Skip to main content

Advertisement

SpringerLink
Log in

A longitudinal study of the role of patient-reported outcomes on survival prediction of palliative cancer inpatients in Taiwan

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Goals of work

This study explores the significance of patient-reported outcomes for predicting length of survival of palliative cancer patients.

Patients and methods

Patients were recruited upon admission to the inpatient palliative care unit. Weekly assessment of 180 terminal cancer patients was carried out throughout their survival time using the Medical Outcome Study 36-Item Short-Form Health Survey, the Taiwanese version of the M.D. Anderson Symptom Inventory (MDASI-T), the Karnofsky Performance Status (KPS), the Brief Pain Inventory, and the Brief Fatigue Inventory. Generalized estimating equations (GEE) were utilized to analyze whether the patient-reported outcomes predicted survival time.

Main results

Of all patients, 64 had one assessment, 51 had two, 25 had three, and 40 had four or more assessments, up to a maximum of eight. The univariate analysis showed that gender (P < 0.01), KPS (P < 0.01), the physical component summary score (P = 0.02), the MDASI-T total score (P < 0.01), composite fatigue severity (P < 0.01), and composite pain severity (P < 0.01) were significantly associated with length of survival. The multivariate analysis showed that gender (P < 0.01), KPS (P < 0.01), and the MDASI-T total score (P = 0.01) were significant predictors of survival time.

Conclusions

This is the first study to explore the significance of patient-related outcomes for predicting length of survival of palliative cancer patients using the GEE method. This study confirms that overall symptom severity is a significant factor in assessing the length of survival of palliative cancer patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Blazeby JM, Brookes ST, Alderson D (2001) The prognostic value of quality of life scores during treatment for oesophageal cancer. Gut 49:227–230. doi:10.1136/gut.49.2.227

    Article  PubMed  CAS  Google Scholar 

  2. Bottomley A, Flechtner H, Efficace F, Vanvoorden V, Coens C, Therasse P, Velikova G, Blazeby J, Greimel E, European Organisation for Research and Treatment of Cancer (EORTC) Data Center and Quality of Life Group (2005) Health related quality of life outcomes in cancer clinical trials. Eur J Cancer 41:1697–1709. doi:10.1016/j.ejca.2005.05.007

    Article  PubMed  CAS  Google Scholar 

  3. Bruera E, Miller MJ, Kuehn N, MacEachern T, Hanson J (1992) Estimate of survival of patients admitted to a palliative care unit: a prospective study. J Pain Symptom Manage 7:82–86. doi:10.1016/0885-3924(92)90118-2

    Article  PubMed  CAS  Google Scholar 

  4. Bruley DK (1999) Beyond reliability and validity: analysis of selected quality-of-life instruments for use in palliative care. J Palliat Med 2:299–309. doi:10.1089/jpm.1999.2.299

    Article  PubMed  CAS  Google Scholar 

  5. Buccheri G, Ferrigno D, Tamburini M (1996) Karnofsky and ECOG performance status scoring in lung cancer: a prospective, longitudinal study of 536 patients from a single institution. Eur J Cancer 32A:1135–1141. doi:10.1016/0959-8049(95)00664-8

    Article  PubMed  CAS  Google Scholar 

  6. Carey MS, Bacon M, Tu D, Butler L, Bezjak A, Stuart GC (2008) The prognostic effects of performance status and quality of life scores on progression-free survival and overall survival in advanced ovarian cancer. Gynecol Oncol 108:100–105. doi:10.1016/j.ygyno.2007.08.088

    Article  PubMed  CAS  Google Scholar 

  7. Chang MC, Chang YC, Chiou JF, Tsou TS, Lin CC (2002) Overcoming patient-related barriers to cancer pain management for home care patients: a pilot study. Cancer Nurs 25:470–476. doi:10.1097/00002820-200212000-00012

    Article  PubMed  Google Scholar 

  8. Cheung WY, Barmala N, Zarinehbaf S, Rodin G, Le LW, Zimmermann C (2008) The association of physical and psychological symptom burden with time to death among palliative cancer outpatients. J Pain Symptom Manage. doi:10.1016/j.jpainsymman.2008.03.008

