Self‐reported quality of life as a predictor of mortality in renal cell carcinoma

Abstract

BACKGROUND:This study evaluated the utility of self-reported quality of life (QOL) metrics in predicting mortality among all-comers with renal cell carcinoma (RCC) and externally tested the findings in a registry of patients with small renal masses. METHODS: The Surveillance, Epidemiology, and End Results-Medicare Health Outcomes Survey (SEER-MHOS) captured QOL metrics composed of mental component summary (MCS) and physical component summary (PCS) scores. Regression models assessed associations of MCS and PCS with all-cause, RCC-specific, and non-RCC-specific mortality. Harrell's concordance statistic (the C-index) and the Akaike information criterion (AIC) determined predictive accuracy and parsimony, respectively. Findings were tested in the prospective Delayed Intervention and Surveillance for Small Renal Masses (DISSRM) registry. RESULTS: In SEER-MHOS, 1494 patients had a median age of 73.4 years and a median follow-up time of 5.6 years. Each additional MCS and PCS point reduced the hazard of all-cause mortality by 1.3% (95% CI, 0.981-0.993; P < .001) and 2.3% (95% CI, 0.971-0.984; P < .001), respectively. Models with QOL metrics demonstrated higher predictive accuracy (C-index, 72.3% vs 70.1%) and parsimony (AIC, 9376.5 vs 9454.5) than models without QOL metrics. QOL metrics exerted a greater effect on non-RCC-specific mortality than RCC-specific mortality. External testing in the DISSRM registry confirmed these findings with similar results for all-cause mortality. CONCLUSIONS: Models with self-reported QOL metrics predicted all-cause mortality in patients with RCC with higher accuracy and parsimony than those without QOL metrics. Physical health was a stronger predictor of mortality than mental health. The findings support the incorporation of QOL metrics into prognostic models and patient counseling for RCC.

The History and Applications of the Veterans RAND 12-Item Health Survey (VR-12)

“…A change in PCS or MCS scores of 1 to 2 points or greater has been shown to be predictive of other important health outcomes. For instance, each additional PCS and MCS point decreased the risk of death from any cause by 2.3% and 1.3%, respectively, in patients with renal cell carcinoma (Alam et al, 2022).…”

Quality of life and its association with predictors in lung transplant recipients: a latent profile analysis

“…Additionally, patients who have lower QOL may report more negative clinical and psychological outcomes. Specifically, lower QOL related-indicators were associated with a higher risk of all-cause mortality and unplanned readmission ( 8 , 9 ). Conversely, those outcomes were negatively associated with QOL, creating a vicious cycle that ultimately may lead to a decreased life expectancy ( 10 ).…”

Patient-reported experience of diagnosis, management, and burden of renal cell carcinomas: Results from the 2020 Global Patient Survey from 41 countries.

“…Although many individual national surveys by patient organisations [4,5] have been conducted over the years, they either focused on one particular aspect of psychological wellbeing (eg, distress or fear of recurrence) or were not peer-reviewed and published in the literature, and no conclusions could be drawn about country-level variations in patient experience or best practice. Other examples of patient-reported surveys in the literature include those that measure physical health and quality of life [6] but these did not prioritise the unmet needs of this group across the care pathway. Here we report on the first global patient survey on the diagnosis, management, and burden of RCC conducted by the International Kidney Coalition (IKCC) and involving its affiliate organisations worldwide.…”