OBJECTIVES

Health-related quality of life (HRQoL) can predict overall survival (OS), however, none have compared the associations of HRQoL measured before (T0) and after (T1) diagnosis of Kidney Cancer (KC). This study determined the association of HRQoL with OS at T0, T1 and change from T0 to T1 with OS in older Americans with KC.

METHODS

A longitudinal cohort study of KC patients age ≥65 years in the Surveillance, Epidemiology and End Results cancer registry data linked with Medicare Health Outcomes Survey (1998-2013) was conducted. OS was months between diagnosis and death/end-of-study. Physical component summary (PCS) and mental component summary (MCS) of SF36/VR12 and health utility (HU) represented HRQoL. Clinically meaningful differences were 5 points for PCS/MCS and 0.05-point for HU. Multivariable Cox Proportional Hazard models were used to estimate adjusted hazard ratios (95% CI).

RESULTS :

A total of 188 KC patients (average age of 75 years) were included. 89 (47%) died during the study period. Risk of death was significantly higher for every five-point lower MCS/PCS at T0 or T1 (MCS _T0: 1.16 (1.02-1.31); PCS _T0: 1.15 (1.02-1.29); MCS_T1: 1.16 (1.01-1.34); PCS _T1: 1.26 (1.12-1.50)). A five-point reduction in MCS/PCS from T0 to T1 was associated with 18-30% greater risk of death (MCS_T0-T1: 1.18 (1.03-1.36); PCS_T0-T1: 1.30 (1.14-1.50)). For each 0.05-unit lower HU at T0 and T1, the risk of death was similarly higher (HU_T0: 1.13 (1.01-1.25); HU_T1: 1.26 (1.08-1.47)). A 0.05-point reduction in HU from T0 to T1 was also associated with 31% greater risk of death (1.31 (1.13-1.53)).

CONCLUSIONS

Lower HRQoL and greater HRQoL reduction were associated with greater risk of death in older KC patients, with HRQoL at T1 and HRQoL changes being more strongly associated with OS. The findings highlight the prognostic value of HRQoL on OS and emphasize the importance of regular HRQoL assessments in understanding KC prognosis.