  9. Chow E, Harth T, Hruby G, Finkelstein J, Wu J, Danjoux C (2001) How accurate are physicians’ clinical predictions of survival and the available prognostic tools in estimating survival times in terminally ill cancer patients? A systematic review. Clin Oncol 13:209–218

    CAS  Google Scholar 

  10. Chow E, Fung K, Panzarella T, Bezjak A, Danjoux C, Tannock I (2002) A predictive model for survival in metastatic cancer patients attending an outpatient palliative radiotherapy clinic. Int J Radiat Oncol Biol Phys 53:1291–1302. doi:10.1016/S0360-3016(02)02832-8

    Article  PubMed  Google Scholar 

  11. Cleeland CS, Mendoza TR, Wang XS, Chou C, Harle MT, Morrissey M, Engstrom MC (2000) Assessing symptom distress in cancer patients: the M. D. Anderson Symptom Inventory. Cancer 89:1634–1646 doi:10.1002/1097-0142(20001001)89:7<1634::AID-CNCR29>3.0.CO;2-V

    Article  PubMed  CAS  Google Scholar 

  12. Coates A, Porzsolt F, Osoba D (1997) Quality of life in oncology practice: prognostic value of EORTC QLQ-C30 scores in patients with advanced malignancy. Eur J Cancer 33:1025–1030. doi:10.1016/S0959-8049(97)00049-X

    Article  PubMed  CAS  Google Scholar 

  13. Degner LF, Sloan JA (1995) Symptom distress in newly diagnosed ambulatory cancer patients and as a predictor of survival in lung cancer. J Pain Symptom Manage 10:423–431. doi:10.1016/0885-3924(95)00056-5

    Article  PubMed  CAS  Google Scholar 

  14. den Daas N (1995) Estimating length of survival in end-stage cancer: a review of the literature. J Pain Symptom Manage 10:548–555. doi:10.1016/0885-3924(95)00103-6

    Article  PubMed  CAS  Google Scholar 

  15. Efficace F, Biganzoli L, Piccart M, Coens C, Van Steen K, Cufer T, Coleman RE, Calvert HA, Gamucci T, Twelves C, Fargeot P, Bottomley A, EORTC-BCG-IDBBC-NDDG (2004) Baseline health-related quality-of-life data as prognostic factors in a phase III multicentre study of women with metastatic breast cancer. Eur J Cancer 40:1021–1030. doi:10.1016/j.ejca.2004.01.014

    Article  PubMed  CAS  Google Scholar 

  16. Fang FM, Tsai WL, Chiu HC, Kuo WR, Hsiung CY (2004) Quality of life as a survival predictor for esophageal squamous cell carcinoma treated with radiotherapy. Int J Radiat Oncol Biol Phys 58:1394–1404. doi:10.1016/j.ijrobp.2003.09.100

    Article  PubMed  Google Scholar 

  17. Forster LE, Lynn J (1988) Predicting life span for applicants to inpatient hospice. Arch Intern Med 148:2540–2543. doi:10.1001/archinte.148.12.2540

    Article  PubMed  CAS  Google Scholar 

  18. Ganz PA, Lee JJ, Siau J (1991) Quality of life assessment. An independent prognostic variable for survival in lung cancer. Cancer 67:3131–3135 doi:10.1002/1097-0142(19910615)67:12<3131::AID-CNCR2820671232>3.0.CO;2-4

    Article  PubMed  CAS  Google Scholar 

  19. Gotay CC, Kawamoto CT, Bottomley A, Efficace F (2008) The prognostic significance of patient-reported outcomes in cancer clinical trials. J Clin Oncol 26:1355–1363. doi:10.1200/JCO.2007.13.3439

    Article  PubMed  Google Scholar 

  20. Gupta D, Granick J, Grutsch JF, Lis CG (2007) The prognostic association of health-related quality of life scores with survival in breast cancer. Support Care Cancer 15:387–393. doi:10.1007/s00520-006-0165-z

