Abstract
BACKGROUND: Understanding the determinants of global quality of life in cancer patients is crucial for improving their overall well-being. While correlations between various factors and quality of life have been established, the causal relationships remain largely unexplored. This study aimed to identify the causal factors influencing global quality of life in cancer patients and compare them with known correlative factors. METHODS: We conducted a retrospective analysis of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire data, alongside demographic and disease-related features, collected from new cancer patients during their initial visit to an oncology outpatient clinic. Correlations with global quality of life were identified using univariate and multivariate regression analyses. Causal inference analysis was performed using two approaches. First, we employed the Dowhy Python library for causal analysis, incorporating prior information and manual characterization of an acyclic graph. Second, we utilized the Linear Non-Gaussian Acyclic Model (LiNGAM) machine learning algorithm from the Lingam Python library, which automatically generated an acyclic graph without prior information. The significance level was set at p < 0.05. RESULTS: Multivariate analysis of 469 new admissions revealed that disease stage, role functioning, emotional functioning, social functioning, fatigue, pain and diarrhea were linked with global quality of life. The most influential direct causal factors were emotional functioning, social functioning, and physical functioning, while the most influential indirect factors were physical functioning, emotional functioning, and fatigue. Additionally, the most prominent total causal factors were identified as type of cancer (diagnosis), cancer stage, and sex, with total causal effect ratios of -9.47, -4.67, and - 1.48, respectively. The LiNGAM algorithm identified type of cancer (diagnosis), nausea and vomiting and social functioning as significant, with total causal effect ratios of -9.47, -0.42, and 0.42, respectively. CONCLUSIONS: This study identified that causal factors for global quality of life in new cancer patients are distinct from correlative factors. Understanding these causal relationships could provide valuable insights into the complex dynamics of quality of life in cancer patients and guide targeted interventions to improve their well-being.