Quality-of-life outcomes for adjuvant chemotherapy in early-stage non-small-cell lung cancer: results from a randomized trial, JBR.10

Abstract

Purpose: Adjuvant chemotherapy for early stage non-small-cell lung cancer (NSCLC) is now the standard of care, but there is little information regarding its impact on quality of life (QOL). We report the QOL results of JBR.10, a North American, intergroup, randomized trial of adjuvant cisplatin and vinorelbine compared with observation in patients who have completely resected, stages IB to II NSCLC.

Patients and methods: QOL was assessed with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire C30 and a trial-specific checklist at baseline and at weeks 5 and 9 for those who received chemotherapy and at follow-up months 3, 6, 9, 12, 18, 24, 30 and 36. A 10-point change in QOL scores from baseline was considered clinically significant.

Results: Four hundred eighty-two patients were randomly assigned on JBR.10. A total of 173 patients (82% of the expected) in the observation arm and 186 (85% of expected) in the chemotherapy arm completed baseline QOL assessments. The two groups were comparable, with low global QOL scores and significant symptom burden, especially pain and fatigue, after thoracotomy. Changes in QOL during chemotherapy were relatively modest; fatigue, nausea, and vomiting worsened, but there was a reduction in pain and no change in global QOL. Patients in the observation arm showed considerable improvements in QOL by 3 months. QOL, except for symptoms of sensory neuropathy and hearing loss, in those treated with chemotherapy returned to baseline by 9 months.

Conclusion: The findings of this trial indicate that the negative effects of adjuvant chemotherapy on QOL appear to be temporary, and that improvements (with a return to baseline function) are likely in most patients.

Fig A1.

Global quality-of-life scores (> and < median) and overall survival (OS) by treatment arm.

Fig A2.

Global quality-of-life scores (> and < median) and overall survival (OS) by treatment arm.

Fig 1.

Flow chart of compliance with quality-of-life (QOL) questionnaire completion.

Fig 2.

Baseline quality-of-life (QOL) scores in the two arms.

Fig 3.

Proportion of patients with improved, stable, and worsened quality of life, and proportion of patients with missing quality-of-life data, in several domains and symptoms at 12 weeks and 12 months of follow-up.

Fig 4.

Mean quality-of-life baseline scores and mean change scores by study arm in follow-up period.