Health-related quality of life supersedes other psychosocial predictors of long-term survival in cancer patients undergoing radiotherapy

Abstract

Background. To investigate the prognostic value of several psychosocial factors for long-term survival in cancer patients. Material and methods. Baseline data were gathered in routine radiotherapy practice during 44 months. The analysis is based on 938 patients for whom follow-up data were available. Baseline psychosocial distress, depression, health-related quality of life (HRQOL), and life satisfaction were assessed using Questionnaire on Stress in Cancer Patients (QSC-R23), Self-Rating Depression Scale (SDS), Functional Assessment of Therapy – General (FACT-G) questionnaire, and Questions on Life Satisfaction (FLZ^M). Patients were followed up for 7 to 10 years. Kaplan-Meier plots and Cox proportional hazards models were used to investigate associations between sociodemographic, clinical, psychosocial factors and overall survival (OS). Results. Patients’ median survival time was 35 months (95% CI 28.9–41.1). Significant multivariate predictors of OS were age, health insurance type, Karnofsky performance status, cancer site, and cancer stage. Controlling for these variables, HRQOL was the only psychosocial predictor of survival (hazard ratio 0.988, 95% CI 0.979–0.997, p =0.009). The physical well-being and the functional well-being subscales of the FACT-G emerged as the relevant HRQOL facets predictive of survival. Conclusion. HRQOL has incremental predictive value for long-term survival in cancer patients.