Elsevier

Lung Cancer

Volume 113, November 2017, Pages 140-151
Lung Cancer

Review
Patient-reported outcome measures (PROMs) in the management of lung cancer: A systematic review

https://doi.org/10.1016/j.lungcan.2017.09.011Get rights and content

Highlights

  • PROMs are indicators of the impact of the disease and treatment on health.

  • The EORTC QLQ-C30 and additional module QLQ-LC13 is used most frequently in lung cancer research.

  • The routine use of PROMs in lung cancer is still not widely recognized despite the positive effects.

  • PROMs appear to be a strong predictive factor of survival in lung cancer.

  • Electronic administration keeps developing to facilitate the process of implementation.

Abstract

Lung cancer is often associated with a poor quality of life, as reflected by patient-reported outcome measures (PROMs). The aim of this paper is to describe and compare the PROMs that are available.

In this manuscript, we review the impact of PROMs on the management of lung cancer. Quality of the study and risk of bias were assessed using the appraisal tools recommended by the Dutch Cochrane Center. Out of 51 studies included in this review, ten instruments were identified and categorized as either generic, cancer- or lung cancer-specific. PROMs are primarily applied in scientific research to compare the therapy outcomes and in drug development to support labeling claims. The interest for the routine use of PROMs in daily practice is growing, which has positive effects on the communication with the patient, mutual decision making and the monitoring and managing of the patient. Besides that, PROMs have an independent prognostic value for survival in lung cancer and economic evaluations can be conducted using their results. Electronic platforms simplify the implementation of PROMs in the daily clinic.

The EORTC QLQ-C30 and its lung cancer-specific module QLQ-LC13 are the most frequently used instruments in lung cancer patients. PROMs have the potential to improve the quality of care with a proper implementation in the routine practice. PROMS are needed to value and understand the experience of the patient.

Introduction

Lung cancer is worldwide the most common form of cancer. In 2012 counted approximately 1.8 million new cases and 1.6 million deaths. This makes lung cancer responsible for almost 20% of cancer related deaths [1]. The incidence and mortality are highest in the developed countries of Europe, North-America and Australasia [2]. It has a poor survival with an average five-year survival rate of 15% [3].

Initially there is a symptom-free course after which nonspecific and bothersome symptoms arise like e.g. cough, pain, dyspnea and hemoptysis. Due to the symptom-free course, lung cancer is often diagnosed in an advanced stage and its symptoms impact on quality of life (QoL) [4]. Moreover the chemotherapy that improves survival frequently have adverse effects, which also influence quality of life [5].

Health-related quality of life (hrQoL) includes several domains, which consider the general perception of the patient on the impact of disease or treatment on physical as well as psychological and social aspects of life [6]. Given the prognosis and the impact of both disease and treatment on the morbidity and outcome of lung cancer patients, the preservation and evaluation of the hrQoL is very important [7], [8]. The concept of QoL is used for a long time in the oncology, but the term patient-reported outcome measure (PROM) is new [9].

Patient-reported outcomes (PROs) are outcomes regarding the health of the patient and are directly reported by the patient [10]. They can range from simple symptomatic (fatigue, pain,…) to more complex concepts like hrQoL and its associated domains [6]. The instruments used for measuring PROs are called PROMs. The popularity of PROMs has grown and they are increasingly used (Fig. 1). They might contribute to the paradigm shift to patient-centered care and improve the objective outcomes of the patients.

Up to date, no review article has described the use of PROMs in lung cancer and no comparison between all lung cancer-specific instruments has been published. Therefore, the main objective of this review is to analyze the use of PROMs in the treatment of lung cancer with the aim of improving the quality of care. The secondary objective is to evaluate which instruments are currently being used in the care of lung cancer. Finally, the development, content and validation of lung cancer-specific instruments are concisely summarized.

Section snippets

Methods

This review was conducted in accordance with the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [11]. The database search is conducted in PubMed, Web of Science and Google Scholar with a restriction from January 2010 to February 2016. The aim of the time restriction is to give an overview of the current situation. The last search was conducted on February 21, 2016. The included studies were assessed for their quality using appraisal tools

Results

The search yielded a total of 1438 hits along with nine additional articles after a manual search. After removing duplicates, 1118 articles remained for the screening process. After screening the titles and abstracts 1023 articles were excluded. The remaining 95 articles were evaluated for full text, which led to the exclusion of 55 more articles. The screening of reference lists yielded another 11 relevant articles. Therefore a total of 51 articles were included in this review (Fig. 2).

The

Discussion

Worldwide, lung cancer remains a disease with severe morbidity and mortality. Therefore, in addition to survival, the QoL of the patient is of great importance. There is a growing interest in measuring the QoL with the aid of PROMs.

We concluded that to date PROMs are primarily collected in the context of scientific research. Moreover, the majority of the clinical trials do not use generic instruments but give preference to disease-specific instruments as they are more sensitive for subtle

Acknowledgement

The authors wish to acknowledge support of Andrew Bottomley, Assistant Director-Head Quality of Life Department of the EORTC, by providing information.

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