Prognostic value of changes in quality of life scores in prostate cancer

e15001 Background: Several studies in oncology literature have demonstrated the prognostic value of baseline quality of life (QoL). However, there is little to no information on the prognostic effects of changes in QoL during treatment. We investigated whether changes in QoL could predict survival in prostate cancer. METHODS We evaluated 250 prostate cancer patients treated at our institution between Jan 2001 and Dec 2009 who were available for a minimum follow-up of 3 months. QoL was evaluated at baseline and after 3 months of treatment using EORTC-QLQ-C30. The QLQ-C30 incorporates a global scale, 5 functional scales and 8 symptom scales. Scores range from 0-100 with higher scores in the global and functional scales and lower scores in the symptom scales indicating better QoL. Patient survival was defined as the time between date of first patient visit and date of death from any cause/date of last contact. Cox regression was performed to evaluate the prognostic significance of baseline, 3-month and changes in QoL scores. Change scores were calculated by subtracting baseline from 3-month QoL scores. RESULTS Mean age at diagnosis was 59.7 years. 149 patients were newly diagnosed at our hospital while 101 were previously treated elsewhere. Patient stage of disease at diagnosis was I, 3; II, 165; III, 31; IV, 48; and 3 indeterminate. Median overall survival was 89.1 months (95% CI: 56.5-121.7). Baseline QoL scales predictive of survival upon multivariate analysis were fatigue (p=0.005) and constipation (p=0.02). 3-month QoL scale predictive of survival upon multivariate analysis was fatigue (p=0.05). Associations between changes in QoL and survival were observed only for dyspnea. Every 10-point increase (worsening) in dyspnea from baseline to 3 months was associated with a 21% increase in death (HR=1.21; 95% CI=1.05 to 1.35, p=0.01). CONCLUSIONS This exploratory study provides some preliminary evidence to indicate that prostate cancer patients with worse baseline and 3-month fatigue and patients whose dyspnea worsens within 3 months of treatment are at significantly increased risk of shorter survival. These findings may be used in clinical practice to systematically address QoL-related problems of cancer patients throughout their treatment course.