Association between Adverse Events and Quality of Life in Patients Treated with Radiotherapy for Locally Advanced Non-Small Cell Lung Cancer
Wilkie JR, Hochstedler K, Schipper M, Matuszak MM, Paximadis P, Dominello MM, Grills IS, Hayman JA, Dess RT, Pierce LJ, Spratt DE, Bergsma DP, Movsas B, and Jolly S. Association between Adverse Events and Quality of Life in Patients Treated with Radiotherapy for Locally Advanced Non-Small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2019; 105(1):S95-S96.
Int J Radiat Oncol Biol Phys
Purpose/Objective(s): Clinician-reported adverse events (AEs) and declines in patient-reported quality of life (QOL) are common during and after definitive radiotherapy (RT) for locally advanced non-small cell lung cancer (LA-NSCLC), but associations between these two outcomes are not well known. The purpose of this study was to assess associations between AEs and patient reported outcomes (PROs) including QOL at different time points during and after definitive radiotherapy for LA-NSCLC in a state-wide consortium. Materials/Methods: Eligible patients included those treated with definitive RT for LA-NSCLC at 24 institutions within the Michigan Radiation Oncology Quality Consortium (MROQC) between 2012-2018 (n=1367). The Functional Assessment of Cancer Therapy Trial Outcome Index (FACT-TOI) was collected at baseline, end of treatment, and at 1, 3 and 6 months post-RT. The FACT-TOI includes 3 QOL components: Physical Well Being (PWB), Functional Well Being (FWB), and Lung Cancer Subscale (LCS). Clinicians graded AEs using CTCAE weekly during RT and at the same follow-up visits. An AE score was calculated as the sum of AE grades for pneumonitis, pleuritic pain, cough, dyspnea, esophagitis and esophageal pain at each time point. Spearman correlation coefficients were calculated for AEs and similar PROs, and between AEs and change in each QOL component from baseline. Changes in QOL were compared at different time points for patients with grade ≥ 2 esophagitis (versus grade ≤ 1) and grade ≥ 2 pneumonitis (versus grade ≤ 1) using Student’s t-tests. Results: All QOL domains declined from baseline to the end of RT then recovered at different rates up to 6 months after RT. Mean AE scores at end of RT and 1, 3, and 6 months post-RT were 3.3, 2.3, 2.2, and 2.3, respectively. Correlation coefficients ranged from 0.36 to 0.66 for AEs and similar PROs. Among AEs, esophagitis had the strongest correlation with change in PWB (r=-0.32), while dyspnea had the strongest correlation with change in FWB (r=-0.21) and LCS (r=-0.31). Correlations for AE score were slightly greater, with r=-0.39 for PWB, r=-0.25 for FWB, and r=-0.36 for LCS. The difference in average change in QOL from baseline between the two esophagitis groups was clinically meaningful and statistically significant during the last week of RT for PWB, and at 1 month post-RT for PWB and FWB but not for LCS (statistically significant only). Differences between the pneumonitis groups were clinically meaningful at 6 months post-RT for PWB and LCS, but they were not statistically significant. Conclusion: Patients with higher quantity and severity of clinician-reported AEs have greater average declines in self-reported QOL during and after RT for LA-NSCLC. The associations between AEs and QOL were modest, however, suggesting that treatment-related AEs account for only a portion of QOL changes that patients experience, and reinforce the complementary nature of PROs and AEs.