Baseline health-related quality-of-life data as prognostic factors in a phase III multicentre study of women with metastatic breast cancer.

The potential value of baseline health-related quality-of-life (HRQOL) and clinical factors in predicting prognosis was examined using data from an international randomised phase III trial which compared doxorubicin and paclitaxel with doxorubicin and cylophosphamide as first line chemotherapy in 275 women with metastatic breast cancer. The European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and the related breast module (QLQ-BR23) were used to assess baseline HRQOL data. The Cox proportional-hazards regression model was used for both univariate and multivariate analyses of survival. In the univariate analyses, performance status (P<0.001) and number of sites involved (P=0.001) were the most important clinical prognostic factors. The HRQOL variables at baseline most strongly associated with longer survival were better appetite, physical and role functioning, as well as less fatigue (P<0.001). The final multivariate model retained performance status (P<0.001) and appetite loss (P=0.005) as the variables best predicting survival. Substantial loss of appetite was the only independent HRQOL factor predicting poor survival and was strongly correlated (/r/>0.5) with fatigue, role and physical functioning. In addition to known clinical factors, appetite loss appears to be a significant prognostic factor for survival in women with metastatic breast cancer. However, the mechanism underlying this association remains to be precisely defined in future studies.

A comprehensive life cycle water analysis framework for residential buildings

Most studies on the environmental performance of buildings focus on energy demand and associated greenhouse gas emissions. They often neglect to consider the range of other resource demands and environmental impacts associated with buildings, including water. Studies that assess water use in buildings typically consider only operational water, which excludes the embodied water in building materials or the water associated with the mobility of building occupants. A new framework is presented that quantifies water requirements at the building scale (i.e. the embodied and operational water of the building as well as its maintenance and refurbishment) and at the city scale (i.e. the embodied water of nearby infrastructures such as roads, gas distribution and others) and the transport-related indirect water use of building occupants. A case study house located in Melbourne, Australia, is analysed using the new framework. The results show that each of the embodied, operational and transport requirements is nearly equally important. By integrating these three water requirements, the developed framework provides architects, building designers, planners and decision-makers with a powerful means to understand and effectively reduce the overall water use and associated environmental impacts of residential buildings.