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Pretreatment Quality of Life and Functional Status Assessment Significantly Predict Survival of Elderly Patients With Advanced Non—Small-Cell Lung Cancer Receiving Chemotherapy: A Prognostic Analysis of the Multicenter Italian Lung Cancer in the Elderly Study

From the S Giuseppe Moscati Hospital, Avellino; National Cancer Institute; Medical Statistics, Second University of Napoli; Pneumology V, Monaldi Hospital, Napoli; S Carlo Hospital, Potenza; Mariano Santo Hospital, Cosenza; S Giovanni di Dio e Ruggi d'Aragona, Salerno; Civil Hospital, Noale, Venezia; Sacco Hospital; S Gerardo Hospital, Monza, Milano; Civil Hospital, Rovereto, Trento; Molinette Hospital; San Luigi Gonzaga Hospital, Orbassano, Torino; Forlanini Hospital; Instituto Nazionale Ripose e Cura Anziani, Roma; Civil Hospital, Padova; Pneumology, University of Palermo, Palermo; S Vincenzo Hospital, Taormina, Catania; Centro di Riferimento Oncologico, Aviano, Pordenone, Italy

Address reprint requests to Cesare Gridelli, MD, c/o Unità Sperimentazioni Cliniche, Istituto Nazionale Tumori, Via Mariano Semmola, 80131 Napoli, Italy; e-mail: cgridelli{at}libero.it

PURPOSE: To study the prognostic value for overall survival of baseline assessment of functional status, comorbidity, and quality of life (QoL) in elderly patients with advanced non—small-cell lung cancer treated with chemotherapy.

PATIENTS AND METHODS: Data from 566 patients enrolled onto the phase III randomized Multicenter Italian Lung Cancer in the Elderly Study (MILES) study were analyzed. Functional status was measured as activities of daily living (ADL) and instrumental ADL (IADL). The presence of comorbidity was assessed with a checklist of 33 items; items 29 and 30 of the European Organisation for Research and Treatment of Cancer (EORTC) core questionnaire QLQ-C30 (EORTC QLQ-C30) were used to estimate QoL. ADL was dichotomized as none versus one or more dependency. For IADL and QoL, three categories were defined using first and third quartiles as cut points. Comorbidity was summarized using the Charlson scale. Analysis was performed by Cox model, and stratified by treatment arm.

RESULTS: Better values of baseline QoL (P = .0003) and IADL (P = .04) were significantly associated with better prognosis, whereas ADL (P = .44) and Charlson score (P = .66) had no prognostic value. Performance status 2 (P = .006) and a higher number of metastatic sites (P = .02) also predicted shorter overall survival.

CONCLUSIONS: Pretreatment global QoL and IADL scores, but not ADL and comorbidity, have significant prognostic value for survival of elderly patients with advanced non—small-cell lung cancer who were treated with chemotherapy. Using these scores in clinical practice might improve prognostic prediction for treatment planning.

Supported in part by Associazione Italiana per la Ricerca sul Cancro (AIRC), Clinical Trials Promoting Group (CTPG), and Gruppo Italiano di Oncologia Geriatrica (GIOGer). P.M. is the recipient of an AIRC fellowship.

Presented in part at the 38th Annual Meeting of the American Society of Clinical Oncology, Orlando, FL, May 18-21, 2002 (poster).

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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