Quality of life (QoL) as predictive mediator variable for survival in patients with intracerebral neoplasma during radiotherapy

Background: The prognosis for patients with malignant astrocytoma
or brain metastases is often fatal despite intensive therapy.
Therefore we wished to elucidate whether the quality of life (QoL)
is a determinant of overall survival (OAS). Patients and Methods:
From 1997 to 2000 153 patients with brain tumours were screened; 39
patients (26%) refused to participate and further 47 patients were
excluded (cerebral impairment 14%, amaurosis/language problems 3%,
Karnofsky performance score < 50% 7%, death 8%, non-compliance
7%). Thus, 57 patients were analysed (33 with primary brain
tumours, 24 with brain metastases). With the FACT-G questionnaire
cancer-specific aspects of health-related QoL were assessed.
Results: Patients with metastases showed a lower QoL in the
physical sphere than patients with astrocytoma, but there were no
significant differences in OAS. Median survival of patients with
good QoL was 31.3 months versus 14.2 months in patients with bad
QoL. Only the two variables `living with a spouse' and FACT-G sum
score had a statistically significant influence on survival (p =
0.033 and p = 0.003) modelled by the Cox-PH regression. Patients
who did not live with a spouse had shorter survival times than the
other patients. Conclusion: Health-related QoL can serve to
identify a patient group with higher risks of death.