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Health-related quality of life after first-line anti-cancer treatments for advanced non-small cell lung cancer in clinical practice

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Abstract

Purpose

This study attempted to compare changes in the Quality-of-Life (QoL) scores after three different first-line anti-cancer treatments for advanced non-small cell lung cancer (NSCLC) in a real-world clinical setting.

Patients and methods

From May 2011 to December 2013, we prospectively measured the QoL scores of patients with locally advanced or metastatic NSCLC using the World Health Organization Quality-of-Life—Brief (WHOQOL-BREF) questionnaire. Each QoL measurement was matched by age and sex with one healthy referent from the National Health Interview Survey. Dynamic changes in patients’ QoL scores and major determinants were repeatedly assessed by construction of a mixed-effects model to adjust for possible confounders.

Results

A total of 336 patients with 577 QoL measurements related to first-line anti-cancer treatments were enrolled. Performance status was the most important predictor of QoL scores in all domains after controlling for potential confounders. With age- and sex-matched healthy subjects as the reference, patients treated with gemcitabine + platinum showed significantly lower scores in multiple physical and psychological domain items in the WHOQOL-BREF. However, pemetrexed + platinum and gefitinib/erlotinib affected patients’ QoL scores in ‘energy/fatigue’ and ‘daily activities’ with smaller magnitudes, and the scores appeared to improve after 3–4 months of treatment.

Conclusions

Patients receiving gemcitabine + platinum as first-line anti-cancer treatment for advanced NSCLC experienced relatively poor QoL scores throughout treatment course. Studies to develop a real-time computerized system automatically updating the mixed-effects model for QoL to facilitate participatory clinical decision making by physicians, patients, and their families merit further research.

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Acknowledgments

This research was supported, in part, by the Ministry of Science and Technology [NSC102-2314-B-006-029-MY2]; the Ministry of Health and Welfare [DOH100-TD-C-111-003 to W.W. Lai, MOHW103-TD-B-111-06 and MOHW103-TDU-B-211-113002 to W.C. Su]; and the Ministry of Education, Taiwan, R.O.C., the Aim for the Top University Project to National Cheng Kung University. We thank the help from Cancer Data Bank of National Cheng Kung University Hospital for retrieving the cancer case database.

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Authors and Affiliations

  1. Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, Tainan, 704, Taiwan

    Szu-Chun Yang, Tzuen-Ren Hsiue, Wu-Chou Su & Jung-Der Wang

  2. Department of Public Health, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, Tainan, 704, Taiwan

    Szu-Chun Yang & Jung-Der Wang

  3. Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, Tainan, 704, Taiwan

    Wu-Wei Lai

  4. Department of Environmental Health, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA

    Cheng-Kuan Lin

  5. Institute of Statistical Science, Academia Sinica, 128 Academia Road Section 2, Taipei, 115, Taiwan

    Jing-Shiang Hwang

  6. Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, Tainan, 704, Taiwan

    Jung-Der Wang

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  1. Szu-Chun Yang
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Correspondence to Jung-Der Wang.

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All authors declare that they have no conflict of interest.

Ethical approval

The original study was approved by the Institutional Review Board at National Cheng Kung University Hospital. All participants signed informed consent.

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Yang, SC., Lai, WW., Hsiue, TR. et al. Health-related quality of life after first-line anti-cancer treatments for advanced non-small cell lung cancer in clinical practice. Qual Life Res 25, 1441–1449 (2016). https://doi.org/10.1007/s11136-015-1174-5

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