Predicting Survival of Patients With Advanced Non-Small Cell Lung Cancer

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Quality of Life is the Most Important Indicator for Predicting Survival of Patients With Advanced Non-Small Cell Lung Cancer

Healthcare providers have observed it for years—patients who appear to have a better quality of life while battling their cancer live longer. Now, a prospective, multi-institutional study examining the quality of life of patients with locally advanced non-small cell lung backs that observation. In fact, quality of life is so important, it out-weighs other classic predictors of survival.

“In the past, we’ve consider the stage of disease or tumor size along with other empirical data to predict how long a patient will survive, but now we know quality of life is a critical factor in determining survival,” said Nicos Nicolaou, M.D., an attending physician in the radiation oncology department at Fox Chase Cancer Center in Philadelphia and lead author of the abstract. 

The study included patients with locally advanced non-small cell lung cancer enrolled in a treatment trial (Radiation Therapy Oncology Group 9801 assessing the addition of amifostine to induction chemotherapy followed by concurrent chemoradiation). In addition to quality of life surveys, factors used to predict overall survival, included stage of disease, gender, age, race, marital status, type of tumor, tumor location in the lung, blood oxygen level, and type of treatment.

“Our study shows that what matters most is what patients themselves are telling us about their quality of life”, said Benjamin Movsas, M.D., principal investigator of the RTOG study and senior author of the abstract. Movsas is chairman of the Radiation Oncology Department at Henry Ford Hospital in Detroit.

Of the 239 patients analyzed, 91 percent completed a pre-treatment quality of life questionnaire. Patients with a quality of life score less than the median (66.7) had a 69% higher rate of death than patients with a quality of life score greater than 66.7 (p=0.002).

“We conducted two different statistical analysis including all the usual prognostic factors and either way, quality of life remained the strongest predictor of overall survival. What’s more, if a patient’s quality of life increased over time, we saw a corresponding increase in survival,” Movsas said.

Married patients or those with a partner had the highest quality of life score.

“We found a significantly lower quality of life score for single, divorced and widowed patients which deserves further study,” Nicolaou said. “These findings underscore the importance of helping our patients improve the quality of life where we can in order to help them live longer better.”

“Quality of life measures should be incorporated into treatment decision making and clinical trials,” Movsas concluded.

The results of the study were presented today at the American Society for Therapeutic Radiology and Oncology’s 49th Annual Meeting in Los Angeles.

Quality of Life (QOL) Supercedes the Classic Predictors of Survival in Locally Advanced Non-Small Cell Lung Cancer (NSCLC): An Analysis of Radiation Therapy Oncology Group (RTOG) 9801

Authors: N. Nicolaou*1, J. Moughan*2, L. Sarna*3, C. Langer*1, M. Werner-Wasik*4, R. Komaki*5, M. Machtay*6, T. Wasserman*7, D. Bruner*8, B. Movsas*9. , et al.,

1Fox Chase Cancer Center, Philadelphia, PA, 2Radiation Therapy Oncology Group, Philadelphia, PA, 3Univ of California Los Angeles, Los Angeles, CA, 4Thomas Jefferson Univ., Philadelphia, PA, 5MD Anderson Cancer Center, Houston, TX, 6Thomas Jefferson Univ, Philadelphia, PA, 7Washington Univ, St. Louis, MO, 8Univ of Pennsylvania, Philadelphia, PA, 9Henry Ford Health System, Detroit, MI,

Abstract:
Purpose/Objective(s): This analysis was conducted to determine the added value of QOL as a prognostic factor for overall survival (OS) for patients (pts) with locally advanced NSCLC treated on RTOG 9801.

Materials/Methods: The following pre-treatment factors were analyzed as predictors for OS on univariate and multivariate analysis (MVA): KPS (70-80 vs. 90-100), AJCC stage (II/IIIA vs. IIIB), gender, age, race, marital status, histology (squamous vs. other), tumor location (lower vs. other), hemoglobin (<12 vs. >= 12 g/dL), treatment arm (amifostine
[AM] vs. no-AM) and global QOL score (from the EORTC-QLQ-C30 instrument). Only pts with <5% weight loss within 3 months were eligible for enrollment. 243 pts with stage II/IIIAB NSCLC received induction paclitaxel (P) and carboplatin (C) on days 1, 22 and then concurrent weekly P/C and hyperfractionated radiation (69.6 Gy at 1.2 Gy BID). Patients were randomly assigned to AM 500 mg 4x/week or no-AM during chemoradiation. A multivariate Cox proportional hazards model was performed. The models were built using a backwards selection process, eliminating variables that have p-value >0.05.

Results: Of the 239 analyzable patients, 91% had pre-treatment QOL. The median follow-up time for patients still alive was 58.7 months (mo) and 17.3 mo for all patients. The median baseline global QOL score was 66.7 on both treatment arms. Whether the global QOL score was treated as a dichotomized variable (based on the median score of 66.7) or a continuous variable, all other variables fell out of the MVA for OS, except for the global QOL score. Patients with a global QOL score less than the median (66.7) had a 69% higher rate of death than patients with a QOL score >= 66.7 (p=0.002). A clinically meaningful increase in the QOL score (of 10 points) corresponded to a decrease in the hazard of death by 10% (p=0.002). Patients who were married or had a partner had higher QOL scores than those who were not (p=0.004).

Conclusions: When added to known prognostic factors, the baseline global QOL score replaced them all as the sole predictor of OS for patients with locally advanced NSCLC. This highlights the need to incorporate QOL measures into clinical oncology trials. The significantly lower QOL score for single/divorced /widowed patients deserves further study.

Source: Fox Chase Cancer Center

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