Supportive Care in Cancer

, Volume 26, Issue 11, pp 3925–3932 | Cite as

Investigating the prognostic ability of health-related quality of life on survival: a prospective cohort study of adults with lung cancer

  • Laura C. PinheiroEmail author
  • Bryce B. Reeve
Original Article



Health-related quality of life (HRQOL) is an important predictor for overall survival (OS). To date, no studies compared associations between HRQOL assessed before and after a cancer diagnosis for OS. Our objectives were to (1) investigate associations between HRQOL changes and OS and (2) identify the best HRQOL assessment time point to predict OS.


We used the Surveillance, Epidemiology and End Results linked with the Medicare Health Outcomes Survey data. Medicare Advantage beneficiaries with SEER-confirmed, incident lung cancer between 1998 and 2013 were included. We only included individuals who completed pre- and post-diagnosis assessments. HRQOL was captured using the Short-Form (SF-36) and Katz’s Activities of Daily Living (ADL). Cox Proportional Hazards models examined associations between HRQOL and OS, adjusting for potential confounders. AICs compared model fit.


Five hundred thirty-five adults with mean age of 75 years at diagnosis were included. We observed 300 deaths. Poor HRQOL was associated with greater risk of death across HRQOL assessments. SF-36 before diagnosis, after diagnosis, and change over time had AHRs of 1.01–1.08, 1.10–1.20, and 1.06–1.12, respectively. Pre-diagnosis, post-diagnosis, and changes in ADLs had AHRs of 0.90–2.06, 1.72–2.56, and 1.66–2.21, respectively. Post-diagnosis HRQOL and HRQOL change models had the smallest AICs and largest AHRs, suggesting they were most associated with OS.


This is the first study to compare the prognostic ability of pre-diagnosis, post-diagnosis, and HRQOL changes for OS. The prognostic value of HRQOL at distinct points in the cancer continuum underscores the importance of routine HRQOL monitoring as part of patient-centered cancer care.


Quality of life Cohort study Lung cancer 


Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. This article does not contain any studies with animals performed by any of the authors.

Conflict of interest

My co-authors and I have no conflicts of interest or financial disclosures. At the time the study was conducted, both authors were employed by the University of North Carolina at Chapel Hill. Informed consent from study subjects was not needed as the University of North Carolina at Chapel Hill IRB granted this research exemption from review. All authors have read and approved the manuscript for submission to Supportive Care in Cancer. This manuscript has not been published elsewhere and is not under consideration by another journal.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of General Internal Medicine, Department of MedicineWeill Cornell MedicineNew YorkUSA
  2. 2.Center for Health Measurement, Population Health SciencesDuke University School of MedicineDurhamUSA

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