Sztankay Monika, Giesinger Johannes Maria, Zabernigg August, Krempler Elisabeth, Pall Georg, Hilbe Wolfgang, Burghuber Otto, Hochmair Maximilian, Rumpold Gerhard, Doering Stephan, Holzner Bernhard
Department of Psychiatry, Psychotherapy & Psychosomatics, Medical University of Innsbruck, Innsbruck, Austria.
Leopold-Franzens-University of Innsbruck, Innsbruck, Austria.
BMC Cancer. 2017 Aug 23;17(1):565. doi: 10.1186/s12885-017-3543-7.
Maintenance therapy (MT) with pemetrexed has been shown to improve overall and progression-free survival of patients with non-squamous non-small cell lung cancer (NSCLC), without impairing patients' health-related quality of life (HRQOL) substantially. Comprehensive data on HRQOL under real-life conditions are necessary to enable informed decision-making. This study aims to (1) assess HRQOL during first-line chemotherapy and subsequent MT and (2) record patients' and physicians' reasons leading to clinical decisions on MT.
Patients treated for NSCLC at three Austrian medical centres were included. HRQOL was assessed at every chemotherapy cycle using the EORTC QLQ-C30/+LC13 questionnaire. Semi-structured interviews were conducted before MT initiation and at the time of discontinuation to evaluate patients' and physicians' reasons for treatment decisions. Longitudinal QOL analysis was based on linear mixed models.
Sixty-one (73%) out of 84 patients were considered for MT. Thirty-six patients (43%) received MT and 29 (35%) discontinued therapy. Decisions on MT initiation (in 20 cases by the physician vs 4 by the patient) and discontinuation (19 vs 10) were mainly voiced by the physician. Treatment toxicity of first-line chemotherapy was the main reason for rejection of MT in patients with stable disease and was more often indicated by patients than clinicians. HRQOL data were collected from 83 patients at 422 assessment time points and indicated significantly lower symptom severity during MT compared with first-line therapy for nausea and vomiting (p = 0.006), sleep disturbances (p < 0.001), appetite loss (p = 0.043), constipation (p = 0.017) and chest pain (p = 0.022), and a deterioration in emotional functioning (p = 0.023) and cognitive functioning (p = 0.044) during MT.
Our results indicate that HRQOL and symptom burden improve between first-line treatment to MT in some respects, although some late toxicity persists. Discrepancies between patients' and physicians' perception of reasons for rejecting MT were evident. Thus, the integration of patient-reported outcomes, such as HRQOL, is required to enable shared decision-making and personalised healthcare based on mutual understanding of treatment objectives.
培美曲塞维持治疗（MT）已被证明可改善非鳞状非小细胞肺癌（NSCLC）患者的总生存期和无进展生存期，且不会大幅损害患者的健康相关生活质量（HRQOL）。需要真实生活条件下关于HRQOL的全面数据以做出明智的决策。本研究旨在：（1）评估一线化疗及后续MT期间的HRQOL；（2）记录患者和医生做出MT临床决策的原因。
纳入在奥地利三个医疗中心接受NSCLC治疗的患者。使用欧洲癌症研究与治疗组织QLQ-C30/+LC13问卷在每个化疗周期评估HRQOL。在MT开始前和停药时进行半结构化访谈，以评估患者和医生做出治疗决策的原因。纵向QOL分析基于线性混合模型。
84例患者中有61例（73%）被考虑进行MT。36例患者（43%）接受了MT，29例（35%）停止治疗。MT开始的决策（医生做出20例，患者做出4例）和停药决策（19例对10例）主要由医生提出。一线化疗的治疗毒性是疾病稳定患者拒绝MT的主要原因，患者提及的频率高于临床医生。从83例患者的422个评估时间点收集了HRQOL数据，结果显示与一线治疗相比，MT期间恶心和呕吐（p = 0.006）、睡眠障碍（p < 0.001）、食欲减退（p = 0.043）、便秘（p = 0.017）和胸痛（p = 0.022）的症状严重程度显著降低，且MT期间情绪功能（p = 0.023）和认知功能（p = 0.044）有所恶化。
我们的结果表明，从一线治疗到MT，HRQOL和症状负担在某些方面有所改善，尽管一些晚期毒性仍然存在。患者和医生对拒绝MT原因的认知存在差异。因此，需要整合患者报告的结果，如HRQOL，以基于对治疗目标的相互理解实现共同决策和个性化医疗。
