Symptom burden and quality of life in advanced non-small cell lung cancer patients in France and Germany
Introduction
Lung cancer remains the most common cancer worldwide, both in terms of new cases (1.6 million cases, 12.7% of total cancer cases) and deaths (1.4 million deaths, 18.2%) [1]. In 2008, the age standardized incidence rate was estimated to be 30.0 per 100,000 and 28.1 per 100,000 in France and Germany respectively [2]. Despite recent advances in treatment of the non-small cell lung cancer (NSCLC) patients, the prognosis remains poor. Across Europe, lung cancer accounts for the highest proportion of male cancer deaths (182,080 deaths, 25% of all male cancer deaths) with standardized rate of 37.6/100,000 in men [3]. In Germany, lung cancer has been reported to account for 25% of all cancer-related deaths among men and 13% among women in 2008 [4].
Previous studies have reported dyspnea, cough, fatigue and pain as common symptoms reported among patients with NSCLC [5], [6]. Despite the advent of targeted therapies, symptom burden seems to be high in the advanced lung cancer patient population compared to other tumors. Symptom measures are now extensively incorporated into clinical studies of lung cancer. Recently published studies have assessed symptom burden in lung cancer patients in the United States [7], [8]. In Europe however, the number of studies assessing the symptom burden in advanced lung cancer patients in population based settings appears to be limited in recent studies. It is critical to assess the impact of these symptoms on patient's health related quality of life (HRQOL) to ensure proactive symptom management and minimize any negative impact on quality of life of the patients.
Our main objectives were to assess in patients with advanced lung cancer from France and Germany: (1) patient reported lung cancer symptom burden, (2) patient reported disease specific and generic quality of life for patients with advanced NSCLC and (3) the impact of lung cancer symptoms on patients’ quality of life. Top level results were presented as an oral presentation at the World Conference of Lung Cancer in 2011 [9]. Here we present in-depth details of a lung cancer disease specific program conducted in France and Germany and the corresponding results from the patient reported outcomes related analyses.
Section snippets
Patient recruitment
Patients with advanced (stage IIIB/IV) NSCLC in France (n = 613) and Germany (n = 600), who were receiving drug treatment for lung cancer in non-clinical trial settings, were recruited into the Adelphi NSCLC Disease Specific Programme (DSP), a multinational study that captures a cross-section of robust, real-world data [10].
The DSP is a patient record-based study of oncologists and pulmonologists and their patients. These physicians contributed to the study on a volunteer basis and received payment
Patient demographics
During the study period, 613 patients (France) and 600 patients (Germany) were approached for inclusion in the study, and 69% of these patients (N = 837; n = 320 [France] and n = 517 [Germany]) consented to complete symptom and quality of life questionnaires at a single time point. Patient demographics and baseline characteristics are shown in Table 1. The majority of patients were Caucasian (93%), male (67%), and the average age was 63 years (median age was 64 years) at the time of questionnaire
Discussion
Our study provides a robust assessment of current symptom burden, disease specific and generic QOL in advanced lung cancer patients in France and Germany. Since our study was conducted in a population-based setting, our study results represent the advanced NSCLC population in the real-world rather than a clinical trial-specific setting. Loss of appetite, fatigue, cough, pain and shortness of breath were reported by the vast majority of patients at varying severity levels. Data from our study
Conclusion
The results of our study re-emphasize the importance of a lung cancer treatment goal to reduce dyspnea, pain and other symptoms in advanced NSCLC patients, which could have a positive impact on QOL and functioning, more so because patients with advanced NSCLC have limited survival. Future novel therapies for advanced NSCLC which alleviate these symptoms in addition to their beneficial effects on tumor progression and proactive symptom management might help improve QOL in advanced lung cancer
Conflict of interest statement
Shrividya Iyer is a current employee of Pfizer. Gavin Taylor-Stokes and Adam Roughley are current employees of Adelphi Real World. Gavin Taylor-Stokes and Adam Roughley were paid consultants to Pfizer in connection with the development of this manuscript.
Role of the funding source
The Adelphi lung cancer disease specific program was supported by Pfizer and other pharmaceutical companies; the collection of patient reported outcomes and related analyses was sponsored by Pfizer, Inc.
Acknowledgements
Editorial assistance was provided by Martin Quinn at Acumed (Tytherington, UK) and funded by Pfizer, Inc.
References (19)
- et al.
European cancer mortality predictions for the year 2011
Ann Oncol
(2011) Symptoms in adults with lung cancer: a systematic research review
J Pain Symptom Manage
(2000)- et al.
Quality of life and symptom burden among long-term lung cancer survivors
J Thorac Oncol
(2012) - et al.
Reliability and validity of the Functional Assessment of Cancer Therapy-Lung (FACT-L) quality of life instrument
Lung Cancer
(1995) - et al.
qualitative exploration of a respiratory distress symptom cluster in lung cancer: cough, breathlessness and fatigue
Lung Cancer
(2011) - et al.
Fatigue in ambulatory patients with advanced lung cancer: prevalence, correlated factors, and screening
J Pain Symptom Manage
(2001) - et al.
Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008
Int J Cancer
(2010) - GLOBOCAN 2008. Cancer fact sheet 2010. Available at:...
- Gesellschaft der epidemiologischen Krebsregister in Deutschland e.V. (GEKID). Association of Population-based Cancer...
Cited by (139)
The dyadic relationship of supportive care needs with quality of life in lung cancer survivor and spousal caregiver couples
2023, Asia-Pacific Journal of Oncology NursingExploring the feasibility of a combined exercise program for patients with advanced lung or pancreatic cancer
2023, Asia-Pacific Journal of Oncology NursingSystematic review of the literature on the occurrence and characteristics of dyspnea in oncology patients
2023, Critical Reviews in Oncology/HematologyCitation Excerpt :The other study used an ad-hoc questionnaire to evaluate dyspnea’s level of interference with physical, psychological, and social aspects of patients’ daily lives (Dómine et al., 2019). In terms of associations between dyspnea and QOL, three studies used EORTC-QLQ-C30 (Larsson et al., 2012; Silvoniemi et al., 2016; Yun et al., 2012), three used the Functional Assessment of Cancer Therapy-Lung (FACT-L) scale (Iyer et al., 2014; Iyer et al., 2013; Uronis et al., 2012), and two used the CRQ (Farquhar et al., 2014; Javadzadeh et al., 2016). The remaining three studies used the Short Form Six-Dimension (SF-6D) (Ong et al., 2019), LCSS (Tan et al., 2017), and the linear analogue self-assessment scale (Cheville et al., 2011b).