The prognostic value of health-related quality-of-life data in predicting survival in glioblastoma cancer patients: results from an international randomised phase III EORTC Brain Tumour and Radiation Oncology Groups, and NCIC Clinical Trials Group study

Abstract

This is one of the few studies that have explored the value of baseline symptoms and health-related quality of life (HRQOL) in predicting survival in brain cancer patients. Baseline HRQOL scores (from the EORTC QLQ-C30 and the Brain Cancer Module (BN 20)) were examined in 490 newly diagnosed glioblastoma cancer patients for the relationship with overall survival by using Cox proportional hazards regression models. Refined techniques as the bootstrap re-sampling procedure and the computation of C-indexes and R 2 -coefficients were used to try and validate the model. Classical analysis controlled for major clinical prognostic factors selected cognitive functioning (P ¼ 0.0001), global health status (P ¼ 0.0055) and social functioning (Po0.0001) as statistically significant prognostic factors of survival. However, several issues question the validity of these findings. C-indexes and R 2 -coefficients, which are measures of the predictive ability of the models, did not exhibit major improvements when adding selected or all HRQOL scores to clinical factors. While classical techniques lead to positive results, more refined analyses suggest that baseline HRQOL scores add relatively little to clinical factors to predict survival. These results may have implications for future use of HRQOL as a prognostic factor in cancer patients.

Review on Quality of Life Issues in Patients with Primary Brain Tumors

“…HRQOL parameters have been shown to be independent prognostic factors in various types of cancers [54]. At present, the prognostic value of baseline HRQOL data in predicting the survival duration of glioma patients is questionable.…”

“…However, HRQOL was closely related to functional status, and after correction for this in a multivariate analysis, no prognostic significance of HRQOL scores remained [21]. Two EORTC brain tumor studies regarding this issue were analyzed by Mauer et al [54,56]. Classical analysis of EORTC QLQ-C30 subscores, controlled for major prognostic factors such as age and performance status, identified cognitive functioning, global health status, and social functioning as statistically significant prognostic factors for survival in glioblastoma patients.…”

Prognostic value of health‐related quality of life for death risk stratification in patients with unresectable glioblastoma

“…Interestingly, the future uncertainty dimension from the QLQ‐BN20 questionnaire was used but not highlighted in the final model in the EORTC study of Mauer et al 4. Nevertheless, the previous study focused not only on patients with UGB but also on those with resectable tumors, which might explain these discrepant results.…”

“…In this context, health‐related quality of life (HRQoL) is a major subject of concern for patients with UGB, who are often symptomatic at the time of diagnosis and are confronted with cognitive deficit due to tumor burden 4, 5, 6, 7. In palliative care patients, the prognostic value of HRQoL has been demonstrated for several types of cancer 8.…”

Editorial: Patient validation of retrospective data

“…2 The cancer-specific health-related quality-of-life instrument EORTC QLQC-30 has a brain tumor module (BN-20) 9 developed for patients with brain tumors, but unfortunately it contains mainly questions relevant for assessing adverse reactions to chemotherapy and radiotherapy. Quality-oflife questionnaires could also pave the way for more costeffectiveness analyses since QALYs (quality-adjusted life years) and cost per QALY can be calculated.…”