World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website http://www.wjon.org

Original Article

Volume 2, Number 4, August 2011, pages 166-174

What QLQ-C15-PAL Symptoms Matter Most for Overall Quality of Life in Patients With Advanced Cancer?

**Table 1.** Patient Characteristics (n = 369)
Characteristics	Value
Age (years)
n	369
Mean ± SD	65 ± 12
Inter-quartiles	58 – 75
Median (range)	66 (22 – 89)
KPS
n	362
Mean ± SD	67 ± 15
Inter-quartiles	60 – 80
Median (range)	70 (30 – 100)
Gender
Male	199 (54%)
Female	170 (46%)
Primary cancer site
Lung	145 (39%)
Breast	73 (20%)
Prostate	64 (17%)
Renal Cell	28 (8%)
Colorectal	18 (5%)
Unknown	8 (2%)
Others	33 (9%)

Table 1. Patient Characteristics (n = 369)

Characteristics

Value

Age (years)

369

Mean ± SD

65 ± 12

Inter-quartiles

58 – 75

Median (range)

66 (22 – 89)

KPS

362

Mean ± SD

67 ± 15

Inter-quartiles

60 – 80

Median (range)

70 (30 – 100)

Gender

Male

199 (54%)

Female

170 (46%)

Primary cancer site

Lung

145 (39%)

Breast

73 (20%)

Prostate

64 (17%)

Renal Cell

28 (8%)

Colorectal

18 (5%)

Unknown

8 (2%)

Others

33 (9%)

**Table 2.** Pearson Correlations Between all Functional/Symptom Scale Variables and Overall QOL in All Patients With Advanced Cancer
Variable	Correlation (r)	p-value^a	n
a. All p-values are less than 0.05 and considered statistically significant.
Physical Functioning	0.43	< 0.0001	352
Emotional Functioning	0.53	< 0.0001	357
Fatigue	-0.46	< 0.0001	361
Nausea / Vomiting	-0.28	< 0.0001	361
Pain	-0.41	< 0.0001	362
Dyspnoea	-0.19	0.0004	361
Insomnia	-0.27	< 0.0001	362
Appetite loss	-0.39	< 0.0001	361
Constipation	-0.24	< 0.0001	362

Table 2. Pearson Correlations Between all Functional/Symptom Scale Variables and Overall QOL in All Patients With Advanced Cancer

Variable

Correlation (r)

p-value^a

a. All p-values are less than 0.05 and considered statistically significant.

Physical Functioning

0.43

< 0.0001

352

Emotional Functioning

0.53

< 0.0001

357

Fatigue

-0.46

< 0.0001

361

Nausea / Vomiting

-0.28

< 0.0001

361

Pain

-0.41

< 0.0001

362

Dyspnoea

-0.19

0.0004

361

Insomnia

-0.27

< 0.0001

362

Appetite loss

-0.39

< 0.0001

361

Constipation

-0.24

< 0.0001

362

**Table 3.** Multiple Linear Regression Analysis of All Functional/Symptom Scale Variables With Overall QOL^a in All Patients With Advanced Cancer
Variable	Coefficient	Standardized Coefficient	t	p-value
a.Overall QOL was considered the outcome. In the first model, the 2 functional scales were entered simultaneously in the regression equation, while in the second model, the 7 symptom scales were entered simultaneously. * P-values less than 0.05 are considered statistically significant.
Functional scales
Physical Functioning	0.27	0.29	6.32	< 0.0001*
Emotional Functioning	0.45	0.44	9.55	< 0.0001*
	Intercept = 7.30, multiple R = 0.60, multiple R² = 0.35, adjusted R² = 0.35
Symptom scales
Fatigue	-0.23	-0.24	-4.09	< 0.0001*
Nausea / Vomiting	-0.02	-0.02	-0.40	0.69
Pain	-0.14	-0.19	-3.35	0.0009*
Dyspnoea	-0.03	-0.03	-0.57	0.57
Insomnia	-0.05	-0.07	-1.42	0.16
Appetite loss	-0.12	-0.16	-2.89	0.0041*
Constipation	-0.03	-0.03	-0.69	0.49
	Intercept = 78.56, multiple R = 0.54, multiple R² = 0.29, adjusted R² = 0.28

Table 3. Multiple Linear Regression Analysis of All Functional/Symptom Scale Variables With Overall QOL^a in All Patients With Advanced Cancer

Variable

Coefficient

Standardized Coefficient

p-value

a.Overall QOL was considered the outcome. In the first model, the 2 functional scales were entered simultaneously in the regression equation, while in the second model, the 7 symptom scales were entered simultaneously. * P-values less than 0.05 are considered statistically significant.

