Studies have suggested that quality of life (QOL) assessments can predict progression-free survival (PFS) and overall survival (OS) in patients with cancer, though this doesn’t appear to hold true for all cancer types or in all treatment settings.1-5

The prognostic value observed in some patients has prompted researchers to recommend more widespread use of QOL assessments in clinical trials. However, researchers also acknowledge that QOL assessments can place an added burden on both patients and clinicians.

“Workflow is increasingly challenging in contemporary medical practice,” said Ridwan Alam, MD, of Johns Hopkins University School of Medicine in Baltimore. “Adding another questionnaire to clinical workflow may add additional stress to both clinicians and patients. It is incredibly important to make sure these questionnaires have value.”

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Recent Findings in RCC

Dr Alam coauthored a recent study suggesting that QOL assessments could predict all-cause mortality in patients with renal cell carcinoma (RCC).6 He and his colleagues evaluated 2 cohorts of patients.

One cohort included 1494 patients with T1-T4 RCC who were followed for a median of 5.6 years. In this group, better mental and physical QOL at baseline were associated with a lower risk of all-cause mortality.

The second cohort included 479 patients with T1 RCC who were followed for a median of 3.9 years. In this group, mental QOL was not significantly associated with all-cause mortality, but physical QOL was.

“The relationship between physical QOL and overall survival was more impressive than anticipated and is an important measure for future exploration,” Dr Alam said.

Findings in Lung and Prostate Cancer

In another recent study, David Hui, MD, of MD Anderson Cancer Center in Houston, and colleagues evaluated the role of QOL scores in predicting PFS and OS in patients with advanced cancers.7

The researchers analyzed data from 3 SWOG clinical trials, which included 1295 evaluable patients. Two trials (S0027 and S9509) enrolled patients with advanced non-small cell lung cancer (NSCLC), and 1 enrolled patients with hormone-refractory prostate cancer (S0421).

In all 3 trials, patients were asked to complete Functional Assessment of Cancer Therapy (FACT) questionnaires at baseline. Dr Hui and colleagues looked at the association between baseline FACT Trial Outcome Index (TOI) scores and survival.

In a univariable analysis, higher FACT-TOI scores were significantly associated with better PFS in all 3 trials. In a multivariable analysis, FACT-TOI score was only significantly associated with PFS in 1 NSCLC trial (S0027).

In both univariable and multivariable analyses, higher FACT-TOI scores were significantly associated with OS across all 3 trials.

Translation to Other Cancers

Though Dr Hui and Dr Alam’s studies add to the body of evidence supporting the prognostic value of QOL assessments, it remains unclear whether QOL can predict PFS and OS across cancer types.

“Strictly speaking, we can only apply the study findings to patients similar to those in our study,” Dr Hui said. “However, the greater literature has generally found similar findings in patients with other cancer types. So the overall picture suggests that baseline health-related QOL is associated with survival, particularly strongly for overall survival and weakly [or] moderately for progression-free survival.”

Dr Alam said his team’s findings could likely translate to other cancers as long as those malignancies are typically asymptomatic.  

“These findings are likely applicable to a wide variety of cancers where the cancer is not causing physical symptoms,” Dr Alam said. “In cancers causing symptoms, it’s much harder to tell how treating the cancer may improve physical symptoms and creates an additional layer of complexity.”

Implementing QOL Assessments

Dr Hui said that one of the take-home messages of his study is that researchers should consider routinely incorporating QOL assessments in clinical trials. In fact, he and his colleagues noted that a limitation of their study is how few clinical trials actually employ QOL assessments and how little data there is to evaluate.

Dr Hui said one reason for this gap in data is likely concern that asking patients to fill out a QOL questionnaire would be an added burden on the patient. Another reason is that not enough clinicians are familiar with interpreting the answers to such questionnaires even when patients do fill them out. 

Dr Alam agreed that more widely implementing QOL assessments will be beneficial only if it doesn’t further burden patients and clinicians. He suggested that improved electronic medical records might help streamline the process.

Disclosures: Dr Hui disclosed research funding from Helsinn Healthcare. Dr Alam reported having no disclosures.


  1. Ediebah DE, Quinten C, Coens C, et al. Quality of life as a prognostic indicator of survival: A pooled analysis of individual patient data from Canadian cancer trials group clinical trials. Cancer. 2018;124(16):3409-3416. doi:10.1002/cncr.31556
  2. Lehto US, Ojanen M, Väkevä A, Dyba T, Aromaa A, Kellokumpu-Lehtinen P. Early quality-of-life and psychological predictors of disease-free time and survival in localized prostate cancer. Qual Life Res. 2019;28(3):677-686. doi:10.1007/s11136-018-2069-z
  3. Fernando HC, Landreneau RJ, Mandrekar SJ, et al. Analysis of longitudinal quality-of-life data in high-risk operable patients with lung cancer: Results from the ACOSOG Z4032 (Alliance) multicenter randomized trial. J Thorac Cardiovasc Surg. 2015;149(3):718-25. doi: 10.1016/j.jtcvs.2014.11.003
  4. Takada K, Kashiwagi S, Asano Y, et al. Prognostic value of quality of life in endocrine therapy for elderly patients with breast cancer: A retrospective study. Anticancer Res. 2019;39(6):2941-2950. doi:10.21873/anticanres.13424
  5. Cella D, Cappelleri JC, Bushmakin A, et al. Quality of life predicts progression-free survival in patients with metastatic renal cell carcinoma treated with sunitinib versus interferon alfa. J Oncol Pract. 2009;5(2):66-70. doi:10.1200/JOP.0922004
  6. Alam R, Patel HD, Su ZT, et al. Self‐reported quality of life as a predictor of mortality in renal cell carcinoma. Cancer. Published online October 5, 2021. doi:10.1002/cncr.33956
  7. Hui E, Darke AK, Guthrie KA, et al. Association between health-related quality of life and progression-free survival in patients with advanced cancer: A secondary analysis of SWOG clinical trials. JCO Oncol Pract. Published online October 4, 2021. doi:10.1200/OP.21.00407

This article originally appeared on Cancer Therapy Advisor