QLQ-C30 Scale Global Physical Role Emotional Cognitive Social Fatigue Nausea/Vomiting Pain Dyspnea Insomnia Appetite Loss Constipation Diarrhea Braun et al. BMC Cancer 2011, 11:353 http://www.biomedcentral.com/1471-2407/11/353 Table 3 Distribution of QoL scores by stage of disease and prior treatment history Locoregional (N = 511) Stage of disease Metastatic (N = 656) Newly diagnosed (N = 605) Treatment History Previously treated (N = 589) 53.8 69.4 60.4 64.5 75.1 62.0 45.0 13.9 34.7 39.5 39.0 30.2 22.7 9.9 53.1 68.0 57.2 63.5 74.5 60.2 48.6 15.1 39.0 36.0 41.0 32.3 25.4 9.8 P 0.63 0.35 0.12 0.55 0.68 0.35 0.03 0.36 0.02 0.08 0.31 0.29 0.14 0.92 56.1 73.1 62.4 63.3 75.9 65.3 43.1 12.2 34.0 34.7 40.5 28.4 23.2 8.8 50.8 64.1 55.2 64.8 73.7 56.8 50.6 16.8 40.3 40.6 39.3 34.1 25.2 10.9 Page 4 of 9 P 0.001 < 0.001 < 0.001 0.33 0.16 < 0.001 < 0.001 < 0.001 0.001 0.002 0.54 0.004 0.27 0.07 Higher scores in the global and functioning scales and lower scores in the symptom scales indicate better QoL. sample t-tests. Mean global QoL scores were 53.8 and 53.1 for locoregional and metastatic disease (p = 0.63) and 56.1 and 50.9 for newly diagnosed and previously treated disease respectively (p = 0.001). Fatigue and pain scores were significantly higher (poorer) in patients with metastatic disease as compared to those with locoregio- nal disease. Similarly, physical, role and social function- ing scores and fatigue, nausea/vomiting, pain, dyspnea and appetite loss symptom scores were significantly poorer in previously treated patients as compared to newly diagnosed patients. We also evaluated the rela- tionship between QoL and age at presentation using Pearson correlation (r). The function scales to be signifi- cantly correlated with age were physical (r = -0.06; p = 0.04), emotional (r = 0.07; p = 0.01) and social (r = 0.07; p = 0.01). Physical scale was negatively correlated (such that higher age was associated with a poorer physical function) while emotional and social scales were posi- tively correlated (such that higher age was associated with better emotional and social functions). Among the symptom scales, nausea/vomiting (r = -0.09; p = 0.001), pain (r = -0.16; p = 0.001) and insomnia (r = -0.12; p = 0.001) were negatively correlated with age (such that higher age was associated with better nausea/vomiting, pain and insomnia) while dyspnea (r = 0.08; p = 0.007) was positively correlated (such that higher age was asso- ciated with poorer dyspnea). All these correlations were very weak (with r less than 0.20 in either direction). Univariate analysis: prognostic factors for overall survival Median overall survival for the entire patient cohort was 8.8 months (95% CI: 8.0-9.5 months). The median survi- val for newly diagnosed and previously treated patients was 12.6 and 6.8 months respectively, p < 0.001. The median survival for patients with locoregional and meta- static disease was 12.0 and 7.5 months respectively, p < 0.001. Table 4 describes the results of univariate Cox regression analyses for each QLQ-C30 scale as well as age, stage of disease and prior treatment history. The HRs along with their 95% CIs for every one-unit increase in all QLQ-C30 scales are given. On univariate analysis, QoL scales predictive of survival were global (p < 0.001), physical (p < 0.001), role (p < 0.001), emotional (p = 0.04), cognitive (p = 0.003), social (p < 0.001), fati- gue (p < 0.001), nausea/vomiting (p = 0.001), pain (p < 0.001), dyspnea (p < 0.001), loss of appetite (p < 0.001), constipation (p = 0.001) and diarrhea (P = 0.02). Gen- der, stage of disease at diagnosis and prior treatment history were also found to be significant predictors of survival upon univariate analysis (p < 0.001 for all). Multivariate analysis: prognostic factors for overall survival Table 5 describes the results of multivariate Cox regres- sion analyses using the block entry method for those QLQ-C30 function and symptom scales that were signif- icant upon univariate analysis after controlling for the effects of gender, tumor stage and prior treatment his- tory. Upon multivariate analyses, only physical function (p < 0.001) was predictive of survival independent of other QoL scales, gender, stage, and treatment history. Every 10-point increase in physical function was asso- ciated with a 10% increase in survival (95% CI = 6% to 14%, p < 0.001). Gender, stage of disease and prior treatment history were also found to be significant pre- dictors in the final multivariate model (p < 0.01 for all).