Advertisement

Supportive Care in Cancer

, Volume 21, Issue 11, pp 3021–3030 | Cite as

Determinants of quality of life in advanced cancer patients with bone metastases undergoing palliative radiation treatment

  • Kinsey Lam
  • Edward ChowEmail author
  • Liying Zhang
  • Erin Wong
  • Gillian Bedard
  • Alysa Fairchild
  • Vassilios Vassiliou
  • Mohamed Alm El-Din
  • Reynaldo Jesus-Garcia
  • Aswin Kumar
  • Fabien Forges
  • Ling-Ming Tseng
  • Ming-Feng Hou
  • Wei-Chu Chie
  • Andrew Bottomley
Original Article

Abstract

Purpose

Assessment of health-related quality of life (HRQOL) is critical to effective delivery of palliative care in patients with advanced cancer. The current study analyzes relationships between baseline social determinants of health and medical factors, and self-reported HRQOL in patients with bone metastases receiving palliative radiotherapy.

Methods and materials

Advanced cancer patients referred for radiotherapy treatment of bone metastases completed the EORTC QLQ-C30 questionnaire in multiple outpatient clinics internationally. Demographics and social determinants were collected as baseline information. Univariate and Bonferroni-adjusted multivariate linear regression analyses were used to detect significant correlations between baseline determinants and different HRQOL domains.

Results

Karnofsky Performance Status (KPS) was correlated with better physical (p = 0.0002), role (p < 0.0001), emotional (p < 0.0001), and social (p < 0.0001) functioning, and global health scores (p = 0.0015) and predicted lower symptom scores for fatigue (p < 0.0001), pain (p < 0.0001), appetite loss (p < 0.0001), and constipation (p < 0.0001). Increased age was predictive of better social functioning (p < 0.0001) and less insomnia (p = 0.0036), higher education correlated with better global health status (p = 0.0043), and patients who were employed or retired had improved physical functioning (p = 0.0004 and p = 0.0030, respectively) and less financial challenges compared to patients who were unemployed (p = 0.0005).

Conclusions

Baseline KPS had the greatest influence on EORTC QLQ-C30 domain scores. Age, education level, and employment status had significant impacts, although on fewer domains. Further studies that investigate baseline determinants are worthwhile to clarify relationships in order to care for patients more effectively at the end of life.

Keywords

Quality of life Social determinants Baseline factors EORTC QLQ-C30 Bone metastases Advanced cancer 

Notes

Acknowledgments

We thank the generous support of Bratty Family Fund, Michael and Karyn Goldstein Cancer Research Fund, Joseph and Silvana Melara Cancer Research Fund, and Ofelia Cancer Research Fund.

Conflict of interest

None.

