Association between Health-Related Quality of Life and Completion of First-Line Treatment among Lung Cancer Patients

Abstract

Experts recommend assessing lung cancer patients’ health-related quality of life (HRQOL) in the diagnostic evaluation. We investigated the association between HRQOL and completion of first-line treatment among lung cancer patients in a prospective cohort study. Clinical information on lung cancer patients was obtained from medical records, and information on quality of life and lung cancer-related symptoms was obtained through questionnaires at time of diagnosis. We used directed acyclic graphs to identify potential confounders and mediators between HRQOL and completion of first-line treatment. The association between functioning levels and symptoms and completion of first-line oncological treatment was estimated as odds ratios, with 95% confidence intervals, in logistic regression models. In all, 137 patients (52% men, mean age: 69 years) participated, out of 216 invited. Patients who reported reduced functioning had significantly increased ORs for not completing first-line treatment: poor physical function (OR 4.44), role function (OR 6.09), emotional function (OR 5.86), and social function (OR 3.13). Patients with fatigue (OR 7.55), pain (OR 6.07), appetite loss (OR 4.66), and financial difficulties (OR 17.23) had significantly increased ORs for not completing the first-line treatment. Reduced functioning and presence of symptoms were associated with not completing first-line treatment. An assessment of HRQOL could potentially aid the diagnostic evaluation and treatment planning for lung cancer patients.

Social inequality in cancer survivorship: Educational differences in health‐related quality of life among 27,857 cancer survivors in Denmark

“…One explanation could be our use of the relatively new thresholds for clinical importance, 18 as previous studies that have dichotomized functioning and symptoms measured with the QLQ-C30 commonly set cutoff values below 66 and above 33, respectively. 41,42 In contrast, the cutoff for dyspnea in the present study was >17. 18 This new cutoff may provide a better indication of the…”

“…It is well‐known that long‐term survivors experience substantial fatigue and pain, 40 but dyspnea has to our knowledge not previously been reported as a severe symptom experienced by cancer survivors. One explanation could be our use of the relatively new thresholds for clinical importance, 18 as previous studies that have dichotomized functioning and symptoms measured with the QLQ‐C30 commonly set cutoff values below 66 and above 33, respectively 41,42 . In contrast, the cutoff for dyspnea in the present study was >17 18 .…”

Pretreatment quality of life and survival in patients with lung cancer: a systematic review and meta-analysis

“…In the present study, cognitive QOL alone was not significantly associated with survival. Numerous studies on cognitive QOL in patients with lung cancer have reported less decline compared to other functional QOL [67][68][69]. This is likely because there is little variation in cognitive QOL values and that patients with cognitive decline tend to be excluded from clinical trials [60,68].…”