Patients with Metastatic Lung Cancer and Oncologists’ Views on Achievement of Treatment Goals and Making the Right Treatment Decision: A Prospective Multicenter Study

Abstract

Background Previous studies have investigated patients’ treatment goals before starting a treatment for metastatic lung cancer. Data on the evaluation of treatment goals are lacking. Aim To determine if patients with metastatic lung cancer and their oncologists perceive the treatment goals they defined at the start of systemic treatment as achieved after treatment and if in hindsight they believe it was the right decision to start systemic therapy. Design and Participants A prospective multicenter study in 6 hospitals across the Netherlands between 2016 and 2018. Following systemic treatment, 146 patients with metastatic lung cancer and 23 oncologists completed a questionnaire on the achievement of their treatment goals and whether they made the right treatment decision. Additional interviews with 15 patients and 5 oncologists were conducted. Results According to patients and oncologists, treatment goals were achieved in 30% and 37% for ‘quality of life,’ 49% and 41% for ‘life prolongation,’ 26% and 44% for ‘decrease in tumor size,’ and 44% for ‘cure’, respectively. Most patients and oncologists, in hindsight, felt they had made the right decision to start treatment and also if they had not achieved their goals (72% and 93%). This was related to the feeling that they had to do ‘something.’ Conclusions Before deciding on treatment, the treatment options, including their benefits and side effects, and the goals patients have should be discussed. It is key that these discussions include not only systemic treatment but also palliative care as effective options for doing ‘something.’

Experience of patients considering or using checkpoint inhibitors in cancer treatment: a systematic review of qualitative research

“…For example, one study explicitly added some qualitative interviews to elucidate findings in what commenced as an exclusively quantitative study of patients using multiple types of therapy and explicitly reported only one experience clearly attributable to a patient using an immune checkpoint inhibitor. 44 …”

“…For example, one study explicitly added some qualitative interviews to elucidate findings in what commenced as an exclusively quantitative study of patients using multiple types of therapy and explicitly reported only one experience clearly attributable to a patient using an immune checkpoint inhibitor. 44 By contrast, several studies reported detailed data on patient experiences, permitting deeply nuanced interpretations. For example, one study 43 systematically sampled patients before treatment, during treatment, after successful treatment, and after treatment failed to prevent disease progression, thematically exploring the experiences of each group.…”

“…Ala-Leppilampi et al 33 Bharmal et al 30 Bharmal et al 31 Cheung et al 40 Hyatt et al 34 Ihrig et al 20 Jamieson et al 35 Lambert et al 32 Levy et al 41 Livingstone et al 39 Martin et al 36 Mieras et al 44 Milne et al 16 Park et al 42 Shuk et al 43 Wong et al 38 Wong Open access that patients trust in the expertise of their clinicians and rely on their recommendations, 20 33 43 while two papers revealed that patients also seek advice from communities of patients with past experiences with immunotherapy. 33 42 Three studies published in the period 2017-2020 found there is limited patient-knowledge of checkpoint inhibitors, potentially contributing to patient apprehension at the prospect of commencing this therapy.…”

Health-Related Quality of Life and Survival in Metastasized Non-Small Cell Lung Cancer Patients with and without a Targetable Driver Mutation

“…For these patients, treatment is aimed at life extension while improving HRQOL. We recently found that pre-treatment HRQOL goals are only met by less than half of patients [ 3 , 4 ]. In addition, patients with an incurable disease often have a poor prognostic perception, as a result of the efficacy–effectiveness gap [ 25 ], (which can increase) deficient patient–doctor communication, as well as attempts of patients and their relatives to maintain the hope of a cure.…”

“…For metastatic NSCLC patients, treatment is aimed at life extension while improving or at least preserving health-related quality of life (HRQOL). Due to the increased availability of treatments, especially when a targetable driver mutation is present, treatment decisions in metastatic NSCLC have become a delicate and complicated process for both the clinician as well as the patient and their relatives [ 3 , 4 ]. Currently, most clinical decisions are based on ‘traditional’ clinical criteria, such as mutational status and TNM stage.…”