OBJECTIVES

Health-related quality of life (HRQoL) outcome can be used to monitor health and well-being and is one of the important outcomes that may predict overall survival (OS) in cancer patients. This study examined the association of OS and HRQoL measured before (T0), after cancer diagnosis (T1), and HRQoL changes from T0 to T1 (T1-T0) in patients diagnosed with bladder cancer (BC).

METHODS

This longitudinal retrospective cohort study used the 1998-2013 Surveillance, Epidemiology and End Results (SEER) database linked with Medicare Health Outcomes Survey (MHOS). HRQoL was measured using the SF-36 (1998-2005)/Veterans Rand-12 (2006 onwards) and reported as physical (PCS), mental (MCS) component scores, and 8 domain scores. Adjusted hazard ratios (aHRs [95%CI]) were estimated using multivariable logistic regression models, adjusting for demographics, comorbidities, and cancer specific characteristics.

RESULTS

438 BC patients aged ≥65 years who had HRQoL data at both T0 and T1 were identified. Among those, 220 (50.2%) died and 218 (49.8%) remained alive (censored). Compared to deceased patients, the censored patients were younger (75.3±6.0 vs. 77.2±6.8 years; p<0.01), had longer OS (90.4±39.9 vs. 67.9±42.0 months; p<0.001), had a lower-stage tumor at diagnosis (p<0.001), and had non-invasive tumors (p<0.01). Risk of death was negatively associated with increased PCS at T0 and T1 (aHR_T0=0.984 [0.970-0.998] and aHR_T1=0.976 [0.962-0.990], respectively). At T1, 6 out of 8 domain scores were also significantly associated with OS. However, PCS_T1-T0 and MCS at T0, T1, and T1-T0 were not associated with risk of death.

CONCLUSIONS

We found that PCS was significantly associated with OS in older BC patients in our sample, which implies that older BC patients with better physical health are more likely to survive longer. Therefore, if HRQoL is measured in a routine cancer care, clinicians will be able to intervene early in order to improve or maintain patient’s physical health.