Supportive Care in Cancer

, Volume 17, Issue 3, pp 307–313 | Cite as

Assessing quality of life following neoadjuvant therapy for early stage non-small cell lung cancer (NSCLC): results from a prospective analysis using the Lung Cancer Symptom Scale (LCSS)

  • Richard J. Gralla
  • Martin J. Edelman
  • Frank C. Detterbeck
  • Thierry M. Jahan
  • David M. Loesch
  • Steven A. Limentani
  • Ramaswamy Govindan
  • Guangbin Peng
  • Matthew J. Monberg
  • Coleman K. Obasaju
  • Mark A. Socinski
Original Article
First Online:
Received:
Accepted:

Abstract

Background

The assessment of the impact of neoadjuvant therapy on quality of life (QL) has rarely been prospectively planned and evaluated, although validated QL instruments are available—such as the Lung Cancer Symptom Scale (LCSS) used in this study. The modest but significant survival gains reported with neoadjuvant and adjuvant approaches need to be viewed in terms of the added risks and toxicities associated with two or three modalities of treatment.

Materials and methods

The objective was to compare patient-determined QL ratings from baseline (prior to neoadjuvant chemotherapy) with those in subsequent months of follow-up. All patients had clinical stage I or II non-small cell lung cancer (NSCLC) and participated in one of two similar randomized protocols. Patients received preoperative chemotherapy (three cycles) of gemcitabine plus carboplatin or paclitaxel in one trial or gemcitabine plus carboplatin or cisplatin in the second. Patients completed the LCSS at baseline, every 3 weeks preoperatively, and every 3 months postoperatively up to 12 months.

Results

Full QL data are available for 43 patients with at least one postsurgical evaluation and for 23 patients with evaluation at 1-year postsurgery. In patients with at least one postsurgical evaluation, 84% had an ECOG performance status of 0, 93% had a complete resection, and 67% (95% CI = 52, 81) of patients experienced improved or stable symptoms. A subgroup of patients (14 of 43) reported worsening of QL (33%). These patients experienced a mean worsening of 66% in individual symptom parameters, with an average of seven of nine LCSS symptom parameters declining.

Conclusions

Most patients reported improved or stable QL. Prospectively planned QL assessment is feasible with neoadjuvant trials and adds useful information not otherwise attainable.

Keywords

Lung Cancer Symptom Scale Quality of life Early stage NSCLC Gemcitabine 
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Notes

Acknowledgements

The authors would like to thank all patients for study participation and the following GINEST study investigators: Rafat Ansari (Northern Indiana Research Consortium), Robert Jotte (Rocky Mountain Cancer Centers), Michael S. Buchholtz (Huntington, New York), James Young (Colorado Springs, Colorado), Michael Kosmo (Southwest Cancer Care), James M. Leonardo (East Carolina University), Arkadiusz Dudek (University of Minnesota), James Luketich (University of Pittsburgh Medical Center), Michael Perry (University of Missouri-Columbia), and Harry Raftopoulos (Columbia Presbyterian Medical Center).

This trial was sponsored by Eli Lilly and Company.

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Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Richard J. Gralla
    • 1
  • Martin J. Edelman
    • 2
  • Frank C. Detterbeck
    • 3
  • Thierry M. Jahan
    • 4
  • David M. Loesch
    • 5
  • Steven A. Limentani
    • 6
  • Ramaswamy Govindan
    • 7
  • Guangbin Peng
    • 8
  • Matthew J. Monberg
    • 8
  • Coleman K. Obasaju
    • 8
  • Mark A. Socinski
    • 9
  1. 1.North Shore-LIJ Health SystemLake SuccessUSA
  2. 2.University of Maryland Greenebaum Cancer CenterBaltimoreUSA
  3. 3.Yale Comprehensive Cancer CenterYale UniversityNew HavenUSA
  4. 4.University of California San FranciscoSan FranciscoUSA
  5. 5.Central Indiana Cancer CentersIndianapolisUSA
  6. 6.Blumenthal Cancer CenterCharlotteUSA
  7. 7.Washington University OncologySaint LouisUSA
  8. 8.Eli Lilly and CompanyIndianapolisUSA
  9. 9.Multidisciplinary Thoracic Oncology Group, Lineberger Comprehensive Cancer CenterUniversity of North CarolinaChapel HillUSA

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