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Jovanoski N, Abogunrin S, Di Maio D, Belleli R, Hudson P, Bhadti S, Jones LG. Health State Utility Values in Early-Stage Non-small Cell Lung Cancer: A Systematic Literature Review. PHARMACOECONOMICS - OPEN 2023; 7:723-738. [PMID: 37289325 PMCID: PMC10471534 DOI: 10.1007/s41669-023-00423-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/10/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Non-small cell lung cancer (NSCLC) is the predominant histological subtype of lung cancer and is the leading cause of cancer-related deaths globally. Quality of life is an important consideration for patients and current treatments can adversely affect health-related quality of life (HRQoL). OBJECTIVE The objectives of this systematic literature review (SLR) were to identify and provide a comprehensive catalogue of published health state utility values (HSUVs) in patients with early-stage NSCLC and to understand the factors impacting on HSUVs in this indication. METHODS Electronic searches of Embase, MEDLINE and Evidence-Based Medicine Reviews were conducted via the Ovid platform in March 2021 and June 2022 and were supplemented by grey literature searches of conference proceedings, reference lists, health technology assessment bodies, and other relevant sources. Eligibility criteria were based on patients with early-stage (stage I-III) resectable NSCLC receiving treatment in the adjuvant or neoadjuvant setting. No restriction was placed on interventions or comparators, geography, or publication date. English language publications or non-English language publications with an English abstract were of primary interest. A validated checklist was applied to conduct quality assessment of the full publications. RESULTS Twenty-nine publications (27 full publications and two conference abstracts) met all eligibility criteria and reported 217 HSUVs and seven disutilities associated with patients with early NSCLC. The data showed that increasing disease stage is associated with decreasing HRQoL. It was also indicated that utility values vary by treatment approach; however, the choice of treatment may be influenced by the patients' disease stage at presentation. Few studies aligned with the requirements of health technology assessment (HTA) bodies, indicating a need for future studies to conform to these preferences, making them suitable for use in economic evaluations. CONCLUSIONS This SLR found that disease stage and treatment approach were two of several factors that can impact patient-reported HRQoL. Additional studies are warranted to confirm these findings and to investigate emerging therapies for early NSCLC. In collecting a catalogue of HSUV data, this SLR has begun to identify the challenges associated with identifying reliable utility value estimates suitable for use in economic evaluations of early NSCLC.
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Yan M, Tjong M, Chan WC, Darling G, Delibasic V, Davis LE, Doherty M, Hallet J, Kidane B, Mahar A, Mittmann N, Parmar A, Tan V, Tan H, Wright FC, Coburn NG, Louie AV. Dyspnea in patients with stage IV non-small cell lung cancer: a population-based analysis of disease burden and patterns of care. J Thorac Dis 2023; 15:494-506. [PMID: 36910044 PMCID: PMC9992624 DOI: 10.21037/jtd-22-919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 12/09/2022] [Indexed: 02/23/2023]
Abstract
Background Patients with metastatic non-small cell lung cancer (NSCLC) experience significant morbidity with dyspnea being a common symptom with a prevalence of 70%. The objective of this study was to determine factors associated with a moderate-to-severe dyspnea score based on the Edmonton Symptom Assessment System (ESAS), as well as resultant patterns of intervention and factors correlated to intervention receipt. Methods Using health services administrative data, we conducted a population-based study of all patients diagnosed with metastatic NSCLC treated from January 2007 to September 2018 in the province of Ontario. The primary outcomes of interest are the prevalence of moderate-to-severe dyspnea scores, and the receipt of dyspnea-directed intervention. Differences in baseline characteristic between moderate-to-severe dyspnea and low dyspnea score cohorts were assessed by comparative statistics. Predictors of intervention receipt for patients with moderate-to-severe dyspnea scores were estimated using multivariable modified Poisson regression. Results The initial study cohort included 13,159 patients diagnosed with metastatic NSCLC and of these, 9,434 (71.7%) reported a moderate-to-severe dyspnea score. Compared to patients who did not report moderate-to-severe dyspnea scores, those who reported a moderate-to-severe dyspnea score were more likely to complete a greater number of ESAS surveys, be male, have a higher Elixhauser comorbidity index (ECI) score, and receive subsequent systemic therapy after diagnosis. Most patients with a moderate-to-severe dyspnea score received intervention (96%), of which the most common were palliative care management (87%), thoracic radiotherapy (56%) and thoracentesis (37%). Multivariable regression identified older patients to be less likely to undergo pleurodesis. Thoracentesis was less common for patients living in rural and non-major urban areas, lower income areas, and earlier year of diagnosis. Receipt of thoracic radiotherapy was less common for older patients, females, those with ECI ≥4, patients living in major urban areas, and those with later year of diagnosis. Finally, palliative care referrals were less frequent for patients with ECI ≥4, age 60-69, residence outside of major urban areas, earlier year of diagnosis, and lower income areas. Conclusions Dyspnea is a prevalent symptom amongst patients with metastatic NSCLC. Subpopulations of patients with moderate-to-severe dyspnea scores were in which inequities may exist in access to care that require further attention and evaluation.
