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• W2057697966 abstract "In this issue of the Journal of Thoracic Oncology, Yang et al.1Yang P Cheville A Wampfler J et al.Quality of life and symptom burden among long term lung cancer survivors: changing and adapting.J Thorac Oncol. 2012; 7: 64-70Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar contribute knowledge of importance to all of us treating lung cancer, and their findings may have larger implications for monitoring and analysis in many areas of cancer therapy. By incorporating quality of life (QOL) and patient-reported outcome (PRO) assessment into an analysis of lung cancer patients with long-term survival, we obtain an enhanced knowledge of issues affecting these individuals and can plan for interventions which may benefit specific patients. Most patients in this report had lung cancer surgery, with or without adjuvant therapies, and were monitored at 3 and 5 years for effects on QOL and PROs. Key findings of this analysis include meaningful decreases in QOL associated with worsened symptoms in 35% of patients over the time of follow-up. Although this worsening is worrisome, the optimist may point out that 65% of patients experienced either improvement in QOL and symptoms or no decrease in the long-term setting after having had definitive treatment for the leading cause of cancer-related death in many countries. The findings in this analysis of more than 400 patients are supported by a prior smaller trial with shorter follow-up in patients undergoing neoadjuvant therapy, using the same QOL instrument.2Gralla RJ Edelman MJ Detterbeck FC et al.Assessing quality of life following neoadjuvant therapy for early stage non-small cell lung cancer (NSCLC): results from a prospective analysis using the Lung Cancer Symptom Scale (LCSS).Support Care Cancer. 2009; 17: 307-313Crossref PubMed Scopus (18) Google Scholar Yang et al. proposed that by monitoring QOL and PROs with the use of a simple and well-validated QOL instrument (the Lung Cancer Symptom Scale [LCSS]) with demonstrated high patient acceptance,3Hollen PJ Gralla RJ Kris MG et al.Measurement of quality of life in patients with lung cancer in multicenter trials of new therapies (psychometric assessment of the lung cancer symptom scale).Cancer. 1994; 73: 2087-2098Crossref PubMed Scopus (191) Google Scholar one can identify patients experiencing problems. Personalized interventions can then be targeted to address these issues. I would add that this study provides high-quality information which should be discussed with patients before treatment so that they can be better informed about long-term risks and benefits of these complicated treatments. For the future, it is easy to see that similar analyses could be conducted to compare open thoracotomy with video-assisted thoracoscopic surgery or with stereotactic radiotherapy to understand more fully the value of these different procedures. This trial raises several methodologic issues. The design is a longitudinal analysis using patients as their own controls. In such an analysis, it is important to keep a high percentage of patients in the analysis. The 77% of patients retained seem to be acceptable. The study would have greater context if there had been a concurrent age-matched control group without lung cancer, with a similar percentage of smokers monitored for QOL and PROs over the 3 to 5 years. It is sobering to realize that we are not aware of the magnitude of the decline in QOL and pulmonary symptoms in a largely smoking population over this time. It is possible that many of the issues experienced by these survivors are only partially due to therapy. The authors allude to an important trade-off in QOL evaluation. To retain a high percentage of patients in a study, the QOL instrument must be feasible. Instruments that are perceived to be too burdensome run the risk of discouraging patients from continuing in the trial, threatening the credibility of the study if excessive numbers drop out. On the other hand, the authors voice that there may have been even more value if they had added other instruments assessing emotional and other issues in greater depth. More information can be interesting and desirable; however, the added burden of more questions might have affected the number of patients remaining in the study. In addition, analysis issues may arise when a study assesses dozens of end points and uses instruments not validated in lung cancer. Choosing a validated instrument that addresses well the specified key QOL and PRO areas is crucial in study design, as is a thoughtful prospective analysis plan. All investigators need to appreciate the great deal of work and expense that has gone into the development of such validated lung cancer instruments as the LCSS, the EORTC-QLQ LC-13, and the Functional Assessment of Cancer Therapy-Lung (FACT-L) which are available in more than 50 languages. The latest versions of the instruments should be used, their copyrights must be respected, and the designated procedures need to be followed. In a larger scope, this study illustrates major considerations for oncology trials and clinical evaluation. The study demonstrates that large numbers of patients can be evaluated when using practical QOL methods. It clearly shows that such evaluations yield valuable information that is not otherwise obtainable. Finally, the study is an example of the sensitivity and accuracy of validated instruments. As examples, patients with decreases in QOL had more symptom worsening; and compared with those having just lobectomy, patients undergoing larger resections had greater impacts on QOL and symptoms. These were consistent findings across time points and across symptoms. Such findings should give greater confidence in the accuracy of validated QOL instruments. If QOL assessment is to take its full position in treatment evaluation and patient care, existing barriers must be overcome. With the LCSS, a hand-held computer-assisted version (“eLCSS-QL”) is now widely tested with high patient acceptance and low staff burden. Nonetheless, there is some modest cost to QOL and PRO assessment. Payers will need to reimburse for these assessments if QOL assessments are to become part of daily practice. Prospective studies are needed to demonstrate the likelihood that these assessments are cost saving, in addition to their great clinical value as illustrated by Yang et al. It is time for QOL and PRO assessment to come of age in lung cancer and in all cancer care." @default.
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• W2057697966 date "2012-01-01" @default.
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• W2057697966 title "Coming of Age for Monitoring Quality of Life and Patient-Reported Outcomes" @default.
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