A multilevel analysis of longitudinal ordinal data: evaluation of the level of physical performance of women receiving adjuvant therapy for breast cancer

Longitudinal health-related quality-of-life (QOL) data are often collected as part of clinical studies. Here two analyses of QOL data from a prospecti ve study of breast cancer patients evaluate how physical performance is rel ated to factors such as age, menopausal status and type of adjuvant treatme nt. The first analysis uses summary statistic methods. The same questions a re then addressed using a multilevel model. Because of the structure of the physical performance response, regression models for the analysis of ordin al data are used. The analyses of base-line and follow-up QOL data at four time points over two years from 257 women show that reported baseline physi cal performance was consistently associated with later performance and that women who had received chemotherapy in the month before the QOL assessment had a greater physical performance burden. There is a slight power gain of the multilevel model over the summary statistic analysis. The multilevel m odel also allows relationships with time-dependent covariates to be include d, highlighting treatment-related factors affecting physical performance th at could not be considered within the summary statistic analysis. Checking of the multilevel model assumptions is exemplified.