Functional scales

Physical Functioning

0.27

0.29

6.32

< 0.0001*

Emotional Functioning

0.45

0.44

9.55

< 0.0001*

Intercept = 7.30, multiple R = 0.60, multiple R² = 0.35, adjusted R² = 0.35

Symptom scales

Fatigue

-0.23

-0.24

-4.09

< 0.0001*

Nausea / Vomiting

-0.02

-0.40

0.69

Pain

-0.14

-0.19

-3.35

0.0009*

Dyspnoea

-0.03

-0.57

0.57

Insomnia

-0.05

-0.07

-1.42

0.16

Appetite loss

-0.12

-0.16

-2.89

0.0041*

Constipation

-0.03

-0.69

0.49

Intercept = 78.56, multiple R = 0.54, multiple R² = 0.29, adjusted R² = 0.28

**Table 4.** Multiple Linear Regression Analysis With Physical and Emotional Functioning, Pain and Appetite Loss as Predictors of Overall QOL^a in all Patients With Advanced Cancer
Variable	Coefficient	Standardized Coefficient	t	p-value
a. Overall QOL was considered the outcome. Variables found to be statistically significant for all patients (Table 2) were entered concurrently as independent variables in predicting overall QOL. * P-values less than 0.05 are considered statistically significant.
Functional scales
Physical Functioning	0.15	0.16	3.04	0.0026*
Emotional Functioning	0.37	0.36	7.56	< 0.0001*
Symptom scales
Fatigue	-0.10	-0.11	-1.89	0.06
Pain	-0.09	-0.12	-2.25	0.0251*
Appetite loss	-0.09	-0.11	-2.25	0.0253*
	Intercept = 31.52, multiple R = 0.64, multiple R² = 0.40, adjusted R² = 0.39

Table 4. Multiple Linear Regression Analysis With Physical and Emotional Functioning, Pain and Appetite Loss as Predictors of Overall QOL^a in all Patients With Advanced Cancer

Variable

Coefficient

Standardized Coefficient

p-value

a. Overall QOL was considered the outcome. Variables found to be statistically significant for all patients (Table 2) were entered concurrently as independent variables in predicting overall QOL. * P-values less than 0.05 are considered statistically significant.

Functional scales

Physical Functioning

0.15

0.16

3.04

0.0026*

Emotional Functioning

0.37

0.36

7.56

< 0.0001*

Symptom scales

Fatigue

-0.10

-0.11

-1.89

0.06

Pain

-0.09

-0.12

-2.25

0.0251*

Appetite loss

-0.09

-0.11

-2.25

0.0253*

Intercept = 31.52, multiple R = 0.64, multiple R² = 0.40, adjusted R² = 0.39

**Table 5.** Patient Characteristics of the Three Patient Subgroups
Characteristics	Bone Metastases (n = 190)	Brain Metastases (n = 150)	Advanced Lung Cancer (n = 29)
Age (years)
n	190	150	29
Mean ± SD	67 ± 13	63 ± 11	68 ± 12
Inter-quartiles	59 – 77	56 – 71	58 – 78
Median (range)	68 (26–89)	64 (22–86)	70 (38–85)
KPS
n	184	149	29
Mean ± SD	67 ± 14	74 ± 15	67 ± 16
Inter-quartiles	60 – 80	60 – 90	60 – 80
Median (range)	70 (30–100)	80 (30–100)	70 (30–90)
Gender
Male	116 (61%)	65 (43%)	18 (62%)
Female	74 (39%)	85 (57%)	11 (38%)
Primary cancer site
Lung	41 (22%)	80 (53%)	24 (83%)
Breast	42 (22%)	30 (20%)	1 (4%)
Prostate	63 (33%)	1 (1%)	0 (0.0%)
Renal Cell	18 (10%)	9 (6%)	1 (4%)
Colorectal	6 (3%)	9 (6%)	3 (10%)
Unknown	4 (2%)	4 (3%)	0 (0.0%)
Others	16 (8%)	17 (11%)	0 (0.0%)
Other metastases
No	146 (77%)	79 (53%)	9 (31%)
Yes	44 (23%)	71 (47%)	20 (69%)