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Affiliation(s)
- Michael Yan
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Michael Tjong
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Wing C Chan
- Institute for Clinical Evaluative Sciences (ICES), Toronto, ON, Canada
| | - Gail Darling
- Division of Thoracic Surgery, University of Toronto, Toronto, ON, Canada
| | - Victoria Delibasic
- Department of Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Laura E Davis
- Department of Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, ON, Canada
| | - Mark Doherty
- Department of Oncology, St. Vincent's Hospital Group, Dublin, Ireland.,Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Julie Hallet
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Biniam Kidane
- Division of Thoracic Surgery, University of Manitoba, Winnipeg, Canada
| | - Alyson Mahar
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Nicole Mittmann
- Canadian Agency for Drugs and Technology in Health, Ottawa, Canada
| | - Ambica Parmar
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vivian Tan
- Department of Radiation Oncology, University of Western Ontario, London, Canada
| | - Hendrick Tan
- Department of Radiation Oncology, Fiona Stanley Hospital, Perth, Australia
| | - Frances C Wright
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Natalie G Coburn
- Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Alexander V Louie
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
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Laucis AMB, Hochstedler KA, Schipper MJ, Paximadis PA, Boike TP, Bergsma DP, Movsas B, Kretzler A, Spratt DE, Dess RT, Mietzel MA, Dominello MM, Matuszak MM, Jagsi R, Hayman JA, Pierce LJ, Jolly S. Racial Differences in Treatments and Toxicity in Patients With Non-Small-Cell Lung Cancer Treated With Thoracic Radiation Therapy. JCO Oncol Pract 2022; 18:e1034-e1044. [PMID: 35167337 DOI: 10.1200/op.21.00224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Historical racial disparities in lung cancer surgery rates resulted in lower survival in Black patients. Our objective was to examine racial differences in thoracic radiation treatments and toxicities in patients with non-small-cell lung cancer. METHODS AND MATERIALS A large institutional review board-approved statewide patient-level database of patients with stage II-III non-small-cell lung cancer who received definitive thoracic radiation from March 2012 to November 2019 was analyzed to assess associations between race and other variables. Race (White or Black) was defined by patient self-report. Provider-reported toxicity was defined by Common Terminology Criteria for Adverse Events version 4.0. Patient-reported toxicity was determined by the Functional Assessment of Cancer Therapy-Lung quality-of-life instrument. Univariable and multivariable regression models were fitted to assess relationships between race and variables of interest. Spearman rank-correlation coefficients were calculated between provider-reported toxicity and similar patient-reported outcomes. RESULTS One thousand four hundred forty-one patients from 24 institutions with mean age 68 years (range, 38-94 years) were evaluated. Race was not significantly associated with radiation or chemotherapy approach. There was significantly increased patient-reported general pain in Black patients at the preradiation and end-of-radiation time points. Black patients were significantly less likely to have provider-reported grade 2+ pneumonitis (odds ratio 0.36, P = .03), even after controlling for known patient and treatment factors. Correlation coefficients between provider- and patient-reported toxicities were generally similar across race groups except for a stronger correlation between patient- and provider-reported esophagitis in White patients. CONCLUSION In this large multi-institutional study, we found no evidence of racial differences in radiation treatment or chemotherapy approaches. We did, however, unexpectedly find that Black race was associated with lower odds of provider-reported grade 2+ radiation pneumonitis. The stronger correlation between patient- and provider-reported esophagitis and swallowing symptoms for White patients also suggests possible under-recognition of symptoms in Black patients. Further research is needed to study the implications for Black patients.
