Prognostic effects of health-related quality of life at baseline and early change in health-related quality of life on response to treatment and survival in patients with advanced lung cancer: a prospective observational study in China

Objectives To investigate the relationship among baseline health-related quality of life (HROoL), early changes in HRQoL from baseline to completion of the first cycle of chemotherapy, and prognosis in patients with advanced lung cancer. Design This was a prospective, observational study. Setting The study was conducted in a national cancer centre in South China. Participants A total of 243 patients with chemo-naive with advanced lung cancer were enrolled. Intervention None. Primary and secondary outcome measures The Functional Assessment of Cancer Therapy-Lung was used to assess HROoL at baseline and at the end of the first cycle of chemotherapy. The Trial Outcome Index (TOI) and Lung Cancer Scale (LCS) were calculated as predictive indicators. Response to treatment was evaluated as per the Response Evaluation Criteria in Solid Tumors (RECIST) V.1.1. Survival data were gathered from follow-up to September 2019. Results Patients with 5-point or greater decreases in TOI (65% vs 48%, adjusted risk ratio (aRR)=2.19, 95% CI 1.09 to 4.41) or 2-point or greater decreases in LCS (72% vs 48%, aRR=3.29, 95% CI 1.50 to 7.22) from baseline to completion of the first cycle of chemotherapy were more likely to show stable or progressive disease than those whose HROoL had improved. Baseline TOl <= 54 (80.0% vs 69.9%, adjusted hazard risk (aHR)=1.36, 95% CI 1.01 to 1.84) and LCS <= 21 (77.6% vs 72.5%, aHR=1.36, 95% CI 1.01 to 1.83) were associated with higher risk for death compared with TOI>54 and LCS>21. Area under the curve analysis indicated that early changes in LCS and baseline LCS scores could better predict response to treatment and overall survival than the corresponding TOI values. Conclusions Higher pretreatment HROoL scores could predict longer survival, while declining HRQoL values could predict unfavourable treatment outcome among patients with advanced lung cancer. The use of the LCS is recommended for the routine collection of patient-reported HRQoL.