Patient preferences of chemotherapy treatment options and tolerance of chemotherapy side effects in advanced stage lung cancer

Abstract

Background In the U.S., lung cancer accounts for 14% of cancer diagnoses and 28% of cancer deaths annually. Since no cure exists for advanced lung cancer, the main treatment goal is to prolong survival. Chemotherapy regimens produce side effects with different profiles. Coupling this with individual patient’s preferred side effects could result in patient-centered choices leading to better treatment outcomes. There are apparently no previous studies of or tools for assessing and utilizing patient chemotherapy preferences in clinical settings. The long-term goal of the study was to facilitate patients’ treatment choices for advanced-stage lung cancer. A primary aim was to determine how preferences for chemotherapy side effects relate to chemotherapy choices. Methods An observational, longitudinal, open cohort study of patients with advanced-stage non-small cell lung cancer (NSCLC) was conducted. Data sources included patient medical records and from one to three interviews per subject. Data were analyzed using Chi-square, Fisher’s Exact and McNamara’s test, and logistic regression. Results Patients identified the top three chemotherapy side effects that they would most like to avoid: shortness of breath, bleeding, and fatigue. These side effects were similar between first and last interviews, although the rank order changed after patients experienced chemotherapy. Conclusions Patients ranked drug side effects that they would most like to avoid. Patient-centered clinical care and patient-centered outcomes research are feasible and may be enhanced by stakeholder commitment. The study results are limited to patients with advanced NSCLC. Most of the subjects were White, since patients were drawn from the U.S. Midwest, a predominantly White population.

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“…In advanced lung cancer, patient preferences regarding toxicities to be avoided change over the course of therapy. Shortness of breath was the leading concern initially but was overtaken by fatigue later in the clinical course . Almost one‐half of individuals with lung cancer also change their definition of treatment success.…”

“…Shortness of breath was the leading concern initially but was overtaken by fatigue later in the clinical course. 40 Almost one-half of individuals with lung cancer also change their definition of treatment success. Among those who initially consider success exclusively according to survival metrics, 80% subsequently modify the definition to include quality of life.…”

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