    Article  PubMed  Google Scholar 

  21. Gwede CK, Small BJ, Munster PN, Andrykowski MA, Jacobsen PB (2008) Exploring the differential experience of breast cancer treatment-related symptoms: a cluster analytic approach. Support Care Cancer 16:925–933. doi:10.1007/s00520-007-0364-2

    Article  PubMed  Google Scholar 

  22. Hanley JA, Negassa A, Edwardes MD, Forrester JE (2003) Statistical analysis of correlated data using generalized estimating equations: an orientation. Am J Epidemiol 157:364–375. doi:10.1093/aje/kwf215

    Article  PubMed  Google Scholar 

  23. Hauser CA, Stockler MR, Tattersall MH (2006) Prognostic factors in patients with recently diagnosed incurable cancer: a systematic review. Support Care Cancer 14:999–1011. doi:10.1007/s00520-006-0079-9

    Article  PubMed  Google Scholar 

  24. Herndon JE, Fleishman S, Kornblith AB, Kosty M, Green MR, Holland J (1999) Is quality of life predictive of the survival of patients with advanced nonsmall cell lung carcinoma? Cancer 85:333–340 doi:10.1002/(SICI)1097-0142(19990115)85:2<333::AID-CNCR10>3.0.CO;2-Q

    Article  PubMed  Google Scholar 

  25. Kaasa S, Mastekaasa A, Lund E (1989) Prognostic factors for patients with inoperable non-small cell lung cancer, limited disease. The importance of patients’ subjective experience of disease and psychosocial well-being. Radiother Oncol 15:235–242. doi:10.1016/0167-8140(89)90091-1

    Article  PubMed  CAS  Google Scholar 

  26. Karvonen-Gutierrez CA, Ronis DL, Fowler KE, Terrell JE, Gruber SB, Duffy SA (2008) Quality of life scores predict survival among patients with head and neck cancer. J Clin Oncol 26:2754–2760. doi:10.1200/JCO.2007.12.9510

    Article  PubMed  Google Scholar 

  27. Kim JG, Ryoo BY, Park YH, Kim BS, Kim TY, Im YH, Kang YK (2008) Prognostic factors for survival of patients with advanced gastric cancer treated with cisplatin-based chemotherapy. Cancer Chemother Pharmacol 61:301–307. doi:10.1007/s00280-007-0476-x

    Article  PubMed  CAS  Google Scholar 

  28. Kramer JA, Curran D, Piccart M, de Haes JC, Bruning P, Klijn J, Van Hoorebeeck I, Paridaens R (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 36:1498–1506. doi:10.1016/S0959-8049(00)00144-1

    Article  PubMed  CAS  Google Scholar 

  29. Langendijk H, Aaronson NK, de Jong JM, ten Velde GP, Muller MJ, Wouters M (2000) The prognostic impact of quality of life assessed with the EORTC QLQ-C30 in inoperable non-small cell lung carcinoma treated with radiotherapy. Radiother Oncol 55:19–25. doi:10.1016/S0167-8140(00)00158-4

    Article  PubMed  CAS  Google Scholar 

  30. Liang KY, Zeger SL (1986) Longitudinal data analysis using generalized liner models. Biometrika 73:13–22. doi:10.1093/biomet/73.1.13

    Article  Google Scholar 

  31. Liang KY, Zeger SL, Qaqish B (1992) Multivariate regression analyses for categorical data. J R Stat Soc [Ser A] 54:3–40

    Google Scholar 

  32. Lin CC (2000) Barriers to the analgesic management of cancer pain: a comparison of attitudes of Taiwanese patients and their family caregivers. Pain 88:7–14. doi:10.1016/S0304-3959(00)00303-1

    Article  PubMed  CAS  Google Scholar 

  33. Lin HC, Lin CC (2007) A population-based study on the specific locations of cancer deaths in Taiwan, 1997–2003. Support Care Cancer 15:1333–1339. doi:10.1007/s00520-006-0204-9

