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

BMC Cancer

Research Article

Wolfgang Hilbe¹  August Zabernigg²  Johannes Maria Giesinger³  Bernhard Holzner³  Gerhard Rumpold³  Elisabeth Krempler³  Monika Sztankay⁴  Stephan Doering⁵  Otto Burghuber⁶  Maximilian Hochmair⁶  Georg Pall⁷ 

[1] Department of Internal Medicine I (Haematology and Oncology), Wilhelminenspital Wien, Vienna, Austria;Department of Internal Medicine, Kufstein County Hospital, Kufstein, Austria;Department of Psychiatry, Psychotherapy & Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria;Department of Psychiatry, Psychotherapy & Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria;Leopold-Franzens-University of Innsbruck, Innsbruck, Austria;Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria;Respiratory Oncology Unit, Department of Respiratory and Critical Care Medicine, Otto-Wagner-Spital, Vienna, Austria;Waldburg-Zeil Akutkliniken GmbH & Co. KG, Wangen, Germany;

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

DOI  :  10.1186/s12885-017-3543-7

 received in 2017-04-04, accepted in 2017-08-14,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundMaintenance 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.MethodsPatients 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.ResultsSixty-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.ConclusionsOur 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.

【 授权许可】

CC BY   
© The Author(s). 2017