Elsevier

Lung Cancer

Volume 81, Issue 2, August 2013, Pages 288-293
Lung Cancer

Symptom burden and quality of life in advanced non-small cell lung cancer patients in France and Germany

https://doi.org/10.1016/j.lungcan.2013.03.008Get rights and content

Abstract

Background

To assess patient reported symptom burden and impact on disease specific health related quality of life (HRQOL) in advanced non-small cell lung cancer (NSCLC) patients.

Methods

Patients with advanced (stage IIIB/IV) NSCLC in France (n = 613) and Germany (n = 600) were recruited into a multicenter, patient record-based cross-sectional study. Patient reported symptoms using the Lung Cancer Symptom Scale, which assesses fatigue, loss of appetite, shortness of breath, cough, pain and blood in sputum on a 0–100 visual analog scale. Disease specific and generic HRQOL were assessed using the Functional Assessment of Cancer Therapy-Lung (FACT-L) and the EuroQol five-dimensional questionnaire (EQ-5D) respectively. A multivariate regression analysis was performed with total FACT-L score as the dependent variable and symptom scores as predictors. Age, gender, stage and performance status were used as control variables.

Results

Majority of the patients were male (67%), Caucasian (93%) with an average age of 63 years. Fatigue, loss of appetite, shortness of breath, cough and pain were reported by ≥90% of patients. The mean health utility index score was found to be 0.58 and the mean general health status score was 58.0. Fatigue (β = −0.122; p < 0.001), loss of appetite (β = −0.170; p < 0.001), pain (β = −0.145; p < 0.001), shortness of breath (β = −0.118; p < 0.001) were found to be significant predictors of lung cancer specific quality of life as measured by the FACT-L total score.

Conclusion

Fatigue, loss of appetite, shortness of breath and pain have a significant negative impact on patient reported disease specific HRQOL in advanced NSCLC patients.

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)

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