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Affiliation(s)
- Anna Mary Brown Laucis
- Department of Radiation Oncology, Rogel Comprehensive Cancer Center at the University of Michigan, Ann Arbor, MI
| | | | - Matthew J Schipper
- Department of Radiation Oncology, Rogel Comprehensive Cancer Center at the University of Michigan, Ann Arbor, MI.,Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | | | | | - Derek P Bergsma
- Department of Radiation Oncology, Mercy Health Saint Mary's, Grand Rapids, MI
| | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI
| | - Annette Kretzler
- Department of Radiation Oncology, Henry Ford Allegiance, Jackson, MI
| | - Daniel E Spratt
- Department of Radiation Oncology, Rogel Comprehensive Cancer Center at the University of Michigan, Ann Arbor, MI
| | - Robert T Dess
- Department of Radiation Oncology, Rogel Comprehensive Cancer Center at the University of Michigan, Ann Arbor, MI
| | - Melissa A Mietzel
- Department of Radiation Oncology, Rogel Comprehensive Cancer Center at the University of Michigan, Ann Arbor, MI
| | - Michael M Dominello
- Department of Radiation Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI
| | - Martha M Matuszak
- Department of Radiation Oncology, Rogel Comprehensive Cancer Center at the University of Michigan, Ann Arbor, MI
| | - Reshma Jagsi
- Department of Radiation Oncology, Rogel Comprehensive Cancer Center at the University of Michigan, Ann Arbor, MI
| | - James A Hayman
- Department of Radiation Oncology, Rogel Comprehensive Cancer Center at the University of Michigan, Ann Arbor, MI
| | - Lori J Pierce
- Department of Radiation Oncology, Rogel Comprehensive Cancer Center at the University of Michigan, Ann Arbor, MI
| | - Shruti Jolly
- Department of Radiation Oncology, Rogel Comprehensive Cancer Center at the University of Michigan, Ann Arbor, MI
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Huber RM, Kauffmann-Guerrero D, Hoffmann H, Flentje M. New developments in locally advanced nonsmall cell lung cancer. Eur Respir Rev 2021; 30:30/160/200227. [PMID: 33952600 DOI: 10.1183/16000617.0227-2020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022] Open
Abstract
Locally advanced nonsmall cell lung cancer, due to its varying prognosis, is grouped according to TNM stage IIIA, IIIB and IIIC. Developments over the last 3 years have been focused on the integration of immunotherapy into the combination treatment of a locally definitive therapy (surgery or radiotherapy) and chemotherapy. For concurrent chemoradiotherapy, consolidation therapy with durvalumab was established. Adjuvant targeted therapy has again gained increasing interest. In order to adapt treatment to the specific stage subgroup and its prognosis, fluorodeoxyglucose positron emission tomography/computed tomography and pathological evaluation of the mediastinum are important. Tumours should be investigated for immunological features and driver mutations. Regarding toxicity, evaluation of pulmonary and cardiac function, as well as symptoms and quality of life, is of increasing importance. To improve the management and prognosis of this heterogeneous entity, clinical trials and registries should take these factors into account.
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Affiliation(s)
- Rudolf M Huber
- Division of Respiratory Medicine and Thoracic Oncology, Dept of Medicine, University of Munich - Campus Innenstadt, Comprehensive Pneumology Center Munich (CPC-M) and Thoracic Oncology Centre Munich, Munich, Germany .,Member of the German Centre of Lung Research
| | - Diego Kauffmann-Guerrero
- Division of Respiratory Medicine and Thoracic Oncology, Dept of Medicine, University of Munich - Campus Innenstadt, Comprehensive Pneumology Center Munich (CPC-M) and Thoracic Oncology Centre Munich, Munich, Germany.,Member of the German Centre of Lung Research
| | - Hans Hoffmann
- Division of Thoracic Surgery, Technical University of Munich, Munich, Germany
| | - Michael Flentje
- Dept of Radiation Oncology and Palliative Medicine, University of Würzburg, Würzburg, Germany
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Clinical significance of radiation dose-volume parameters and functional status on the patient-reported quality of life changes after thoracic radiotherapy for lung cancer: a prospective study. Radiol Med 2020; 126:466-473. [PMID: 32889704 DOI: 10.1007/s11547-020-01273-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 08/23/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To date, limited data exist about the relationship between radiation dose-volume parameters and patient-reported quality of life (QOL) after thoracic radiotherapy (RT) for lung cancer. We conducted this prospective study to investigate which clinico-dosimetric factors have an impact on functional declines and symptom developments after thoracic RT for lung cancer. MATERIALS AND METHODS The study included 44 patients who had underwent thoracic three-dimensional conformal RT at our institution from 2016 to 2017. The health-related QOL was assessed using the EORTC QLQ-C30 and QLQ-LC13 questionnaires before RT (preRT), at the end of RT (endRT), and 3, 6, and 12 months after the completion of RT. RT dose-volume parameters of adjacent normal organs such as the lung, heart, and esophagus were retrieved and used for regression analysis. RESULTS Thoracic RT induced a temporary deterioration of many of the functional statuses and symptoms, but most of those improved and recovered to baseline levels 3 months after RT. However, the role function (RF) decline persisted until 6 months after RT (p < 0.05). Dysphagia showed the most noticeable change at the endRT (p < 0.001). In the multiple regression analysis, the absolute volume of body received at least 50 Gy (p = 0.021) and a preRT RF score (p = 0.001) was significantly associated with the endRT RF scores. Dysphagia at the endRT was significantly associated with the V40 of the esophagus (p = 0.047), preRT emotional function (p = 0.029), and receipt of concurrent chemotherapy (p = 0.022). CONCLUSIONS Both the dosimetric parameters and preRT functional status have an impact on the weak aspect of patient-reported QOL, which may cause poor treatment compliance during and after thoracic RT. For patients with a low preRT QOL score or those having large tumor which may result in higher dose volumes, careful RT planning could prevent the deterioration of QOL after RT.
