Longitudinal Health-related Quality of Life among Individuals Considering Treatment for Stage I Non–Small-Cell Lung Cancer

Abstract

Rationale: Due to improvements in screening, there is an increasing number of patients with early stage non-small cell lung cancer who are making treatment decisions. Objectives: Among patients with suspected stage I non-small cell lung cancer (NSCLC), we evaluated longitudinal patient-centered outcomes (PCOs) and the association of changes in PCOs with treatment modality, stereotactic body radiotherapy (SBRT) compared to surgical resection. Methods: We conducted a multi-site, prospective, observational cohort study at seven medical institutions. We evaluated minimum clinically important differences (MCID) of PCOs at four time points (during treatment, 4-6 weeks post-treatment, 6-months post-treatment, and 12-months post-treatment) compared to pre-treatment values using validated instruments. We used adjusted linear mixed models to examine whether the association between treatment and European Organization for Research and Treatment of Cancer global and physical quality of life (QOL) scales differed over time. Results: We included 127 individuals with stage I NSCLC (53 surgery, 74 SBRT). At 12-months, approximately 30% of patients remaining in each group demonstrated a clinical deterioration on global QOL from baseline. There was a significant difference in slopes between treatment groups on global QOL (-12.86, 95% CI = -13.34, -12.37) and physical QOL (-28.71, 95% CI = -29.13, -28.29) between baseline and during treatment, with the steeper decline observed among those who underwent surgery. Differences in slopes between treatment groups were not significant at all other time points. Conclusions: Approximately 30% of patients with stage I NSCLC have a clinically significant decrease in QOL one year after SBRT or surgical resection. Surgical resection was associated with steeper declines in QOL immediately after treatment compared to SBRT, however, these declines were not lasting and resolved within a year for most patients. Our results may facilitate treatment option discussions for patients receiving treatment for early stage NSCLC.