Effectiveness outcomes and health related quality of life impact of disease progression in patients with advanced nonsquamous NSCLC treated in real-world community oncology settings: results from a prospective medical record registry study

Health and Quality of Life Outcomes

Research

William Wong¹  Arliene Ravelo¹  Paul J. E. Miller²  Mark S. Walker²  Lee S. Schwartzberg³ 

[1] Genentech, Inc., 1 DNA Way, 94080, South San Francisco, CA, USA;Vector Oncology, 6555 Quince, Suite 400, 38119, Memphis, TN, USA;West Cancer Center, 7945 Wolf River Blvd., 38138, Germantown, TN, USA;

关键词: Nonsquamous NSCLC;    Community oncology;    Patient reported outcomes;    Treatment effectiveness;    Health related quality of life;   

DOI  :  10.1186/s12955-017-0735-4

 received in 2017-03-24, accepted in 2017-08-02,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundTreatment options for advanced nonsquamous non-small cell lung cancer (NSCLC) in the first line include platinum-based doublet therapy with or without bevacizumab. This study examined efficacy outcomes and patient reported outcomes (PROs) in a community oncology patient sample.MethodsAdvanced nonsquamous NSCLC patients from 34 U.S. community oncology practices treated in first line with bevacizumab regimens (A platinum doublet; gemcitabine doublet; pemetrexed with platinum) or non-bevacizumab regimens (B platinum doublet; gemcitabine doublet; C pemetrexed with platinum) were recruited for this prospective study. Patient characteristics and clinical outcomes were accessed from routine care records. Three validated and widely used PRO measures of health related quality of life (HRQOL) and symptom burden were collected prospectively at each visit and up to one-year follow-up. Effectiveness outcomes were progression free survival (PFS) and overall survival (OS) assessed by Kaplan-Meier and Cox regression methods. PROs were analyzed with linear mixed model regression to examine changes over time, and the effect of disease progression.ResultsOf 147 patients in the study, 145 provided PRO data. Patients in treatment groups were: A (n = 66, 44.9%); B (n = 25, 17.0%); C (n = 56, 38.1%). A was associated with significantly longer OS than B (HR = 0.341, p = 0.0012), and significantly longer than C (HR = 0.602, p = 0.0354). PFS results were similar. Irrespective of regimen group and on 12/32 measures, patients showed significant and clinically meaningful worsening of symptoms and HRQOL at disease progression. After disease progression, the pattern of symptom and HRQOL change showed continued worsening.ConclusionsBevacizumab-containing regimens were associated with longer PFS and OS compared with non-bevacizumab regimens. PRO measures show disease progression is associated with worsening HRQOL. Delaying disease progression can sustain better HRQL and reduce symptom burden.

【 授权许可】

CC BY   
© The Author(s). 2017