    Article  PubMed  Google Scholar 

  34. Lin CC, Chang AP, Chen ML, Cleeland CS, Mendoza TR, Wang XS (2006) Validation of the Taiwanese version of the Brief Fatigue Inventory. J Pain Symptom Manage 32:52–59. doi:10.1016/j.jpainsymman.2005.12.019

    Article  PubMed  Google Scholar 

  35. Lin CC, Chang AP, Cleeland CS, Mendoza TR, Wang XS (2007) Taiwanese version of the M. D. Anderson symptom inventory: symptom assessment in cancer patients. J Pain Symptom Manage 33(2):180–188. doi:10.1016/j.jpainsymman.2006.07.018

    Article  PubMed  Google Scholar 

  36. Llobera J, Esteva M, Rifà J, Benito E, Terrasa J, Rojas C, Pons O, Catalán G, Avellà A (2000) Terminal cancer: duration and prediction of survival time. Eur J Cancer 36:2036–2043. doi:10.1016/S0959-8049(00)00291-4

    Article  PubMed  CAS  Google Scholar 

  37. Loprinzi CL, Laurie JA, Wieand HS, Krook JE, Novotny PJ, Kugler JW, Bartel J, Law M, Bateman M, Klatt NE, Dose AM, Etzell PS, Nelimark RA, Mailliard JA, Moertel CG for the North Central Cancer Treatment Group (1994) Prospective evaluation of prognostic variables from patient-completed questionnaires. J Clin Oncol 12:601–607

    PubMed  CAS  Google Scholar 

  38. Lu JR, Tseng HM, Tsai YJ (2003) Assessment of health-related quality of life in Taiwan: development and psychometric testing of SF-36 Taiwan version. Taiwan J Public Health 22:501–511 in Chinese

    Google Scholar 

  39. Luoma ML, Hakamies-Blomqvist L, Sjöström J, Pluzanska A, Ottoson S, Mouridsen H, Bengtsson NO, Bergh J, Malmström P, Valvere V, Tennvall L, Blomqvist C (2003) Prognostic value of quality of life scores for time to progression (TTP) and overall survival time (OS) in advanced breast cancer. Eur J Cancer 39:1370–1376. doi:10.1016/S0959-8049(02)00775-X

    Article  PubMed  Google Scholar 

  40. Maltoni M, Pirovano M, Scarpi E, Marinari M, Indelli M, Arnoldi E, Gallucci M, Frontini L, Piva L, Amadori D (1995) Prediction of survival of patients terminally ill with cancer. Results of an Italian prospective multicentric study. Cancer 75:2613–2622 doi:10.1002/1097-0142(19950515)75:10<2613::AID-CNCR2820751032>3.0.CO;2-1

    Article  PubMed  CAS  Google Scholar 

  41. Mauer ME, Taphoorn MJ, Bottomley A, Coens C, Efficace F, Sanson M, Brandes AA, van der Rijt CC, Bernsen HJ, Frénay M, Tijssen CC, Lacombe D, van den Bent MJ, EORTC Brain Cancer Group (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 25:5731–5737. doi:10.1200/JCO.2007.11.1476

    Article  PubMed  Google Scholar 

  42. McQuellon RP, Russell GB, Shen P, Stewart JH, Saunders W, Levine EA (2008) Survival and health outcomes after cytoreductive surgery with intraperitoneal hyperthermic chemotherapy for disseminated peritoneal cancer of appendiceal origin. Ann Surg Oncol 15:125–133. doi:10.1245/s10434-007-9678-z

    Article  PubMed  Google Scholar 

  43. Mendoza TR, Wang XS, Cleeland CS, Morrissey M, Johnson BA, Wendt JK, Huber SL (1999) The rapid assessment of fatigue severity in cancer patients: use of the Brief Fatigue Inventory. Cancer 85(5):1186–1196 doi:10.1002/(SICI)1097-0142(19990301)85:5<1186::AID-CNCR24>3.0.CO;2-N

