Williams Loretta A, Xu Cai, Ponce Darcy A, Shi Qiuling, Santorelli Melissa L, Burke Thomas, Altan Mehmet
Department of Symptom Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Value and Implementation Outcomes Research, Oncology, Merck & Co., Inc., Rahway, New Jersey, USA.
Cancer Med. 2025 Aug;14(15):e71111. doi: 10.1002/cam4.71111.
Understanding the symptom burden experienced by patients with cancer can enable appropriate supportive care. Our aim was to describe patient-reported outcomes (PROs) for patients with metastatic NSCLC initiating first-line (1L) systemic therapy under usual care at a large academic center.
Patients eligible for this prospective observational study were ≥ 18 years old when initiating 1L systemic therapy for stage IV NSCLC from January 1, 2017 to December 31, 2020. Patients completed two PRO questionnaires before 1L therapy initiation (baseline) and every ~6 weeks at imaging visits thereafter: the MD Anderson Symptom Inventory for lung cancer (MDASI-LC) and EuroQol EQ-5D-5L. Study follow-up ended on June 30, 2021.
The 609 eligible patients (median age, 63 years; range, 24-87; 51% men) received 1L chemotherapy plus immunotherapy (38%), targeted therapy (29%), chemotherapy (19%), or immunotherapy (13%). The five most severe MDASI-LC symptoms among all assessments were fatigue, pain, shortness of breath, disturbed sleep, and dry mouth; 17%-32% of assessments were rated as moderate or severe. Of all assessments, 39% recorded moderate to severe symptom interference with physical aspects of daily life, and 22% reported moderate to severe interference with affective aspects. Symptom and interference subscale scores generally declined from baseline to 102 weeks overall and for the four 1L regimens.
Our findings confirm previous findings that patients with a new diagnosis of metastatic NSCLC experience a moderate symptom burden. More research is needed to identify predictors and causes of this symptom burden so that it can be effectively addressed.
了解癌症患者所经历的症状负担有助于提供适当的支持性护理。我们的目的是描述在一家大型学术中心接受常规护理的转移性非小细胞肺癌（NSCLC）患者开始一线（1L）全身治疗时患者报告的结局（PROs）。
符合这项前瞻性观察性研究的患者在2017年1月1日至2020年12月31日期间开始接受IV期NSCLC的1L全身治疗时年龄≥18岁。患者在1L治疗开始前（基线）以及此后在影像学检查就诊时每约6周完成两份PRO问卷：肺癌MD安德森症状量表（MDASI-LC）和欧洲五维度健康量表EQ-5D-5L。研究随访于2021年6月30日结束。
609名符合条件的患者（中位年龄63岁；范围24 - 87岁；51%为男性）接受了1L化疗加免疫治疗（38%）、靶向治疗（29%）、化疗（19%）或免疫治疗（13%）。在所有评估中，MDASI-LC最严重的五种症状是疲劳、疼痛、气短、睡眠障碍和口干；17% - 32%的评估被评为中度或重度。在所有评估中，39%记录了对日常生活身体方面有中度至重度症状干扰，22%报告对情感方面有中度至重度干扰。症状和干扰子量表得分总体上以及四种1L治疗方案从基线到102周时通常都有所下降。
我们的研究结果证实了先前的研究结果，即新诊断的转移性NSCLC患者经历中度症状负担。需要更多研究来确定这种症状负担的预测因素和原因，以便能够有效应对。
