The Analysis, Interpretation, and Presentation of Quality of Life Data

Abstract All too often in clinical trials the assessment of quality of life is seen as a bolt-on study. Consequently insufficient consideration is often given to its design, collection, analysis and presentation, and its impact on the trial results and on clinical practice is minimal. In many trials quality of life is a key endpoint, and it is vital that quality of life expertise is involved as soon as possible in the design. Setting a priori quality of life hypotheses will focus the decisions regarding which questionnaire to use, when to administer it, the sample size required, and the primary analyses. Nevertheless quality of life data are complex, and require much skill in determining how to deal with multi-dimensional and longitudinal data, much of which is often missing. There are no agreed standard ways of analysing and presenting quality of life data, but there are guidelines, which if followed, will add transparency to the way results have been calculated. Understanding the impact of treatments on their quality of life is vital to patients, and it is up to us, as statisticians and trialists, to present the data as clearly as we can.

[1]  P. Fayers,et al.  Testing for differences in multiple quality of life dimensions: generating hypotheses from the experience of hospital staff , 1998, Quality of Life Research.

[2]  M. King The interpretation of scores from the EORTC quality of life questionnaire QLQ-C30 , 1996, Quality of Life Research.

[3]  D. L. Fairclough,et al.  Functional Assessment of Cancer Therapy (FACT-G): Non-response to individual questions , 1996, Quality of Life Research.

[4]  R. Stephens,et al.  Approaches to the analysis of quality of life data: experiences gained from a Medical Research Council Lung Cancer Working Party palliative chemotherapy trial , 1994, Quality of Life Research.

[5]  Robert Milroy,et al.  O-179 The Big Lung Trial (BLT): Determining the value of cisplatin-based chemotherapy for all patients with non-small cell lung cancer (NSCLC). Preliminary results in the surgical setting , 2003 .

[6]  Napp,et al.  The big lung trial (BLT): Determining the value of cisplatin- based chemotherapy for all patients with non-small cell lung cancer (NSCLC). Preliminary results in the supportive care setting , 2002 .

[7]  N. Aaronson,et al.  External irradiation versus external irradiation plus endobronchial brachytherapy in inoperable non-small cell lung cancer: a prospective randomized study. , 2001, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[8]  P. Fayers,et al.  Analysis of messy longitudinal data from a randomized clinical trial. MRC Lung Cancer Working Party. , 2000, Statistics in medicine.

[9]  G. Molenberghs,et al.  Summary measures and statistics in the analysis of quality of life data: an example from an EORTC-NCIC-SAKK locally advanced breast cancer study. , 2000, European journal of cancer.

[10]  F D Wolinsky,et al.  Identifying meaningful intra-individual change standards for health-related quality of life measures. , 2000, Journal of evaluation in clinical practice.

[11]  M. Parmar,et al.  Patient-reported short-term and long-term physical and psychologic symptoms; results of the continuous hyperfractionated accelerated radiotherapy (CHART). Randomized trial in non-small-cell lung cancer , 1999 .

[12]  R. Stephens,et al.  Defining and analysing symptom palliation in cancer clinical trials: a deceptively difficult exercise , 1999, British Journal of Cancer.

[13]  R. Stephens,et al.  Patient-reported short-term and long-term physical and psychologic symptoms: results of the continuous hyperfractionated accelerated [correction of acclerated] radiotherapy (CHART) randomized trial in non-small-cell lung cancer. CHART Steering Committee. , 1998, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[14]  D. Machin,et al.  Suggestions for the presentation of quality of life data from clinical trials. , 1998, Statistics in medicine.

[15]  D Machin,et al.  Incomplete quality of life data in randomized trials: missing items. , 1998, Statistics in medicine.

[16]  D. Osoba,et al.  Interpreting the significance of changes in health-related quality-of-life scores. , 1998, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[17]  M. Parmar,et al.  Continuous hyperfractionated accelerated radiotherapy (CHART) versus conventional radiotherapy in non-small-cell lung cancer: a randomised multicentre trial , 1997, The Lancet.

[18]  H. Burris,et al.  Assessing clinical benefit in the treatment of pancreas cancer: gemcitabine compared to 5-fluorouracil. , 1997, European journal of cancer.

[19]  D. Girling Comparison of oral etoposide and standard intravenous multidrug chemotherapy for small-cell lung cancer: a stopped multicentre randomised trial , 1996, The Lancet.

[20]  D. Machin,et al.  Randomised trial of four-drug vs less intensive two-drug chemotherapy in the palliative treatment of patients with small-cell lung cancer (SCLC) and poor prognosis. Medical Research Council Lung Cancer Working Party. , 1996, British Journal of Cancer.

[21]  R. Sanderman Measuring the quality of life of cancer patients with the Rotterdam Symptom Checklist (RSCL): a manual , 1996 .

[22]  D. Girling,et al.  Randomized trial of palliative two-fraction versus more intensive 13-fraction radiotherapy for patients with inoperable non-small cell lung cancer and good performance status. Medical Research Council Lung Cancer Working Party. , 1996, Clinical oncology (Royal College of Radiologists (Great Britain)).

[23]  Andrew Bottomley,et al.  EORTC QLQ-C30 Scoring Manual , 1995 .

[24]  R. Kaplan Quality of life assessment for cost/utility studies in cancer. , 1993, Cancer treatment reviews.

[25]  F. Cavalli,et al.  Feasibility of quality of life assessment in a randomized phase III trial of small cell lung cancer--a lesson from the real world--the Swiss Group for Clinical Cancer Research SAKK. , 1992, Annals of oncology : official journal of the European Society for Medical Oncology.

[26]  D. Osoba,et al.  Quality-of-life assessment: patient compliance with questionnaire completion. , 1992, Journal of the National Cancer Institute.

[27]  D. Osoba,et al.  Quality of life assessment: Patient compliance with questionnaire completion , 1991 .

[28]  P. Fayers,et al.  Assessment of quality of life in small-cell lung cancer using a Daily Diary Card developed by the Medical Research Council Lung Cancer Working Party. , 1991, British Journal of Cancer.

[29]  P Glasziou,et al.  Costs and benefits of adjuvant therapy in breast cancer: a quality-adjusted survival analysis. , 1989, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[30]  G. Huston The Hospital Anxiety and Depression Scale. , 1987, The Journal of rheumatology.

[31]  R. Gelber,et al.  A new endpoint for the assessment of adjuvant therapy in postmenopausal women with operable breast cancer. , 1986, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.