Quality of life and survival - The role of multidimensional symptom assessment

BACKGROUND. Recent data from clinical trials suggest that quality-of-life (QOL) measurements may independently predict survival. The relation between survival and QOL measurements was tested among 122 inpatients and 96 outpatients with malignancies at one of four sites (colon, breast, ovary, or prostate) who participated in a cross-sectional validation study of the Memorial Symptom Assessment Scale (MSAS), a measure of the frequency of, severity of, and distress caused by physical symptoms. METHODS. The relation between MSAS summary scores and survival was evaluated in a multivariate analysis that adjusted concurrently for other important covariates, such as age, site and extent of disease, inpatient status, Karnofsky performance status (KPS), and other QOL measurements. RESULTS. In the multivariate analysis, extent of disease (P < 0.0001), inpatient status (P = 0.014), higher MSAS physical symptom subscale score (P = 0.004), and lower KPS score (P = 0.009) independently predicted decreased survival. Other QOL measurements did not contribute significantly to the model. CONCLUSIONS, The MSAS physical symptom subscale score significantly predicts survival and adds to the prognostic information provided by KPS and extent of disease. Patients may be under-assessed regarding both the number and the severity of symptoms. Measurements of physical symptoms and related distress offer additional prognostic information concerning the survival of patients with cancer and may account for the predictive value of QOL scores. (C) 1998 American Cancer Society.