| Autor: |
Nugent SM; Center to Improve Veteran Involvement in Care and.; Division of Psychiatry.; Cancer Control and Prevention Program.; Department of Radiation Oncology, Washington University, St. Louis, Missouri., Golden SE; Center to Improve Veteran Involvement in Care and., Hooker ER; Center to Improve Veteran Involvement in Care and., Sullivan DR; Center to Improve Veteran Involvement in Care and.; Division of Pulmonary and Critical Care Medicine, Department of Medicine.; Cancer Control and Prevention Program.; Department of Radiation Oncology, Washington University, St. Louis, Missouri., Thomas CR Jr; Department of Radiation Medicine and Knight Cancer Institute, and., Deffebach ME; Section of Pulmonary and Critical Care Medicine, VA Portland Health Care System, Portland, Oregon.; Division of Pulmonary and Critical Care Medicine, Department of Medicine., Sukumar MS; Division of Cardiothoracic Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon., Schipper PH; Division of Cardiothoracic Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon., Tieu BH; Division of Cardiothoracic Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon., Moghanaki D; Division of Clinical Research, Hunter Holmes McGuire Veterans Affairs Medical Center, Richmond, Virginia; and., Wisnivesky J; Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York., Samson P; Department of Radiation Oncology, Washington University, St. Louis, Missouri., Robinson C; Department of Radiation Oncology, Washington University, St. Louis, Missouri., Slatore CG; Center to Improve Veteran Involvement in Care and.; Section of Pulmonary and Critical Care Medicine, VA Portland Health Care System, Portland, Oregon.; Division of Pulmonary and Critical Care Medicine, Department of Medicine.; Cancer Control and Prevention Program.; Department of Radiation Medicine and Knight Cancer Institute, and.; Department of Radiation Oncology, Washington University, St. Louis, Missouri. |
| Abstrakt: |
Rationale: Because of improvements in screening, there is an increasing number of patients with early-stage non-small-cell lung cancer (NSCLC) who are making treatment decisions. Objectives: Among patients with suspected stage I NSCLC, we evaluated longitudinal patient-centered outcomes (PCOs) and the association of changes in PCOs with treatment modality, stereotactic body radiotherapy (SBRT) compared with surgical resection. Methods: We conducted a multisite, prospective, observational cohort study at seven medical institutions. We evaluated minimum clinically important differences of PCOs at four time points (during treatment, 4-6 wk after treatment, 6 mo after treatment, and 12 mo after treatment) compared with pretreatment 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% confidence interval [CI], -13.34 to -12.37) and physical QOL (-28.71; 95% CI, -29.13 to -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 1 year after SBRT or surgical resection. Surgical resection was associated with steeper declines in QOL immediately after treatment compared with 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. |
