Pre-diagnosis health-related quality of life and survival in older women with endometrial cancer
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ORIGINAL ARTICLE
Pre-diagnosis health-related quality of life and survival in older women with endometrial cancer Amy K. Klapheke 1,2
&
Theresa H. M. Keegan 2,3 & Rachel Ruskin 4 & Rosemary D. Cress 1,2
Received: 24 July 2019 / Accepted: 23 January 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Health-related quality of life (HRQOL) is an important prognostic factor in cancer patients. To date, no other studies have assessed the association between HRQOL measured before diagnosis and survival in older women with endometrial cancer. Methods The Surveillance, Epidemiology, and End Results – Medicare Health Outcomes Survey linked database was used to identify 995 women who were at least 65 years old and completed a survey before diagnosis with endometrial cancer. We obtained scores for 10 HRQOL scales, as measured by Medical Outcomes Study Short Form-36 and Veterans RAND 12-Item Survey, and data on activities of daily living (ADLs) impairments and depressive symptoms. Fine and Gray competing risks regression and Cox proportional hazards were used to estimate the association of HRQOL with endometrial cancer-specific and overall survival, respectively. Results Women who died had worse pre-diagnosis HRQOL than women who were still alive at the end of the study period. For every five-point increase in HRQOL score, overall survival improved by 5–9%. The strongest associations were observed for vitality (HR = 0.91, 95% CI 0.86, 0.97, p = 0.0021) and physical functioning (HR = 0.92, 95% CI 0.87, 0.97, p = 0.0010). ADL impairments were generally not predictive of survival, though depressive symptoms were significantly associated with increased hazard of death from all causes (HR = 1.34, 95% CI 1.00, 1.79, p = 0.0466). Conclusion HRQOL measured before diagnosis with endometrial cancer has prognostic value. Having measures of HRQOL available at diagnosis may facilitate timely supportive care to improve survival. Keywords Endometrial cancer . Quality of life . Survival . Elderly
Introduction Endometrial cancer is the fourth most commonly diagnosed cancer among American women and the most common gynecologic malignancy in the USA [1]. Over 40% of women * Amy K. Klapheke [email protected] 1
Public Health Institute, Cancer Registry of Greater California, 1750 Howe Ave. Ste. 550, Sacramento, CA 95825, USA
2
Department of Public Health Sciences, University of California Davis, One Shields Ave., Davis, CA 95616, USA
3
Division of Hematology and Oncology, University of California Davis Comprehensive Cancer Center, 2279 45th St, Sacramento, CA 95817, USA
4
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California Davis Comprehensive Cancer Center, 2279 45th St, Sacramento, CA 95817, USA
diagnosed with endometrial cancer are aged 65 years or older, and about two-thirds of deaths from this cancer occur in this age group [2]. Though mortality rates have generally declined for the most common cancer types over the last several decades, mortality r
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