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Journal of Clinical Oncology, Vol 23, No 6 (February 20), 2005: pp. 1335-1336 © 2005 American Society of Clinical Oncology. DOI: 10.1200/JCO.2005.05.349
Toward a Clearer Understanding of the Prognostic Value of Health-Related Quality-of-Life Parameters in Breast CancerEuropean Organisation for Research and Treatment of Cancer (EORTC), EORTC Data Center, Quality of Life Unit, Brussels, Belgium To the Editor: We read with interest the recent article by Goodwin et al.1 This pivotal study has shed more light onto the key question with regard to the role of health-related quality-of-life (HRQOL) parameters in predicting clinical outcomes in nonmetastatic cancer patients. Although Goodwin et al failed to prove an association between HRQOL parameters and clinical outcomes, we fully agree with the authors that "negative results, reflecting a failure to identify a hypothesized association, are important as positive results" (p 4191). Importantly, the research findings of Goodwin et al should be viewed alongside our recent results published in the Journal of Clinical Oncology.2 Our study also investigated the prognostic value for survival of baseline HRQOL parameters, as measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 in a population of nonmetastatic breast cancer patients. Although our study also included inflammatory breast cancer patients, both studies dealt with patients with no distant metastasis and represent the only two studies addressing this issue using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 in a nonmetastatic breast cancer population. In contrast with the above results of patients with no distant metastasis, all previous studies conducted with advanced metastatic breast cancer patients found that some HRQOL parameters, such as physical well-being, pain, and appetite loss,3-6 independently predicted survival. The contradictory findings of the value of HRQOL parameters in predicting survival in locoregional and advanced metastatic cancer patients challenges researchers to wonder why HRQOL seems to predict survival only in metastatic disease. Both Goodwin et al1 and our recent results2 seem to support the view that a probable reason underlying the association between HRQOL and survival lies in the patient's accuracy in judging their own health more accurately than some conventional prognostic indices. Patients with worse underlying disease report worse HRQOL outcomes.5 At present, this explanation seems to be the one that would best account for the remarkable differences in terms of results between studies of patients with and without distant metastasis. Within this scenario, it is possible to speculate that for patients with early-stage disease whose symptoms are not generally evident, clinical objective data, such as tumor staging, are more likely to override patients' self-reported HRQOL scores in predicting survival. However, once the disease becomes more advanced, patients' judgments seem to play a more important role. Goodwin et al,1 along with our study,2 should not be seen as undermining the substantial value of HRQOL in predicting survival or other traditional clinical outcomes in advanced disease settings. They simply go some way toward illustrating that the clinical implications of this line of research may only be fruitful in the later stages of the disease. Authors' Disclosures of Potential Conflicts of Interest The authors indicated no potential conflicts of interest. REFERENCES
1. Goodwin PJ, Ennis M, Bordeleau LJ, et al: Health-related quality of life and psychosocial status in breast cancer prognosis: Analysis of multiple variables. J Clin Oncol 22:4184-4192, 2004
2. Efficace F, Therasse P, Piccart MJ, et al: Health-related quality of life parameters as prognostic factors in a nonmetastatic breast cancer population: An international multicenter study. J Clin Oncol 22:3381-3388, 2004 3. Kramer JA, Curran D, Piccart M, et al: Identification and interpretation of clinical and quality of life prognostic factors for survival and response to treatment in first-line chemotherapy in advanced breast cancer. Eur J Cancer 36:1498-1506, 2000 4. Luoma ML, Hakamies-Blomqvist L., Sjöström J, et al: Prognostic value of quality of life scores for time to progression (TTP) and overall survival time (OS) in advanced breast cancer. Eur J Cancer 39:1370-1376, 2003 5. Coates A, Gebski V, Signorini D, et al: Prognostic value of quality-of-life scores during chemotherapy for advanced breast cancer: Australian New Zealand Breast Cancer Trials Group. J Clin Oncol 10:1833-1838, 1992[Abstract] 6. Efficace F, Biganzoli L, Piccart M, et al: Baseline health-related quality of life data as prognostic factors in a phase III multicenter study of women with metastatic breast cancer. Eur J Cancer 40:1021-1030, 2004
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Copyright © 2005 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
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