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Multicenter Study
. 2017 Aug 23;17(1):565.
doi: 10.1186/s12885-017-3543-7.

Clinical decision-making and health-related quality of life during first-line and maintenance therapy in patients with advanced non-small cell lung cancer (NSCLC): findings from a real-world setting

Monika Sztankay  1   2 , Johannes Maria Giesinger  3 , August Zabernigg  4 , Elisabeth Krempler  3 , Georg Pall  5 , Wolfgang Hilbe  6 , Otto Burghuber  7 , Maximilian Hochmair  7 , Gerhard Rumpold  3 , Stephan Doering  8 , Bernhard Holzner  3
Affiliations
Multicenter Study

Clinical decision-making and health-related quality of life during first-line and maintenance therapy in patients with advanced non-small cell lung cancer (NSCLC): findings from a real-world setting

Monika Sztankay et al. BMC Cancer. .

Abstract

Background: Maintenance therapy (MT) with pemetrexed has been shown to improve overall and progression-free survival of patients with non-squamous non-small cell lung cancer (NSCLC), without impairing patients' health-related quality of life (HRQOL) substantially. Comprehensive data on HRQOL under real-life conditions are necessary to enable informed decision-making. This study aims to (1) assess HRQOL during first-line chemotherapy and subsequent MT and (2) record patients' and physicians' reasons leading to clinical decisions on MT.

Methods: Patients treated for NSCLC at three Austrian medical centres were included. HRQOL was assessed at every chemotherapy cycle using the EORTC QLQ-C30/+LC13 questionnaire. Semi-structured interviews were conducted before MT initiation and at the time of discontinuation to evaluate patients' and physicians' reasons for treatment decisions. Longitudinal QOL analysis was based on linear mixed models.

Results: Sixty-one (73%) out of 84 patients were considered for MT. Thirty-six patients (43%) received MT and 29 (35%) discontinued therapy. Decisions on MT initiation (in 20 cases by the physician vs 4 by the patient) and discontinuation (19 vs 10) were mainly voiced by the physician. Treatment toxicity of first-line chemotherapy was the main reason for rejection of MT in patients with stable disease and was more often indicated by patients than clinicians. HRQOL data were collected from 83 patients at 422 assessment time points and indicated significantly lower symptom severity during MT compared with first-line therapy for nausea and vomiting (p = 0.006), sleep disturbances (p < 0.001), appetite loss (p = 0.043), constipation (p = 0.017) and chest pain (p = 0.022), and a deterioration in emotional functioning (p = 0.023) and cognitive functioning (p = 0.044) during MT.

Conclusions: Our results indicate that HRQOL and symptom burden improve between first-line treatment to MT in some respects, although some late toxicity persists. Discrepancies between patients' and physicians' perception of reasons for rejecting MT were evident. Thus, the integration of patient-reported outcomes, such as HRQOL, is required to enable shared decision-making and personalised healthcare based on mutual understanding of treatment objectives.

Keywords: Decision making; Health-related quality of life; Maintenance therapy; Non-small cell lung cancer; Pemetrexed.

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Ethics Committee of the Medical University of Innsbruck, Austria (reference number 4961). All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. All patients provided written informed consent.

Consent for publication

Not applicable.

Competing interests

Bernhard Holzner is an owner of the intellectual property rights of the software CHES. None of the other authors has a conflict of interest to declare.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Patient distribution in treatment trajectory, circles indicating time point for interview on decision making. Data on one patient missing
See this image and copyright information in PMC

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