Effect of Brain Metastasis on Patient-Reported Outcomes in Advanced NSCLC Treated in Real-World Community Oncology Settings

Mark S. Walker, William Wong, Arliene Ravelo, Paul J.E. Miller, Lee Schwartzberg

Research output: Contribution to journalArticle

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Abstract

This was a prospective, observational study of health-related quality of life (HRQOL) in advanced non–small-cell lung cancer, to examine the effect of baseline brain metastasis (BBM) over 1 year of follow-up. Assessed HRQOL on the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (QLQ-C30) and other measures across 1100 surveys from 145 patients. Results showed greater deterioration on most measures for patients with BBM. In these, the average 1-year deterioration in patients with BBM was 19.4%. Introduction: Health-related quality of life (HRQOL) in advanced non–small-cell lung cancer (NSCLC) might be affected by the presence of brain metastasis (BM). We report findings from a prospective observational study that examined HRQOL in patients newly diagnosed with advanced NSCLC, with or without baseline BM, through 1 year of follow-up. Patients and Methods: Patients starting first-line treatment of stage IIIB/IV NSCLC were prospectively enrolled and consented at 34 US-based community oncology practices. Data on patient-reported outcomes (PROs) were collected once per cycle during treatment, and at each visit after discontinuation. PROs included the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (QLQ-C30) and Lung Cancer Module (QLQ-LC13), the Lung Cancer Module of the M.D. Anderson Symptom Inventory (MDASI-LC), and the Rotterdam Activity Level Scale (RALS). Linear mixed models were used to examine the effect of baseline BM, including differences in change over time. Results: One hundred forty-five patients provided follow-up PRO data, comprising 1100 individual surveys and 32 PRO end points. The patient group was 58.6% (n = 85) male, and 86.2% (n = 125) Caucasian. Patients with baseline BM were younger (61.3 vs. 65.8 years; P =.040) with more concurrent radiotherapy (59.4% [n = 19] vs. 15.9% [n = 18]; P <.0001). Results showed minimal differences in baseline HRQOL. Of the 20 measures that showed significant group differences in HRQOL over time, 18 showed greater deterioration for patients with baseline BM. These 18 measures included all QLQ-C30 composite measures except Global Health Status, all MDASI-LC measures, and the RALS (all P <.05). For these measures, the average 1-year deterioration in patients with baseline BM was 19.4%. Conclusion: Newly diagnosed advanced NSCLC patients with baseline BM experienced a significantly faster and clinically meaningful deterioration in PRO-based HRQOL compared with those without baseline BM.

Original languageEnglish (US)
Pages (from-to)139-147
Number of pages9
JournalClinical Lung Cancer
Volume19
Issue number2
DOIs
StatePublished - Mar 1 2018

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Non-Small Cell Lung Carcinoma
Neoplasm Metastasis
Quality of Life
Brain
Observational Studies
Patient Reported Outcome Measures
Lung Neoplasms
Organizations
Prospective Studies
Therapeutics
Research
Health Status
Linear Models
Neoplasms
Radiotherapy
Equipment and Supplies
Surveys and Questionnaires

All Science Journal Classification (ASJC) codes

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

Cite this

Effect of Brain Metastasis on Patient-Reported Outcomes in Advanced NSCLC Treated in Real-World Community Oncology Settings. / Walker, Mark S.; Wong, William; Ravelo, Arliene; Miller, Paul J.E.; Schwartzberg, Lee.

In: Clinical Lung Cancer, Vol. 19, No. 2, 01.03.2018, p. 139-147.

Research output: Contribution to journalArticle

Walker, Mark S. ; Wong, William ; Ravelo, Arliene ; Miller, Paul J.E. ; Schwartzberg, Lee. / Effect of Brain Metastasis on Patient-Reported Outcomes in Advanced NSCLC Treated in Real-World Community Oncology Settings. In: Clinical Lung Cancer. 2018 ; Vol. 19, No. 2. pp. 139-147.
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abstract = "This was a prospective, observational study of health-related quality of life (HRQOL) in advanced non–small-cell lung cancer, to examine the effect of baseline brain metastasis (BBM) over 1 year of follow-up. Assessed HRQOL on the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (QLQ-C30) and other measures across 1100 surveys from 145 patients. Results showed greater deterioration on most measures for patients with BBM. In these, the average 1-year deterioration in patients with BBM was 19.4{\%}. Introduction: Health-related quality of life (HRQOL) in advanced non–small-cell lung cancer (NSCLC) might be affected by the presence of brain metastasis (BM). We report findings from a prospective observational study that examined HRQOL in patients newly diagnosed with advanced NSCLC, with or without baseline BM, through 1 year of follow-up. Patients and Methods: Patients starting first-line treatment of stage IIIB/IV NSCLC were prospectively enrolled and consented at 34 US-based community oncology practices. Data on patient-reported outcomes (PROs) were collected once per cycle during treatment, and at each visit after discontinuation. PROs included the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (QLQ-C30) and Lung Cancer Module (QLQ-LC13), the Lung Cancer Module of the M.D. Anderson Symptom Inventory (MDASI-LC), and the Rotterdam Activity Level Scale (RALS). Linear mixed models were used to examine the effect of baseline BM, including differences in change over time. Results: One hundred forty-five patients provided follow-up PRO data, comprising 1100 individual surveys and 32 PRO end points. The patient group was 58.6{\%} (n = 85) male, and 86.2{\%} (n = 125) Caucasian. Patients with baseline BM were younger (61.3 vs. 65.8 years; P =.040) with more concurrent radiotherapy (59.4{\%} [n = 19] vs. 15.9{\%} [n = 18]; P <.0001). Results showed minimal differences in baseline HRQOL. Of the 20 measures that showed significant group differences in HRQOL over time, 18 showed greater deterioration for patients with baseline BM. These 18 measures included all QLQ-C30 composite measures except Global Health Status, all MDASI-LC measures, and the RALS (all P <.05). For these measures, the average 1-year deterioration in patients with baseline BM was 19.4{\%}. Conclusion: Newly diagnosed advanced NSCLC patients with baseline BM experienced a significantly faster and clinically meaningful deterioration in PRO-based HRQOL compared with those without baseline BM.",
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