Key Determinants of Health-Related Quality of Life Among Advanced Lung Cancer Patients: A Qualitative Study in Belgium and Italy

Abstract

Background: The lung cancer (LC) treatment landscape has drastically expanded with the arrival of immunotherapy and targeted therapy. This new variety of treatment options, each with its own characteristics, raises uncertainty regarding the key aspects affecting patients’ health-related quality of life (HRQL). The present qualitative study aimed to investigate how LC patients perceive their HRQL and the factors that they consider to be most influential in determining their HRQL.Methods: This qualitative research incorporates four focus group discussions, with six LC patients in each group. In total, 24 stage III and IV LC patients were included in the discussions, with Italian (n = 12) and Belgian (n = 12) patients, age range: 42–78, median age = 62 (IQR = 9.3 years), SD = 8.5; 62% men. Using thematic analysis, transcripts and notes from the FGDs were analyzed using NVivo software (edition 12).Results: Three main themes capturing determinants of HRQL were identified. First, patients agreed on the importance of physical aspects (symptoms and side-effects) in determining their HRQL. In particular, skin conditions, nausea, fatigue, risk of infections, sensory abnormalities, pain, and changes in physical appearance were highlighted. Second, patients worried about psychological aspects, negatively impacting their wellbeing such as uncertainties regarding their future health state, and a lower degree of autonomy and independence. Third, patients underlined the importance of social aspects, such as communication with healthcare providers and social interaction with friends, family and peers.Conclusion: This study demonstrates that physical, psychological, and social aspects are key factors driving LC patients’ HRQL. Gaining a better understanding of how LC patients perceive their HRQL and how it is affected by their illness and therapy will aid patient-centric decision-making across the drug life cycle, by providing stakeholders (drug developers, regulators, reimbursement bodies, and clinicians) insights about the treatment and disease aspects of importance to LC patients as well as the unmet needs LC patients may have regarding available treatment modalities. Finally, this study underscores a need for individual treatment decision-making that is considerate of uncertainties among LC patients about their future health state, and ways for improving communication between healthcare providers and patients to do so.

Perceived health-related quality of life among patients living with cancer at Kamuzu Central Hospital in Malawi

“…The World Health organization (WHO) de ned quality of life (QOL) as individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concern 8 . Therefore, QOL is a dynamic concept, covering perceptions of both the negative and positive aspects of the dimensions of physical, emotional, social, and cognitive function arising from patient reaction to results of diagnostic tests, the stages of sadness, grief and anger 4,9,10 .…”

“…The perceived factors ranged from lack of staff, lack of continuity of care, professional incompetence or disorganized healthcare services contributing to poor QOL as reported in Norway 12 . Other participants complained of inadequate information to patients and family members generating unpredictable and distressing nal illness trajectories 4,10 . Patients in Belgium, Italy as well as in Ghana had reported physical aspects such as skin conditions, nausea, fatigue, risk of infections sensory abnormalities (e.g., pain); and changes in physical appearance were highlighted to negatively affect quality of life 10,13 .…”

“…Other participants complained of inadequate information to patients and family members generating unpredictable and distressing nal illness trajectories 4,10 . Patients in Belgium, Italy as well as in Ghana had reported physical aspects such as skin conditions, nausea, fatigue, risk of infections sensory abnormalities (e.g., pain); and changes in physical appearance were highlighted to negatively affect quality of life 10,13 . Psychologically, patients were worried about uncertainties regarding their future health state, and a lower degree of autonomy and independence 9 .…”

“…Psychologically, patients were worried about uncertainties regarding their future health state, and a lower degree of autonomy and independence 9 . Socially, people living with cancer noted the importance of communication with healthcare workers and social interaction with families and friends for improved QOL 13,14 . Some patients living with prostate cancer in Uganda had reported lack of information and unavailability of healthcare workers, state of doubt, sense of loneliness and lack of support groups as main factors associated with poor health related quality of life 15 .…”

“…Data on the perceived factors affecting patients living with cancer was almost non-existent in Malawi 16 . Lack of studies evaluating QOL among cancer patients made it di cult to ascertain type of physical, psychological and social problems experienced by them and how to approach them 10 . We therefore conducted the current study aiming at exploring the determinants of perceived health-related QOL among patients living with cancer at a National Cancer Center based at Kamuzu Central Hospital in Malawi.…”