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Can Health-related Quality of Life Predict Survival in Adults with Cystic Fibrosis?

¹ Faculty of Health, University of Central Lancashire, Preston, United Kingdom; ² Adult Cystic Fibrosis Unit, St. James' Hospital, Leeds, United Kingdom; and ³ Adult Cystic Fibrosis Unit, Wythenshawe Hospital, Manchester, United Kingdom

Correspondence and requests for reprints should be addressed to Janice Abbott, Ph.D., C.Psychol., Faculty of Health, University of Central Lancashire, Corporation Street, Preston PR1 2HE, United Kingdom. E-mail: jabbott{at}uclan.ac.uk

Rationale: Advances in the management of cystic fibrosis have led to a significant improvement in survival, although marked differences between individuals are still observed. The value of patient-reported health-related quality of life scores in predicting survival in adults with cystic fibrosis is unknown.

Objectives: To evaluate whether patient-reported health-related quality of life could predict survival in cystic fibrosis.

Methods: From 1996 to 1997 a consecutive series of 223 patients were recruited to evaluate the Cystic Fibrosis Quality of Life Questionnaire. Demographic (age, sex), clinical (FEV₁% predicted, body mass index, diabetes, B. Cepacia complex, intravenous access device, nutritional and lung transplant status) and health-related quality of life variables were recorded (Cystic Fibrosis Quality of Life Questionnaire and the SF-36). These data were used as baseline measures to explore the prognostic association of health-related quality of life and subsequent survival.

Measurements and Main Results: At the census date (December 31, 2006) 154 (69.1%) adults were alive, 66 (29.6%) had died, and three (1.3%) were lost to follow-up. Cox proportional hazards models and bootstrapping procedures examined if health-related quality of life domains predicted survival after adjusting for the demographic and clinical factors. The physical functioning domain of the Cystic Fibrosis Quality of Life Questionnaire and the pain domain of the Short Form-36 had the strongest statistical associations with survival.

Conclusions: Aspects of patient-reported quality of life serve as prognostic measures of survival beyond a number of previously known factors in cystic fibrosis. This needs to be investigated further in a larger longitudinal study.

Key Words: respiratory tract diseases • mortality • health status

AT A GLANCE COMMENTARY Scientific Knowledge on this Subject Advances in the care of patients with cystic fibrosis (CF) have led to an improvement in survival. Even so, survival among people with CF varies substantially. Whether domains of health-related quality of life (HRQoL) can predict survival is unknown. What This Study Adds to the Field Aspects of patient-reported HRQoL serve as prognostic measures of survival beyond a number of previously known factors in cystic fibrosis.

 

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