Pre-diagnosis health-related quality of life and survival in older women with endometrial cancer

• Published in: Supportive care in cancer 2020-10, Vol.28 (10), p.4901-4909
• Main Authors: Klapheke, Amy K., Keegan, Theresa H. M., Ruskin, Rachel, Cress, Rosemary D.
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Aged; Cancer; Cancer patients; Diagnosis; Endometrial cancer; Endometrial Neoplasms - mortality; Epidemiology; Female; Health; Humans; Medical diagnosis; Medical prognosis; Medicare - statistics & numerical data; Medicine; Medicine & Public Health; Middle aged women; Nursing; Nursing Research; Older people; Oncology; Oncology, Experimental; Original Article; Pain Medicine; Patient outcomes; Physical fitness; Prognosis; Quality of Life; Rehabilitation Medicine; SEER Program; Surveys; Surveys and Questionnaires; United States - epidemiology; Womens health
• ISSN: 0941-4355; 1433-7339
• DOI: 10.1007/s00520-020-05324-0

Purpose Health-related quality of life (HRQOL) is an important prognostic factor in cancer patients. To date, no other studies have assessed the association between HRQOL measured before diagnosis and survival in older women with endometrial cancer. Methods The Surveillance, Epidemiology, and End Results – Medicare Health Outcomes Survey linked database was used to identify 995 women who were at least 65 years old and completed a survey before diagnosis with endometrial cancer. We obtained scores for 10 HRQOL scales, as measured by Medical Outcomes Study Short Form-36 and Veterans RAND 12-Item Survey, and data on activities of daily living (ADLs) impairments and depressive symptoms. Fine and Gray competing risks regression and Cox proportional hazards were used to estimate the association of HRQOL with endometrial cancer-specific and overall survival, respectively. Results Women who died had worse pre-diagnosis HRQOL than women who were still alive at the end of the study period. For every five-point increase in HRQOL score, overall survival improved by 5–9%. The strongest associations were observed for vitality (HR = 0.91, 95% CI 0.86, 0.97, p  = 0.0021) and physical functioning (HR = 0.92, 95% CI 0.87, 0.97, p  = 0.0010). ADL impairments were generally not predictive of survival, though depressive symptoms were significantly associated with increased hazard of death from all causes (HR = 1.34, 95% CI 1.00, 1.79, p  = 0.0466). Conclusion HRQOL measured before diagnosis with endometrial cancer has prognostic value. Having measures of HRQOL available at diagnosis may facilitate timely supportive care to improve survival.