Table 5. Patient Characteristics of the Three Patient Subgroups

Characteristics

Bone Metastases (n = 190)

Brain Metastases (n = 150)

Advanced Lung Cancer (n = 29)

Age (years)

190

150

Mean ± SD

67 ± 13

63 ± 11

68 ± 12

Inter-quartiles

59 – 77

56 – 71

58 – 78

Median (range)

68 (26–89)

64 (22–86)

70 (38–85)

KPS

184

149

Mean ± SD

67 ± 14

74 ± 15

67 ± 16

Inter-quartiles

60 – 80

60 – 90

60 – 80

Median (range)

70 (30–100)

80 (30–100)

70 (30–90)

Gender

Male

116 (61%)

65 (43%)

18 (62%)

Female

74 (39%)

85 (57%)

11 (38%)

Primary cancer site

Lung

41 (22%)

80 (53%)

24 (83%)

Breast

42 (22%)

30 (20%)

1 (4%)

Prostate

63 (33%)

1 (1%)

0 (0.0%)

Renal Cell

18 (10%)

9 (6%)

1 (4%)

Colorectal

6 (3%)

9 (6%)

3 (10%)

Unknown

4 (2%)

4 (3%)

0 (0.0%)

Others

16 (8%)

17 (11%)

0 (0.0%)

Other metastases

146 (77%)

79 (53%)

9 (31%)

Yes

44 (23%)

71 (47%)

20 (69%)

**Table 6.** Pearson Correlations Between all Functional/Symptom Scale Variables and Overall QOL in the Three Patient Subgroups
Variable	Bone Metastases	Brain Metastases	Advanced Lung Cancer
a. * P-values less than 0.05 are considered statistically significant.
Physical Functioning	0.33	< 0.0001*	181	0.44	< 0.0001*	145	0.58	0.0020*	26
Emotional Functioning	0.54	< 0.0001*	184	0.50	< 0.0001*	146	0.71	< 0.0001*	27
Fatigue	-0.36	< 0.0001*	185	-0.51	< 0.0001*	148	-0.48	0.0096*	28
Nausea / Vomiting	-0.26	0.0003*	185	-0.22	0.0066*	148	-0.41	0.0293*	28
Pain	-0.40	< 0.0001*	185	-0.34	< 0.0001*	149	-0.27	0.1585	28
Dyspnoea	-0.12	0.1025	185	-0.17	0.0363*	149	-0.48	0.0121*	27
Insomnia	-0.18	0.0122*	185	-0.28	0.0006*	149	-0.42	0.0263*	28
Appetite loss	-0.39	< 0.0001*	185	-0.20	0.0141*	149	-0.77	< 0.0001*	27
Constipation	-0.17	0.0211*	185	-0.22	0.0081*	149	-0.28	0.1532	28

Table 6. Pearson Correlations Between all Functional/Symptom Scale Variables and Overall QOL in the Three Patient Subgroups

Variable

Bone Metastases

Brain Metastases

Advanced Lung Cancer

Correlation (r)

p-value^a

Correlation (r)

p-value^a

Correlation (r)

p-value^a

a. * P-values less than 0.05 are considered statistically significant.

