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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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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DOI: https://doi.org/10.1007/s11136-015-1174-5