Pre-treatment quality of life and survival outcomes in lung cancer patients: a systematic review and meta-analysis.

Abstract / Summary

Lung cancer is a leading cause of cancer-related mortality, with baseline (pre-treatment) quality of life (QOL) increasingly recognized as a potential prognostic factor for survival. This systematic review and meta-analysis evaluates the association between baseline (pre-treatment) QOL and mortality in lung cancer patients. Following PRISMA guidelines and PROSPERO registration (CRD42023398206), we searched PubMed/MEDLINE, Web of Science, and Scopus up to July 2025 for observational studies examining baseline (pre-treatment) QOL and survival in lung cancer patients. Eligible studies used validated QOL tools and reported hazard ratios (HRs) for mortality. Data were extracted independently by two reviewers, and study quality was assessed using the Newcastle-Ottawa Scale. Random-effects meta-analyses quantified associations between global and domain-specific QOL (physical, emotional, cognitive, social) and mortality, with heterogeneity assessed via I2 statistics. Thirty-nine studies (n = 20,235 patients) across 18 countries were included. Lower baseline (pre-treatment) global QoL was associated with increased mortality risk (pooled HR = 1.07; 95% CI: 1.02-1.12), with similar associations observed for physical, emotional, and social QoL domains. Cognitive QoL (HR = 0.99; 95% CI: 0.97-1.00) and FACT-G/FACT-L scores (HR = 0.94; 95% CI: 0.80-1.09) showed no significant association. Substantial heterogeneity (I2 = 72-92%) was observed, likely due to variations in study design, QOL tools, and patient characteristics. Lower baseline QoL is associated with increased mortality risk, indicating that higher QoL is protective and associated with improved survival. Standardized methodologies are needed to address heterogeneity and enhance evidence quality. Findings may vary by disease stage; stage-stratified estimates were rarely reported.

Related Clinical Guidelines