Lung Cancer Study Links Treatment History to Quality-of-Life Differences

Quality-of-life in lung cancer varies based on treatment and disease stage: © stock.adobe.com.

Improving quality of life for patients with non-small cell lung cancer requires a holistic, value-based care approach that considers treatment side effects and patient preferences, not just survival, according to study findings published in Journal of Clinical Oncology.

“A full understanding of treatment side effects and their implications for health-related quality of life is essential to aligning care with patient preferences,” wrote lead investigator Erica Fortune and colleagues in the study. “Future research should investigate how treatment history impacts health-related quality of life outcomes.

Fortune is vice president of research at Cancer Support Community. She holds a doctorate in cognitive and experimental psychology and previously served as a tenured associate professor at Arcadia University.

Several patterns emerged in how treatment history affects quality of life in people with lung cancer, though results were inconsistent across groups. After accounting for clinical and demographic factors, researchers found that individuals who were nonmetastatic and had not undergone surgery reported more sleep disturbance. Contrarily, people who had received immunotherapy reported less depression, and those who had participated in clinical trials experienced less anxiety.

Among participants with metastatic disease who had not had surgery, results showed better physical and social functioning, as well as less pain and fatigue. No significant differences in quality-of-life were found among those with metastatic disease who had undergone surgery.

The findings come from a group of participants who were, on average, 64 years old and predominantly women (68%) and Non-Hispanic White (88%). The average time since diagnosis was 5 years. In terms of clinical characteristics, 16% were nonmetastatic with no history of surgery and 27% were nonmetastatic with a history of surgery. Among those with metastatic disease, 39% had not had surgery and 18% had.

The study analyzed how treatment history might help explain differences in quality of life among people with lung cancer, particularly between those with metastatic and nonmetastatic disease. Researchers used data from 279 U.S. adults with non-small cell lung cancer who participated in Cancer Support Community’s Cancer Experience Registry between February 2015 and November 2023. This retrospective study focused on seven key areas of health-related quality of life measured through the PROMIS-29 version 2.0 tool: anxiety, depression, pain, fatigue, sleep disturbance, physical function, and social function.

Early analyses revealed that individuals with nonmetastatic non-small cell lung cancer were more likely to report higher levels of pain and fatigue, as well as greater impairments in physical and social functioning, compared with those who had metastatic disease. Given these unexpected results, the research team investigated whether differences in past treatment might account for the disparities. Notably, 62% of nonmetastatic participants had undergone surgery, compared with 31% of those with metastatic disease, according to the study.

To explore this further, the team created an interaction term combining metastatic status and surgical history, which they evaluated using backward elimination linear regression models. This approach aimed to clarify how disease stage and prior treatment may interact to influence the lived experience of patients with lung cancer.

Lung cancer is the second most commonly diagnosed cancer and remains the leading cause of cancer-related death, according to the study. Non-small cell lung cancer, which accounts for about 85% of all lung cancer cases, is known for being aggressive and is often diagnosed at a later stage. It carries a heavy symptom burden, a poor prognosis, and typically leads to reduced quality of life. Despite these challenges, the reasons why quality of life varies from person to person remain unclear.

Reference

“Characterizing health related quality of life among individuals living with non-small cell lung in the United States: Findings from the Cancer Experience Registry” by Dr. Erica Fortune, et al., Journal of Clinical Oncology.

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