References

  1. 1.
    Kirkbride P, Tannock IF (2008) Trials in palliative treatment—have the goal posts been moved? Lancet Oncol 9(3):186–187PubMedCrossRefGoogle Scholar
  2. 2.
    Gotay CC (2004) Assessing cancer-related quality of life across a spectrum of applications. J Natl Cancer Inst Monogr 33:126–133PubMedCrossRefGoogle Scholar
  3. 3.
    Aaronson NK, Ahmedzai S, Bergman B et al (1993) The European organization for research and treatment of cancer EORTC QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. JNCI Cancer Spectrum 85(5):365–376CrossRefGoogle Scholar
  4. 4.
    Kramer JA, Curran D, Piccart M et al (2000) Identification and interpretation of clinical and quality of life prognostic factors for survival and response to treatment in first-line chemotherapy in advanced breast cancer. Eur J Cancer 36(12):1498–1506PubMedCrossRefGoogle Scholar
  5. 5.
    Mauer ME, Taphoorn MJ, Bottomley A et al (2007) Prognostic value of health-related quality-of-life data in predicting survival in patients with anaplastic oligodendrogliomas, from a phase III EORTC brain cancer group study. J Clin Oncol 25:5731–5737PubMedCrossRefGoogle Scholar
  6. 6.
    Quinten C, Coens C, Mauer M et al (2009) Baseline quality of life as a prognostic indicator of survival: a meta-analysis of individual patient data from EORTC clinical trials on behalf of the EORTC Clinical Groups. Lancet Oncol 10:865–871PubMedCrossRefGoogle Scholar
  7. 7.
    Schwarz R, Hinz A (2001) Reference data for the quality of life questionnaire EORTC QLQ-C30 in the general German population. Eur J Cancer 37:1345–1351PubMedCrossRefGoogle Scholar
  8. 8.
    Hjermstad MJ, Fayers PM, Bjordal K (1998) Health-related quality of life in the general Norwegian population assessed by the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire: the QLQ = C30 (+3). 16:1188–1196Google Scholar
  9. 9.
    Michelson H, Bolound C, Nilsson B (2000) Reference values from a large sample of the Swedish population. Acta Oncol 39:477–484PubMedCrossRefGoogle Scholar
  10. 10.
    Holzner B, Kemmler G, Cella D (2004) Normative data for functional assessment of cancer therapy—general scale and its use for the interpretation of quality of life scores in cancer survivors. Acta Oncol 43:153–160PubMedCrossRefGoogle Scholar
  11. 11.
    Jordhoy MS, Fayers P, Loge JH (2001) Quality of life in advanced cancer patients: the impact of sociodemographic and medical characteristics. Br J Cancer 85:1478–1485PubMedCrossRefGoogle Scholar
  12. 12.
    Lundh HC, Seiger A, Furst CJ (2006) Quality of life in terminal care—with special reference to age, gender and marital status. Support Care Cancer 14:320–328CrossRefGoogle Scholar
  13. 13.
    Mundy GR (2002) Metastasis to bone: causes, consequences and therapeutic opportunities. Nat Rev Cancer 2(8):584–593PubMedCrossRefGoogle Scholar
  14. 14.
    Wan G, Counte M, Cella D (1997) The influence of personl expectations on cancer patients' reports of health-related quality of life. Psychooncology 6(1):1–11PubMedCrossRefGoogle Scholar
  15. 15.
    Mor V, Allen S, Malin M (1994) The psychosocial impact of cancer on older versus younger patients and their families. Cancer 74(7):2118–2127PubMedCrossRefGoogle Scholar
  16. 16.
    Fossa SD, Hess SL, Dahl AA, Hjermstad MJ, Veenstra M (2007) Stability of health-related quality of life in the Norwegian general population and impact of chronic morbidity in individuals with and without a cancer diagnosis. Acta Oncol 46:452–461PubMedCrossRefGoogle Scholar
  17. 17.
    Peuckmann V, Ekholm O, Rasmussen N (2006) Health-related quality of life in long-term breast cancer survivors: nationwide survey in Denmark. Breast Cancer Res Treat 104(1):39–46PubMedCrossRefGoogle Scholar
  18. 18.
    Zimmerman C, Burman D, Swami N (2011) Determinants of quality of life in patients with advanced cancer. Support Cancer Care 19:621–629CrossRefGoogle Scholar