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Pugh SL, Rodgers JP, Yeager KA, Chen RC, Movsas B, Bonanni R, Dignam J, Bruner DW. Characteristics of Participation in Patient-Reported Outcomes and Electronic Data Capture Components of NRG Oncology Clinical Trials. Int J Radiat Oncol Biol Phys 2020; 108:950-959. [PMID: 32590048 DOI: 10.1016/j.ijrobp.2020.06.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 06/04/2020] [Accepted: 06/17/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE To assess the reasons why patients do not consent to patient-reported outcome (PRO) and electronic PRO data capture components of clinical trials and potential selection bias by having a separate consent. METHODS AND MATERIALS Selected NRG Oncology trials were included based on disease site and inclusion of PROs and electronic PRO data capture via VisionTree Optimal Care as separate consent questions. Reasons for not participating were assessed. Pretreatment characteristics between patients who did and did not consent were tested using χ2 and t tests for univariate comparisons and logistic regression for multivariable analyses. RESULTS Ten trials were selected in head and neck, prostate, gynecologic, breast, lung, and gastrointestinal cancers, with 4 of these trials having electronic PRO data capture. Most patients consented to the PRO component (75.3%) but not electronic PRO data capture (37.8%). More white patients consented to PROs than nonwhite patients across all trials (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.45-0.63; P < .001), and more patients with education after high school consented compared with those with less education (OR, 1.71; 95% CI, 1.46-2.02; P < .001). Patients who are younger (OR, 0.63; 95% CI, 0.47-0.85; P = .002), white (OR, 0.60; 95% CI, 0.44-0.82; P = .001), and a never or former smoker (OR, 0.57; 95% CI, 0.41-0.78; P = .001) are more likely to participate in electronic PRO data capture. CONCLUSIONS These results suggest that a patient's race, age, and education can affect whether a patient chooses to consent or is offered to participate in PRO or electronic PRO data capture components. More investigation is needed, but this analysis provides support for making PROs integrated in the trial.
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Affiliation(s)
- Stephanie L Pugh
- NRG Oncology, Statistics and Data Management Center, American College of Radiology, Philadelphia, Pennsylvania.
| | - Joseph P Rodgers
- NRG Oncology, Statistics and Data Management Center, American College of Radiology, Philadelphia, Pennsylvania
| | | | - Ronald C Chen
- UNC Hospitals Radiation Oncology Clinic, NC Cancer Hospital, Chapel Hill, North Carolina
| | - Benjamin Movsas
- Henry Ford Cancer Institute, Henry Ford Health System, Detroit, Michigan
| | - Roseann Bonanni
- NRG Oncology, Statistics and Data Management Center, American College of Radiology, Philadelphia, Pennsylvania
| | - James Dignam
- NRG Oncology, Statistics and Data Management Center, University of Chicago, Chicago, Illinois
| | - Deborah W Bruner
- Emory University Hospital, Winship Cancer Institute, Atlanta, Georgia
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Voong KR, Feliciano JL. Patient-reported outcome measures in definitive chemoradiation for non-small cell lung cancer. Transl Lung Cancer Res 2020; 9:4-7. [PMID: 32206547 PMCID: PMC7082294 DOI: 10.21037/tlcr.2019.10.06] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Khinh Ranh Voong
- Department of Radiation Oncology and Molecular Radiation Sciences, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA
| | - Josephine L Feliciano
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD, USA
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Vogel J, Simone CB. Patient-reported Outcomes With Stereotactic Body Radiotherapy and Surgery for Lung Cancer. Clin Lung Cancer 2019; 21:e229-e230. [PMID: 31953027 DOI: 10.1016/j.cllc.2019.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 12/19/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Jennifer Vogel
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins Hospital, Baltimore, MD.
| | - Charles B Simone
- Department of Radiation Oncology, New York Proton Center, New York, NY
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