UPDATED WITH INTERVIEW August 19, 2019 // For patients with advanced lung cancer, successful treatment is defined not only as increasing survival but also maintaining quality of life and functionality in the process.

However, the definition of treatment success for patients changes as they go through chemotherapy, according to new findings.

Before they began chemotherapy, most patients (60.4%) defined treatment as more than just survival, in that they not only wanted to live longer but also have a good quality of life (QoL), reach personal goals, and/or be able to spend time with family and friends.

As their treatment progressed, however, almost half (47%) changed their definition of success. For example, among patients who had initially defined treatment success as survival alone, 80% now defined it as both survival and QoL.

Lead author K.M. Islam, MD, PhD, associate professor, epidemiology, Medical College of Georgia, Augusta University, noted that these findings may not be generalizable to other populations because the cohort was predominantly comprised of white patients residing in a specific geographic location.

"We had a good sample for lung cancer and it is difficult to get these many patients," he said. "But this is the population living in this region, and it may not be applicable to other groups of people."

The main finding is that patient goals change during the course of treatment, he emphasized. "Patients with advanced lung cancer have a disease with limited survival, and when they are first diagnosed, many are not thinking clearly," said Islam. "But we need to engage them and communication has to be continuous through the course of treatment."

The study was published in the Journal of Oncology Practice.

At present, there is no known cure for advanced-stage lung cancer, and treatment options for metastatic disease remain limited. The chemotherapy regimens currently used all have similar efficacy in managing symptoms as well as extending survival. From the clinician's perspective, note the authors, the primary goal of treatment for patients with advanced stage non-small cell lung cancer (NSCLC) is generally to prolong the patient's life.

Although new treatments, such as targeted therapies and immunotherapies, have been introduced in the lung cancer regimens, chemotherapy was the primary treatment patients were receiving at the beginning of the study. "We began the study in early 2013," Islam said. "For most patients with advanced lung cancer, it is still the main treatment in many parts of the country and globally. We have targeted therapy for some mutations but it is very limited, and rather than go with a small proportion, we wanted to look at mainstream therapy and use a larger population."

More Than Survival

The study was conducted between January 2014 and April 2016 at eight cancer centers in Midwestern states and one in Florida.

The study included 235 patients with advanced-stage NSCLC who were interviewed before, during, and after first-line chemotherapy, for a maximum of three interviews per participant.

Most patients were from the US Midwest and, reflecting the demographics of the region, were predominantly white (95.3%) and more rural (34%) compared with other regions. The average age was 68 years, roughly half were Medicare beneficiaries, and a third had private insurance.

At the first interview, 60% of patients defined treatment success as more than just survival, and about a quarter of the group (23%) defined success as a good QoL. Only 12% defined treatment success as survival alone.

Almost all patients (90%) who initially stated that both survival and QoL defined treatment success maintained that definition at the time of their final interview.

Further analyses suggested that of the patients who initially defined treatment success as survival alone, 52.4% changed their definition to include other goals and 23.8% changed it to improved QoL only.

When looking at associated patient characteristics, patients younger than 60 years of age and who were not working tended to define treatment success as survival alone (both P = .13). Multivariate analysis showed that patients who were female (OR, 1.51), aged 61-70 years (OR, 1.48), and married (OR, 1.58) were more likely to define treatment success beyond survival. However, these differences did not reach statistical significance.

Other associations showed that patients who earned less than $45,000 per year were more likely to change their definition of success after chemotherapy (P = .02), and there was a nonsignificant association for those who were less educated and were Medicare beneficiaries.

Among participants who changed the definition of treatment success, 60% had less than a college education (P = .14) and more than half of patients who changed their definition of treatment success were Medicare beneficiaries.

"We found many other things are important to patients other than survival, and it's not necessarily quality of life per se," he said.

For example, when a patient was asked what was important to her, she said she wanted to live to see her granddaughter graduate.

"It's a very simple thing but very important to her," Islam said. "The important point is that it's patient-specific, and that they have something to live for and that they want something else, aside from survival alone. This will vary from person to person, but we will see this across races, ethnic groups, and locations."

The study was supported by the Patient-Centered Outcomes Research Institute (PCORI). Several of the authors disclosed relationships with industry, as listed in the article.

J Oncol Pract. Published online July 19, 2019. Abstract

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