Quality of life may predict survival for patients with aggressive lymphoma

Volume 4, Issue 1, 2015


Poor physical, emotional and social well-being may significantly reduce overall survival.

Photograph of Carrie A. Thompson, M.D.

Carrie A. Thompson, M.D.

Self-reported quality of life among patients diagnosed with aggressive lymphoma can predict overall survival and event-free survival, a Mayo Clinic Cancer Center study has found.

The results were presented at the 56th annual meeting of the American Society of Hematology.

"We found that their baseline quality of life is predictive of overall survival and event-free survival, even after adjustment for known factors related to survival," said the study's lead author, Carrie A. Thompson, M.D., a hematologist at the Mayo Clinic Cancer Center.

"Our findings provide evidence that patient-reported outcomes are as important as other more objective International Prognostic Index (IPI) and that quality of life should be assessed at diagnosis as a prognostic factor in patients with aggressive lymphoma," Dr. Thompson said.

IPI is a clinical tool used to help predict the prognosis of patients with aggressive lymphoma.

Dr. Thompson and her colleagues followed 701 patients with aggressive lymphoma who completed baseline quality-of-life questionnaires between September 2002 and December 2009.

Baseline quality of life was measured using the Functional Assessment of Cancer Treatment-General (FACT-G) scale, which measures four quality-of-life domains: physical, social/family, emotional and functional well-being.

At median follow up of 71 months, 316 patients had experienced an event, such as the progression of their disease, and 228 patients had died.

The median overall FACT-G total score was 83, and the median scores on the functional well-being, physical well-being, emotional well-being and social/family well-being were 18, 22, 18 and 25, respectively. Six percent of patients reported a clinically deficient quality-of-life score on the FACT-G, defined as less than 50 on a 0-to-100 scale.

A comparison of quality-of-life scores between patients who were on active therapy and patients who were not yet treated revealed that physical well-being, functional well-being and total FACT-G were lower in patients already on active treatment.

Dr. Thompson and her colleagues found that all quality-of-life measures except emotional well-being were significantly associated with overall survival. They also found that all measures except a self-assessment measuring spiritual well-being remained significant after adjusting for IPI and the non-Hodgkin's lymphoma subtype.

"Associations were stronger for overall survival than event-free survival," Dr. Thompson said.

For overall survival, the strongest associations were with total FACT-G and functional well-being.

Dr. Thompson and her colleagues also found that a self-assessment for measuring overall quality of life was associated with overall survival.

"Patients with a clinically deficient quality of life, defined as less than 50 on the FACT-G 0-to-100 scale, had a median overall survival of 59 months compared with 121 months for patients with baseline quality-of-life scores greater than 50," Dr. Thompson said.