We have previously reported that higher patient satisfaction (PS) with service quality is associated with favorable survival outcomes in a variety of cancers. However, we argued that patients with greater satisfaction might be the ones with better self-rated health (SRH), a recognized predictor of cancer survival.
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We therefore investigated whether SRH can supersede patient satisfaction as a predictor of survival in prostate cancer.
Nine hundred seventeen prostate cancer treated at four Cancer Treatment Centers of America® hospitals between July 2011 and March 2013. PS was measured on a 7-point scale ranging from "completely dissatisfied" to "completely satisfied". SRH was measured on a 7-point scale ranging from "very poor" to "excellent". Both were dichotomized into two categories: top box response (7) versus all others (1-6). Patient survival was the primary end point. Cox regression was used to evaluate the association between PS and survival controlling for covariates.
The response rate for this study was 72 %. Majority of patients (n = 517) had stage II disease. Seven hundred eighty-seven (85. 8 %) patients were "completely satisfied". Three hundred nineteen (34. 8 %) patients had "excellent" SRH. There was a weak but significant correlation between satisfaction and SRH (Kendall's tau b = 0. 18; p < 0. 001). On univariate analysis, "completely satisfied" patients had a significantly lower risk of mortality (HR = 0. 46; 95 % CI: 0. 25-0. 85; p = 0. 01). Similarly, patients with "excellent" SRH had a significantly lower risk of mortality (HR = 0. 25; 95 % CI: 0. 11-0. 58; p = 0. 001). On multivariate analysis, SRH was found to be a significant predictor of survival (HR = 0. 31; 95 % CI: 0. 12-0. 79; p = 0. 01) while patient satisfaction was not (HR = 0. 76; 95 % CI: 0. 40-1. 5; p = 0. 40).
SRH supersedes patient satisfaction with service quality as a predictor of survival in prostate cancer. SRH should be used as a control variable in analyses involving patient satisfaction as a predictor of clinical cancer outcomes.
Health and quality of life outcomes. 2015 Sep 04*** epublish ***
Digant Gupta, Kamal Patel, Christopher G Lis
Cancer Treatment Centers of America® (CTCA), 500 Remington Road, Schaumburg, IL, 60173, USA. Cancer Treatment Centers of America® (CTCA), 500 Remington Road, Schaumburg, IL, 60173, USA. Cancer Treatment Centers of America® (CTCA), 500 Remington Road, Schaumburg, IL, 60173, USA.