    Article  PubMed  CAS  Google Scholar 

  44. Montazeri A, Milroy R, Hole D, McEwen J, Gillis CR (2001) Quality of life in lung cancer patients as an important prognostic factor. Lung Cancer 31:233–240. doi:10.1016/S0169-5002(00)00179-3

    Article  PubMed  CAS  Google Scholar 

  45. Mor V, Laliberte L, Morris JN, Wiemann M (1984) The Karnofsky performance status scale: an examination of its reliability and validity in a research setting. Cancer 53:2002–2007 doi:10.1002/1097-0142(19840501)53:9<2002::AID-CNCR2820530933>3.0.CO;2-W

    Article  PubMed  CAS  Google Scholar 

  46. Morita T, Tsunoda J, Inoue S, Chihara S (1999) The palliative prognostic index: a scoring system for survival prediction of terminally ill cancer patients. Support Care Cancer 7:128–133. doi:10.1007/s005200050242

    Article  PubMed  CAS  Google Scholar 

  47. Okuyama T, Wang XS, Akechi T, Mendoza TR, Hosaka T, Cleeland CS, Uchitomi Y (2003) Japanese version of the M. D. Anderson Symptom Inventory: a validation study. J Pain Symptom Manage 26:1093–1104. doi:10.1016/j.jpainsymman.2003.05.003

    Article  PubMed  Google Scholar 

  48. Osoba D (1994) Lessons learned from measuring health-related quality of life in oncology. J Clin Oncol 12:608–616

    PubMed  CAS  Google Scholar 

  49. Palmer JL, Fisch MJ (2005) Association between symptom distress and survival in outpatients seen in a palliative care cancer center. J Pain Symptom Manage 29:565–571. doi:10.1016/j.jpainsymman.2004.11.007

    Article  PubMed  Google Scholar 

  50. Parkes CM (1972) Accuracy of predictions of survival in later stages of cancer. BMJ 2:29–31

    Article  PubMed  CAS  Google Scholar 

  51. Reuben DB, Mor V, Hiris J (1988) Clinical symptoms and length of survival in patients with terminal cancer. Arch Intern Med 148:1586–1591. doi:10.1001/archinte.148.7.1586

    Article  PubMed  CAS  Google Scholar 

  52. Robinson DW, Eisenberg DF, Cella D, Zhao N, de Boer C, DeWitte M (2008) The prognostic significance of patient-reported outcomes in pancreatic cancer cachexia. J Support Oncol 6:283–290

    PubMed  Google Scholar 

  53. Rosenthal MA, Gebski VJ, Kefford RF, Stuart-Harris RC (1993) Prediction of life-expectancy in hospice patients: identification of novel prognostic factors. Palliat Med 7:199–204. doi:10.1177/026921639300700306

    Article  PubMed  CAS  Google Scholar 

  54. Roychowdhury DF, Hayden A, Liepa AM (2003) Health-related quality-of-life parameters as independent prognostic factors in advanced or metastatic bladder cancer. J Clin Oncol 21:673–678. doi:10.1200/JCO.2003.04.166

    Article  PubMed  CAS  Google Scholar 

  55. Ruckdeschel JC, Piantadosi S (1991) Quality-of-life assessment in lung surgery for bronchogenic carcinoma. Theor Surg 6:201–205

    Google Scholar 

  56. Seidman AD, Portenoy R, Yao TJ, Lepore J, Mont EK, Kortmansky J, Onetto N, Ren L, Grechko J, Beltangady M, Usakewicz J, Southrada M, Houston C, McCabe M, Salvaggio R, Thaler H, Norton L (1995) Quality of life in phase II trials: a study of methodology and predictive value in patients with advanced breast cancer treated with paclitaxel plus granulocyte colony-stimulating factor. J Natl Cancer Inst 87:1316–1322. doi:10.1093/jnci/87.17.1316

