Braun et al. BMC Cancer 2011, 11:353 http://www.biomedcentral.com/1471-2407/11/353 R E S E A R C H A R T I C L E Open Access Quality of life assessment as a predictor of survival in non-small cell lung cancer Donald P Braun, Digant Gupta* and Edgar D Staren Abstract Background: There are conflicting and inconsistent results in the literature on the prognostic role of quality of life (QoL) in cancer. We investigated whether QoL at admission could predict survival in lung cancer patients. Methods: The study population consisted of 1194 non-small cell lung cancer patients treated at our institution between Jan 2001 and Dec 2008. QoL was evaluated using EORTC-QLQ-C30 prior to initiation of treatment. Patient survival was defined as the time interval between the date of first patient visit and the date of death from any cause/date of last contact. Univariate and multivariate Cox regression evaluated the prognostic significance of QoL. Results: Mean age at presentation was 58.3 years. There were 605 newly diagnosed and 589 previously treated patients; 601 males and 593 females. Stage of disease at diagnosis was I, 100; II, 63; III, 348; IV, 656; and 27 indeterminate. Upon multivariate analyses, global QoL as well as physical function predicted patient survival in the entire study population. Every 10-point increase in physical function was associated with a 10% increase in survival (95% CI = 6% to 14%, p < 0.001). Similarly, every 10-point increase in global QoL was associated with a 9% increase in survival (95% CI = 6% to 11%, p < 0.001). Furthermore, physical function, nausea/vomiting, insomnia, and diarrhea (p < 0.05 for all) in newly diagnosed patients, but only physical function (p < 0.001) in previously treated patients were predictive of survival. Conclusions: Baseline global QoL and physical function provide useful prognostic information in non-small cell lung cancer patients. Background Lung cancer is the most common cancer in the United States in terms of incidence and mortality with 219,440 new cases and 159,390 deaths in 2009 [1]. Patients with lung cancer experience a variety of distressing symp- toms, many of which begin prior to diagnosis and con- tinue throughout the course of the disease and its treatment, adversely affecting functional status and qual- ity of life (QoL) [2,3]. The vast majority of patients, especially those with advanced disease, do not have curative treatment options and therefore, the goal of therapy for such patients is prolongation of survival without negatively impacting QoL [4]. Unfortunately, differences in survival time across the spectrum of avail- able treatments for advanced lung cancer are modest. Thus, treatment for lung cancer which offers the * Correspondence: gupta_digant@yahoo.com Cancer Treatment Centers of America®® at Midwestern Regional Medical Center, Zion, IL, 60099, USA potential for prolonging patient survival must always be judged in the context of its effects on patient QoL [5-8]. Since every patient’s QoL is multidimensional, consist- ing of physical, functional, psychological, social, and spiritual domains [5], there is a growing consensus that treatment efficacy should be judged by its effects on both quantity and quality of life. This has led to the inclusion of QoL assessment as a primary endpoint in all types of clinical trials along with the traditional end- points of tumor response and survival. There is general agreement in the medical and scientific research com- munities that patients are the best source of QoL infor- mation, especially when these patient-reported outcomes can be defined scientifically and measured with validated tools. Extensive data in the literature have shown that QoL tools measuring the activities of daily life can predict survival in several different types of cancers independent of the extent of the disease and other clinical prognostic factors [9-27]. These studies have used different QoL © 2011 Braun et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.