Physical Functioning

0.33

< 0.0001*

181

0.44

< 0.0001*

145

0.58

0.0020*

Emotional Functioning

0.54

< 0.0001*

184

0.50

< 0.0001*

146

0.71

< 0.0001*

Fatigue

-0.36

< 0.0001*

185

-0.51

< 0.0001*

148

-0.48

0.0096*

Nausea / Vomiting

-0.26

0.0003*

185

-0.22

0.0066*

148

-0.41

0.0293*

Pain

-0.40

< 0.0001*

185

-0.34

< 0.0001*

149

-0.27

0.1585

Dyspnoea

-0.12

0.1025

185

-0.17

0.0363*

149

-0.48

0.0121*

Insomnia

-0.18

0.0122*

185

-0.28

0.0006*

149

-0.42

0.0263*

Appetite loss

-0.39

< 0.0001*

185

-0.20

0.0141*

149

-0.77

< 0.0001*

Constipation

-0.17

0.0211*

185

-0.22

0.0081*

149

-0.28

0.1532

**Table 7.** Multiple Linear Regression Analysis With Emotional Functioning and Appetite Loss Associated With Overall QOL^a in Patients With Bone Metastases
Variable	Coefficient	Standardized Coefficient	t	p-value
a. Overall QOL was considered the outcome. Initial modeling identified significant functional/symptom scales that were then entered concurrently as independent variables. * P-values less than 0.05 are considered statistically significant.
Functional scales
Physical Functioning	0.08	0.09	1.22	0.22
Emotional Functioning	0.36	0.41	6.06	< 0.0001*
Symptom scales
Pain	-0.11	-0.13	-1.74	0.08
Appetite loss	-0.11	-0.16	-2.27	0.0242*
	Intercept = 31.58, multiple R = 0.60, multiple R² = 0.36, adjusted R² = 0.35

Table 7. Multiple Linear Regression Analysis With Emotional Functioning and Appetite Loss Associated With Overall QOL^a in Patients With Bone Metastases

Variable

Coefficient

Standardized Coefficient

p-value

a. Overall QOL was considered the outcome. Initial modeling identified significant functional/symptom scales that were then entered concurrently as independent variables. * P-values less than 0.05 are considered statistically significant.

Functional scales

Physical Functioning

0.08

0.09

1.22

0.22

Emotional Functioning

0.36

0.41

6.06

< 0.0001*

Symptom scales

Pain

-0.11

-0.13

-1.74

0.08

Appetite loss

-0.11

-0.16

-2.27

0.0242*

Intercept = 31.58, multiple R = 0.60, multiple R² = 0.36, adjusted R² = 0.35

**Table 8.** Multiple Linear Regression Analysis With Physical and Emotional Functioning and Fatigue Associated With Overall QOL^a in Patients With Brain Metastases
Variable	Coefficient	Standardized Coefficient	t	p-value
a. Overall QOL was considered the outcome. Initial modeling identified significant functional/symptom scales that were then entered concurrently as independent variables. * P-values less than 0.05 are considered statistically significant.
Functional scales
Physical Functioning	0.18	0.19	2.36	0.0198*
Emotional Functioning	0.38	0.33	4.57	< 0.0001*
Symptom scales
Fatigue	-0.28	-0.28	-3.36	0.001*
	Intercept = 33.18, multiple R = 0.62, multiple R² = 0.3, adjusted R² = 0.372

Table 8. Multiple Linear Regression Analysis With Physical and Emotional Functioning and Fatigue Associated With Overall QOL^a in Patients With Brain Metastases

Variable

Coefficient

Standardized Coefficient

p-value

Functional scales

Physical Functioning

0.18

0.19

2.36

0.0198*

Emotional Functioning

0.38

0.33

4.57

< 0.0001*

Symptom scales

Fatigue

-0.28

-3.36

0.001*

Intercept = 33.18, multiple R = 0.62, multiple R² = 0.3, adjusted R² = 0.372

**Table 9.** Multiple Linear Regression Analysis With Physical and Emotional Functioning and Fatigue Associated With Overall QOL^a in Patients With Advanced Lung Cancer
Variable	Coefficient	Standardized Coefficient	t	p-value
a. Overall QOL was considered the outcome. Initial modeling identified significant functional/symptom scales that were then entered concurrently as independent variables. * P-values less than 0.05 are considered statistically significant.
Functional scales
Physical Functioning	0.19	0.19	1.23	0.23
Emotional Functioning	0.43	0.33	1.98	0.06
Symptom scales
Appetite loss	-0.34	-0.43	-2.26	0.0347*
	Intercept = 19.43, multiple R = 0.81, multiple R² = 0.66, adjusted R² = 0.61

Table 9. Multiple Linear Regression Analysis With Physical and Emotional Functioning and Fatigue Associated With Overall QOL^a in Patients With Advanced Lung Cancer

Variable

Coefficient

Standardized Coefficient

p-value

Functional scales

Physical Functioning

0.19

1.23

0.23

Emotional Functioning

0.43

0.33

1.98

0.06

Symptom scales

Appetite loss

-0.34

-0.43

-2.26

0.0347*

Intercept = 19.43, multiple R = 0.81, multiple R² = 0.66, adjusted R² = 0.61