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Health Status Measurements at Diagnosis As Predictors of Survival Among Adults With Brain Tumors

Helen McCarter, William Furlong, Anthony C. Whitton, David Feeny, Sonja DePauw, Andrew R. Willan, Ronald D. Barr

From The Juravinski Cancer Centre; Department of Clinical Epidemiology and Biostatistics; Department of Pediatrics; Centre for Health Economics and Policy Analysis, McMaster University; McMaster Children's Hospital, Hamilton Health Sciences, Hamilton; Health Utilities Inc, Dundas; Institute of Health Economics; Departments of Economics and Public Health Sciences, University of Alberta, Edmonton; Program in Population Health Sciences, Hospital for Sick Children, Toronto, Canada; and Kaiser Permanente Northwest Center for Health Research, Portland, OR

Address reprint requests to Ronald D. Barr, MD, Health Sciences Centre, Room 3N27B, 1200 Main St W, Hamilton, Ontario, L8S 4J9, Canada; e-mail: rbarr{at}mcmaster.ca

PURPOSE: The intent of this study was to determine whether baseline measures of functional capacity and performance could be used to predict survival in adults following the diagnosis of brain tumors.

PATIENTS AND METHODS: Comprehensive health status and health-related quality of life (HRQL) were measured using the Health Utilities Index (HUI; McMaster University, Hamilton, Canada) system by a self-assessment questionnaire in a survey of 100 consecutive patients. The Karnofsky Performance Score (KPS) and Folstein's Mini-Mental State Examination (MMSE) scores were measured by a physician blinded to the HUI results. The patients were observed for up to 5 years to recorded dates of death.

RESULTS: An HUI questionnaire was completed for 93% of the patients and 69% died within 5 years of assessment. The HUI revealed a burden of morbidity and complexity of disability that far exceeded that reported for the general population. KPS and MMSE correlated strongly with each other (r = 0.52; P < .001). A decrease of 0.1 units in HUI Mark 2 (HUI2) self-care single-attribute utility score was associated with an increased hazard of death of 30% (P = .023) for patients with low-grade tumors (n=25). For patients with high-grade tumors (n=56), a 10 unit decrease in the KPS, a 5 unit decrease in MMSE, and a 0.1 decrease in HUI Mark 3 (HUI3) speech and dexterity single-attribute scores were associated with an increased hazard of death of 20% (P = .022), 26% (P = .015), 36% (P = .021), and 18% (P = .035), respectively.

CONCLUSION: Scores derived from the measurement of HRQL following diagnosis can predict survival in adults with brain tumors.

Supported by the Hamilton Health Sciences Foundation. A.R.W. is funded through the Discovery Grant Program of the Natural Sciences and Engineering Research Council of Canada (Grant No. 44868-03).

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

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