Originally published as JCO Early Release 10.1200/JCO.2008.20.0295 on May 18 2009

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Health-Related Quality of Life As a Survival Predictor for Patients With Localized Head and Neck Cancer Treated With Radiation Therapy

From the Laval University Cancer Research Center; the Centre Hospitalier Universitaire de Québec, Québec; the Centre Hospitalier de l'Université de Montréal, Montréal; the Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke; and the Complexe Hospitalier de la Sagamie, Saguenay, Québec, Canada.

Corresponding author: François Meyer, MD, DSc, Laval University Cancer Research Center, CHUQ-HDQ, 11, cote du palais, Québec, G1R 2J6, Canada; e-mail: francois.meyer{at}chuq.qc.ca.

Purpose To assess the added prognostic value for overall survival (OS) of baseline health-related quality of life (HRQOL) and of early changes in HRQOL among patients with localized head and neck cancer (HNC) treated with radiation therapy.

Patients and Methods All 540 patients with HNC who participated in a randomized trial completed two HRQOL instruments before radiation therapy: the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 (EORTC QLQ-C30) and the Head and Neck Radiotherapy Questionnaire. Six months after the end of radiation therapy, 497 trial participants again completed the two HRQOL instruments. During the follow-up, 179 deaths were observed. Multivariate Cox proportional hazards models were used to test whether HRQOL variables, baseline and change, provided additional prognostic value beyond recognized prognostic factors.

Results The baseline EORTC QLQ-C30 physical functioning (PF) score was an independent predictor of OS. The hazard ratio (HR) associated with a 10-point increment in baseline PF was 0.87 (95% CI, 0.81 to 0.94). In multivariate models, the change in HRQOL was significantly associated with OS for most HRQOL dimensions. Among these, PF change was the strongest predictor. The magnitude of the association between PF change and survival decreased over time. At 1 year, the HR associated with a positive PF change of 10 points was 0.75 (95% CI, 0.68 to 0.83). After PF is taken into account, no other HRQOL variable was associated with survival.

Conclusion Our findings indicate that both baseline PF and PF change provide added prognostic value for OS beyond established predictors in patients with HNC. Assessing HRQOL could help better predict survival of cancer patients.

Supported by Grants No. 4738, 8176, and 13211 from the Canadian Cancer Society.

Presented at the 5th Annual Conference of the American Psychosocial Oncology Society, February 28-March 2, 2008, Irvine, CA (baseline data), and at the 20th World Cancer Congress of the International Union Against Cancer (UICC), August 27-31, 2008, Geneva, Switzerland (change data).

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

Clinical Trials repository link available on JCO.org.

Clinical trial information can be found for the following: NCT00169845 [ClinicalTrials.gov] .

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