it for years -- patients who appear to have a better quality of life while battling their cancer live longer.

Now, a prospective, multi-institutional study examining the quality of life of patients with locally advanced non-small cell lung backs that observation. In fact, quality of life is so important, it out-weighs other classic predictors of survival.

“In the past, we've consider the stage of disease or tumor size along with other empirical data to predict how long a patient will survive, but now we know quality of life is a critical factor in determining survival,” said Nicos Nicolaou, M.D., an attending physician in the radiation oncology department at Fox Chase Cancer Center in Philadelphia and lead author of the abstract.

The study included patients with locally advanced non-small cell lung cancer enrolled in a treatment trial (Radiation Therapy Oncology Group 9801 assessing the addition of amifostine to induction chemotherapy followed by concurrent chemoradiation). In addition to quality of life surveys, factors used to predict overall survival, included stage of disease, gender, age, race, marital status, type of tumor, tumor location in the lung, blood oxygen level, and type of treatment.

"Our study shows that what matters most is what patients themselves are telling us about their quality of life", said Benjamin Movsas, M.D., principal investigator of the RTOG study and senior author of the abstract. Movsas is chairman of the Radiation Oncology Department at Henry Ford Hospital in Detroit.

Of the 239 patients analyzed, 91 percent completed a pre-treatment quality of life questionnaire. Patients with a quality of life score less than the median (66.7) had a 69% higher rate of death than patients with a quality of life score greater than 66.7 (p=0.002).

“We conducted two different statistical analysis including all the usual prognostic factors and either way, quality of life remained the strongest predictor of overall survival. What's more, if a patient's quality of life increased over time, we saw a corresponding increase in survival,” Movsas said.

Married patients or those with a partner had the highest quality of life score.

“We found a significantly lower quality of life score for single, divorced and widowed patients which deserves further study,” Nicolaou said. “These findings underscore the importance of helping our patients improve the quality of life where we can in order to help them live longer better.”

“Quality of life measures should be incorporated into treatment decision making and clinical trials,” Movsas concluded.

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