  19. 19.
    for,the EORTC Quality of Life Group, Groenvold M, Petersen MA et al (2006) The development of the EORTC QLQ-C15-PAL: a shortened questionnaire for cancer patients in palliative care. Eur J Cancer 42(1):55–64PubMedCrossRefGoogle Scholar
  20. 20.
    Caissie A, Culleton S, Nguyen J, Zhang L, Zeng L, Holden L et al (2012) EORTC QLQ-C15-PAL quality of life scores in patients with advanced cancer referred for palliative radiotherapy. Support Care Cancer 20(4):841–848PubMedCrossRefGoogle Scholar
  21. 21.
    Taechaboonsermsak P, Kaewkungwal J, Singhasivanon P (2005) Causal relationship between health promoting behavior and quality of life in cervical cancer patients undergoing radiotherapy. Southeast Asian J Trop Med Public Health 36:1568–1575PubMedGoogle Scholar
  22. 22.
    Michkeviciene A, Vanagas G, Ulys A (2012) Factors affecting health-related HRQOL in prostate cancer patients. Scand J Urol Nephrol 46(3):180–7CrossRefGoogle Scholar
  23. 23.
    Awadalla A, Ohaeri J, Gholoum A (2007) Factors associated with quality of life of outpatients with breast cancer and gynecologic cancers and their family caregivers: a controlled study. BMC Cancer 7:102PubMedCrossRefGoogle Scholar
  24. 24.
    Anderson A, Mortensen L (2006) Socioeconomic inequality in birth outcomes: what do the indicators tell us, and where do we find the data? CMAJ 174(10):1429–1430CrossRefGoogle Scholar
  25. 25.
    Norris CM, Ghali WA, Galbraith PD, Graham MM, Jensen LA, Knudtson ML (2004) Women with coronary artery disease report worse health-related quality of life outcomes compared to men. Health Qual Life Outcomes 5(2):21CrossRefGoogle Scholar
  26. 26.
    Agewall S, Berglund M, Henareh L (2004) Reduced quality of life after myocardial infarction in women compared with men. Clin Cardiol 27(5):271–4PubMedCrossRefGoogle Scholar
  27. 27.
    Mainio A, Hakko H, Niemela A, Koivukangas J, Rasanen P (2006) Gender difference in relation to depression and quality of life among patients with a primary brain tumor. Eur Psychiatry 21(3):194–199PubMedCrossRefGoogle Scholar
  28. 28.
    Yates J, Chalmer B, McKegney F (1980) Evaluation of patients with advanced cancer using the Karnofsky performance status. Cancer 45:2220–2224PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Kinsey Lam
    • 1
  • Edward Chow
    • 1
    Email author
  • Liying Zhang
    • 1
  • Erin Wong
    • 1
  • Gillian Bedard
    • 1
  • Alysa Fairchild
    • 2
  • Vassilios Vassiliou
    • 3
  • Mohamed Alm El-Din
    • 4
  • Reynaldo Jesus-Garcia
    • 5
  • Aswin Kumar
    • 6
  • Fabien Forges
    • 7
  • Ling-Ming Tseng
    • 8
  • Ming-Feng Hou
    • 9
  • Wei-Chu Chie
    • 10
  • Andrew Bottomley
    • 11
  1. 1.Department of Radiation Oncology, Odette Cancer CentreUniversity of Toronto, Sunnybrook Health Sciences CentreTorontoCanada
  2. 2.Department of Radiation Oncology, Cross Cancer InstituteUniversity of AlbertaEdmontonCanada
  3. 3.Department of Radiation OncologyBank of Cyprus Oncology CentreNicosiaCyprus
  4. 4.Department of Clinical OncologyTanta University Hospital, Tanta Faculty of MedicineTantaEgypt
  5. 5.Department of Orthopedic OncologyFederal University of São PauloSão PauloBrazil
  6. 6.Division of Gynaecology and Genitourinary Oncology, Department of Radiation OncologyRegional Cancer CenterTrivandrumIndia
  7. 7.Inserm CIE3 and Unit of Clinical Research, Innovation, and PharmacologySaint Etienne University HospitalSaint-EtienneFrance
  8. 8.Department of Surgery, Taipei Veterans General HospitalNational Yang-Ming UniversityTaipeiTaiwan
  9. 9.Department of Gastroenterologic SurgeryKaohsiung Medical University HospitalKaohsiungTaiwan
  10. 10.Department of Public Health and Institute of Epidemiology and Preventative MedicineNational Taiwan UniversityTaipeiTaiwan
  11. 11.European Organisation for Research and Treatment of CancerBrusselsBelgium

Personalised recommendations