EuroQol and survival prediction in terminal cancer patients: a multicenter prospective study in hospice-palliative care units

Abstract

GOALS OF WORK: Although the EuroQol (EQ-5D) is widely used for economic evaluation, it remains unclear whether it can be combined with medical data to predict survival in patients with terminal cancer. PATIENTS AND METHODS: We carried out this prospective study on 142 terminal cancer patients in four hospice-palliative care units. Association was sought between survival time and a range of variables such as cancer site, performance, previous treatment, age, sex, pain, and EuroQol. The EQ-5D was transformed into the corresponding EQ-5D utility. For univariate analysis, we estimated differences in survival with the Gehan generalized Wilcoxon test. For those variables that were significant, we performed multivariate analysis using the Cox proportional hazard model. MAIN RESULTS: Univariate analysis showed that sex, age, performance, previous use of chemotherapy, and the EQ-5D utility provided statistically significant prognostic survival information. The median survival time was 13.0 days for the group with an EQ-5D utility score lower than -0.5 and 21.0 days for the group with an EQ-5D utility score above -0.5. In multivariate analysis with the Cox proportional hazard model, an EQ-5D utility score < or = 0.5 (RR 1.57, 95% confidence interval 1.06-2.33) was an independent negative predictor of survival. CONCLUSIONS: The EQ-5D quality-of-life assessment tool might be useful for predicting survival time for terminal cancer patients.