Quality of life and survival in advanced cervical cancer: A Gynecologic Oncology Group study

• Published in: Gynecologic oncology 2012-05, Vol.125 (2), p.315-319
• Main Authors: Chase, Dana M, Huang, Helen Q, Wenzel, Lari, Cella, David, McQuellon, Richard, Long, Harry J, Moore, David H, Monk, Bradley J
• Format: Article
• Language: English
• Subjects: Adult; Aged; Cervical cancer; Disease-Free Survival; Female; Hematology, Oncology and Palliative Medicine; Humans; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Obstetrics and Gynecology; Proportional Hazards Models; Quality of Life; Randomized Controlled Trials as Topic; Survival Rate; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - physiopathology; Uterine Cervical Neoplasms - psychology; Uterine Cervical Neoplasms - therapy
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2012.01.047

Abstract Purpose To determine associations between pretreatment health-related quality of life subscales with progression-free (PFS) and overall survival (OS) in advanced and recurrent cervical cancer. Patients and Methods Patients included those participating in Gynecologic Oncology Group advanced or recurrent cervical cancer phase III treatment trials who completed the Functional Assessment of Cancer Therapy for patients with cervical cancer (FACT-Cx) and a single-item pain scale at study entry. The FACT-Cx includes five domains: physical (PWB), emotional (EWB), social (SWB), functional well being (FWB), and cervix cancer subscale (CCS). A high quality of life (QoL) score reflects better QoL. After stratifying by protocol and adjusting for patient and disease characteristics, a Cox proportional hazards model was fitted for each subscale as a continuous variable. If statistically significant, (p < 0.05), an analysis on mean item scores (MIS) was performed. Results Nine-hundred-ninety-one patients were enrolled from 1997 to 2007. The majority (87%) had recurrent disease. After adjustment for covariates and predictors, only the PWB domain (better physical QoL) was associated with improved OS [HR 0.96 95% CI 0.95–0.98; p < 0.001]. When classifying patients based on the MIS of each subscale, the patients with the lowest risk of death were likely to report less compromised QoL (MIS > 3) for PWB [HR 0.44 (0.33–0.58) P < 0.001], FWB [0.49 (0.38–0.62) P < 0.001], and CCS [0.48 (0.38–0.61) P < 0.001]. Conclusion The pretreatment patient-reported PWB as measured by the PWB subscale of the FACT-Cx, is significantly associated with survival in advanced cervical cancer trials, even after controlling for known prognostic factors.