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. 2024 Apr 1;7(4):e246872.
doi: 10.1001/jamanetworkopen.2024.6872.

Unmet Needs, Quality of Life, and Financial Toxicity Among Survivors of Lung Cancer

Melinda L Hsu  1   2 , Mary C Boulanger  1   3 , Sarah Olson  4 , Cyd Eaton  4 , Laura Prichett  4 , Matthew Guo  5 , Mattea Miller  5 , Julie Brahmer  1 , Patrick M Forde  1 , Kristen A Marrone  1 , Michelle Turner  1 , Josephine L Feliciano  1
Affiliations

Unmet Needs, Quality of Life, and Financial Toxicity Among Survivors of Lung Cancer

Melinda L Hsu et al. JAMA Netw Open. .

Abstract

Importance: Despite a growing population of survivors of lung cancer, there is limited understanding of the survivorship journey. Survivors of lung cancer experience unmet physical, social, emotional, and medical needs regardless of stage at diagnosis or treatment modalities.

Objective: To investigate the association of unmet needs with quality of life (QOL) and financial toxicity (FT) among survivors of lung cancer.

Design, setting, and participants: This survey study was conducted at Johns Hopkins Sidney Kimmel Comprehensive Cancer Center thoracic oncology clinics between December 1, 2020, and September 30, 2021, to assess needs (physical, social, emotional, and medical), QOL, and FT among survivors of lung cancer. Patients had non-small cell lung cancer of any stage and were alive longer than 1 year from diagnosis. A cross-sectional survey was administered, which consisted of an adapted needs survey developed by the Mayo Survey Research Center, the Comprehensive Score for Financial Toxicity measure, and the European Organization for Research and Treatment of Cancer QLQ-C30 QOL scale. Demographic and clinical information was obtained through retrospective medical record review. Data analysis was performed between May 9 and December 8, 2022.

Main outcomes and measures: Separate multiple linear regression models, treating QOL and FT as dependent variables, were performed to assess the adjusted association of total number of unmet needs and type of unmet need (physical, emotional, social, or medical) with QOL and FT.

Results: Of the 360 survivors of lung cancer approached, 232 completed the survey and were included in this study. These 232 respondents had a median age of 69 (IQR, 60.5-75.0) years. Most respondents were women (144 [62.1%]), were married (165 [71.1%]), and had stage III or IV lung cancer (140 [60.3%]). Race and ethnicity was reported as Black (33 [14.2%]), White (172 [74.1%]), or other race or ethnicity (27 [11.6%]). A higher number of total unmet needs was associated with lower QOL (β [SE], -1.37 [0.18]; P < .001) and higher FT (β [SE], -0.33 [0.45]; P < .001). In the context of needs domains, greater unmet physical needs (β [SE], -1.24 [0.54]; P = .02), social needs (β [SE], -3.60 [1.34]; P = .01), and medical needs (β [SE], -2.66 [0.98]; P = .01) were associated with lower QOL, whereas only greater social needs was associated with higher FT (β [SE], -3.40 [0.53]; P < .001).

Conclusions and relevance: The findings of this survey study suggest that among survivors of lung cancer, unmet needs were associated with lower QOL and higher FT. Future studies evaluating targeted interventions to address these unmet needs may improve QOL and FT among survivors of lung cancer.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Hsu reported receiving personal fees from Mirati, Regeneron, and Targeted Oncology outside the submitted work. Dr Brahmer reported receiving grants from AstraZeneca and Bristol-Myers Squibb (BMS) and personal fees from Merck, Roche, and Regeneron outside the submitted work. Dr Brahmer also reported serving as an advisory board member for Incyte, Amgen, RAPT Therapeutics, Sanofi, and GlaxoSmithKline and serving as a data and safety monitoring board member for Janssen, Sanofi, and GlaxoSmithKline. Dr Forde reported receiving research grants (paid to Johns Hopkins Sidney Kimmel Comprehensive Cancer Center) from AstraZeneca, BMS, Novartis, Regeneron, and BioNTech; serving as a consultant to Ascendis, AstraZeneca, BMS, Curevac, Novartis, Regeneron, G1, Genelux, Genentech, Gritstone, Merck, Janssen, F-Star, Sanofi, Amgen, Fosun, Teva, Synthekine, Flame, Iteos, Tavotek, and Teva; and serving as a data and safety monitoring board member for Polaris outside the submitted work. Dr Marrone reported receiving grants from Mirati and BMS and receiving personal fees from Mirati, Daiichi-Sankyo, Janssen, Regeneron, Amgen, AstraZeneca, and Merck outside the submitted work. Ms Turner reported receiving speaker fees from AstraZeneca, Mirati, and Merck outside the submitted work. Dr Feliciano reported receiving grants from BMS; receiving consulting fees from Takeda, AstraZeneca, and Merck; and serving on the Eli Lilly advisory board outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Enrollment of Survivors of Lung Cancer
aSurveys were considered incomplete if 20% of responses or more were missing or if the global health quality of life score, financial difficulties score, or any independent variable was missing.
See this image and copyright information in PMC

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