    Article  PubMed  CAS  Google Scholar 

  57. Sloan JA, Loprinzi CL, Laurine JA, Novotny PJ, Vargas-Chanes D, Krook JE, O’Connell MJ, Kugler JW, Tirona MT, Kardinal CG, Wiesenfeld M, Tschetter LK, Hatfield AK, Schaefer PL (2001) A simple stratification factor prognostic for survival in advanced cancer: the good/bad/uncertain index. J Clin Oncol 19:3539–3546

    PubMed  CAS  Google Scholar 

  58. Sprangers MA (2002) Quality-of-life assessment in oncology: achievements and challenges. Acta Oncol 41:229–237. doi:10.1080/02841860260088764

    Article  PubMed  Google Scholar 

  59. The WHOQOL Group (1995) The World Health Organization Quality of Life Assessment (WHOQOL): position paper from the World Health Organization. Soc Sci Med 41:1403–1409. doi:10.1016/0277-9536(95)00112-K

    Article  Google Scholar 

  60. Tseng HM, Lu JR, Tsai YJ (2003) Assessment of health-related quality of life (II): norming and validation of SF-36 Taiwan version. Taiwan J Public Health 22:512–518 in Chinese

    Google Scholar 

  61. United States Food and Drug Administration (2006) Guidance of industry patient-reported outcome measures: use in medical product development to support labeling claims. United States Food and Drug Administration, Rockville

    Google Scholar 

  62. van de Poll-Franse LV, Sadetsky N, Kwan L, Litwin MS (2008) Severity of cardiovascular disease and health-related quality of life in men with prostate cancer: a longitudinal analysis from CaPSURE. Qual Life Res 17:845–855. doi:10.1007/s11136-008-9356-z

    Article  PubMed  Google Scholar 

  63. Viganò A, Dorgan M, Bruera E, Suarez-Almazor ME (1999) The relative accuracy of the clinical estimation of the duration of life for patients with end of life cancer. Cancer 86:170–176. doi:10.1002/(SICI)1097-0142(19990701)86:1doi:<doi:170::AID-CNCR23doi:>doi:3.0.CO;2-S

    Article  PubMed  Google Scholar 

  64. Vigano A, Donaldson N, Higginson IJ, Bruera E, Mahmud S, Suarez-Almazor M (2004) Quality of life and survival prediction in terminal cancer patients: a multicenter study. Cancer 101:1090–1098. doi:10.1002/cncr.20472

    Article  PubMed  Google Scholar 

  65. Wang XS, Mendoza TR, Gao SZ, Cleeland CS (1996) The Chinese version of the Brief Pain Inventory (BPI-C): its development and use in a study of cancer pain. Pain 67:407–416. doi:10.1016/0304-3959(96)03147-8

    Article  PubMed  CAS  Google Scholar 

  66. Ware JE, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30:473–483. doi:10.1097/00005650-199206000-00002

    Article  PubMed  Google Scholar 

  67. Watson M, Haviland JS, Greer S, Davidson J, Bliss JM (1999) Influence of psychological response on survival in breast cancer: a population-based cohort study. Lancet 354:1331–1336. doi:10.1016/S0140-6736(98)11392-2

    Article  PubMed  CAS  Google Scholar 

  68. Zeger SL, Liang KY (1986) Longitudinal data analysis for discrete and continuous outcomes. Biometrics 42:121–130. doi:10.2307/2531248

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Ms. Denise Dipert for her careful review and expertise on editing this manuscript. This study was supported by the National Science Council NSC 91-2314-B-038-007.

Author information

Authors and Affiliations

  1. Taipei Veterans General Hospital, Taipei Medical University, Taipei, Taiwan

    Jing-An Chang

  2. School of Nursing, Taipei Medical University, 250 Wu-Hsing Street, Taipei, 110, Taiwan

    Chia-Chin Lin

Authors
  1. Jing-An Chang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Chia-Chin Lin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chia-Chin Lin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chang, JA., Lin, CC. A longitudinal study of the role of patient-reported outcomes on survival prediction of palliative cancer inpatients in Taiwan. Support Care Cancer 17, 1285–1294 (2009). https://doi.org/10.1007/s00520-009-0583-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-009-0583-9

Keywords

Search

Navigation