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The impact of symptoms and comorbidity on health utility scores and health-related quality of life in small cell lung cancer using real world data

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Abstract

Purpose

Small cell lung cancer (SCLC) is a highly fatal disease associated with significant morbidity, with a need for real-world symptom and health utility score (HUS) data. HUS can be measured using an EQ-5D-5L questionnaire, however most captured data is available in non-SCLC (NSCLC) only. As new treatment regimens become available in SCLC it becomes important to understand factors which influence health-related quality of life and health utility.

Methods

A prospective observational cohort study (2012–2017) of ambulatory histologically confirmed SCLC evaluated patient-reported EQ-5D-5L-derived HUS, toxicity and symptoms. A set of NSCLC patients was used to compare differential factors affecting HUS. Clinical and demographic factors were evaluated for differential interactions between lung cancer types. Comorbidity scores were documented for each patient.

Results

In 75 SCLC and 150 NSCLC patients, those with SCLC had lower mean HUS ((SCLC vs NSCLC: mean 0.69 vs 0.79); (p < 0.001)) when clinically stable and with progressive disease: ((SCLC mean HUS = 0.60 vs NSCLC mean HUS = 0.77), (p = 0.04)). SCLC patients also had higher comorbidity scores ((1.11 vs 0.73); (p < 0.015)). In multivariable analyses, increased symptom severity and comorbidity scores decreased HUS in both SCLC and NSCLC (p < 0.001); however, only comorbidity scores differentially affected HUS (p < 0.0001), with a greater reduction of HUS adjusted per unit of comorbidity in SCLC.

Conclusion

Patients with advanced SCLC had significantly lower HUS than NSCLC. Both patient cohorts are impacted by symptoms and comorbidity, however, comorbidity had a greater negative effect in SCLC patients.

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Funding

This study received no external funding.

Author information

Author notes

  1. Geoffrey Liu and Grainne O'Kane have contributed equally.

Authors and Affiliations

  1. Medical Oncology and Hematology, Department of Medicine, Princess Margaret Cancer Centre, 610 University Avenue, Toronto, ON, M5G2M9, Canada

    Ali Vedadi, Sharara Shakik, M. Catherine Brown, Frances A. Shepherd, Natasha B. Leighl, Adrian Sacher, Penelope A. Bradbury, Geoffrey Liu & Grainne M. O’Kane

  2. Department of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

    Sharara Shakik & Geoffrey Liu

  3. Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, Canada

    Benjamin H. Lok

  4. Institute for Medical Science, University of Toronto, Toronto, Canada

    Benjamin H. Lok & Geoffrey Liu

  5. Biostatistics, Applied Clinical Research Unit, Princess Margaret Cancer Centre, Toronto, Canada

    Wei Xu

  6. Department of Biostatistics, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada

    Wei Xu & Geoffrey Liu

  7. Department of Medical Biophysics, University of Toronto, Toronto, Canada

    Geoffrey Liu

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  1. Ali Vedadi
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Contributions

GOK, GL, AV, SS, WX analyzed and interpreted the data. AV, GL, GOK developed the study design and wrote the manuscript. All authors critically revised the paper. All authors have read and approved the final version of the manuscript.

Corresponding author

Correspondence to Geoffrey Liu.

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Conflict of interest

Dr. Liu reports Grants and honoraria from AstraZeneca and Takeda; honoraria from Novartis, AbbVie; and advisory boards from Roche, Pfizer, Merck, Bristol Myers Squibb, and Bayer. The remaining authors have stated that they have no conflicts of interest. We have full control of all primary data and agree to allow the journal to review data if requested.

Ethical approval

Ethics approval was obtained from the institutional research-ethics board of the University Health Network/Princess Margaret Cancer Centre. The University Health Network is the umbrella legal hospital network entity that includes multiple hospitals, including Princess Margaret Cancer Centre, the location where the study was carried out and where the affiliated authors are attached. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed written consent was obtained from all participants of the study. All data collected through questionnaires were anonymized and contained no identifying information.

Research involving human participants and/or animals

This study was a retrospective, observational, non-interventional study involving human participants.

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Vedadi, A., Shakik, S., Brown, M.C. et al. The impact of symptoms and comorbidity on health utility scores and health-related quality of life in small cell lung cancer using real world data. Qual Life Res 30, 445–454 (2021). https://doi.org/10.1007/s11136-020-02615-1

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