1. ¹European Organisation for Research and Treatment of Cancer, Quality of Life Unit, Data Center, Avenue Mounier 83/11, 1200 Brussels, Belgium
2. ²Centre Hospitalier Universitaire Vaudois and University of Lausanne, rue du Bugnon 46, 1011 Lausanne, Switzerland
3. ³Medical Center Haaglanden/Westeinde Hospital, Lijnbaan 32 Box 432, 2501 The Hague, The Netherlands
4. ⁴QOL consulting, Edendale Court 4939, West Vancouver V7W 3H7, Canada
5. ⁵Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
6. ⁶Hamilton Health Sciences, Juravinski Cancer Center, Concession Street 699, Hamilton, Ontario L8V 5C2, Canada
7. ⁷Hopital Universitaire Erasme, Route de Lennik 808, 1070 Brussels, Belgium
8. ⁸Department of Clinical Neurosciences, University of Calgary and Foothills Hospital, Alberta, Canada
9. ⁹Tom Baker Cancer Center, University of Calgary, 1331 29th Street N.W., Calgary, AB T2N 4N2, Canada
10. ¹⁰Erasmus University Medical Center, Postbus 5201, 3008 AE Rotterdam, The Netherlands
11. ¹¹Department of Neurology, University of Tübingen, Hoppe-Seyler-Str. 3, 72076 Tübingen, Germany

Correspondence: Dr M Mauer, E-mail: Murielle.Mauer@eortc.be

Received 2 April 2007; Revised 11 June 2007; Accepted 11 June 2007; Published online 3 July 2007.

Abstract

This is one of the few studies that have explored the value of baseline symptoms and health-related quality of life (HRQOL) in predicting survival in brain cancer patients. Baseline HRQOL scores (from the EORTC QLQ-C30 and the Brain Cancer Module (BN 20)) were examined in 490 newly diagnosed glioblastoma cancer patients for the relationship with overall survival by using Cox proportional hazards regression models. Refined techniques as the bootstrap re-sampling procedure and the computation of C-indexes and R²-coefficients were used to try and validate the model. Classical analysis controlled for major clinical prognostic factors selected cognitive functioning (P=0.0001), global health status (P=0.0055) and social functioning (P<0.0001) as statistically significant prognostic factors of survival. However, several issues question the validity of these findings. C-indexes and R²-coefficients, which are measures of the predictive ability of the models, did not exhibit major improvements when adding selected or all HRQOL scores to clinical factors. While classical techniques lead to positive results, more refined analyses suggest that baseline HRQOL scores add relatively little to clinical factors to predict survival. These results may have implications for future use of HRQOL as a prognostic factor in cancer patients.