ReviewPatient-reported outcome measures (PROMs) in the management of lung cancer: A systematic review
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.
References (65)
- et al.
How best to assess the quality of life in long-term survivors after surgery for NSCLC? Comparison between clinical predictors and questionnaire scores
Clin. Lung Cancer
(2013) - et al.
Supportive care in lung cancer: milestones over the past 40 years
J. Thorac. Oncol.
(2015) - et al.
An evidence-based determination of issues affecting quality of life and patient-reported outcomes in lung cancer: results of a survey of 660 patients
J. Thorac. Oncol.
(2014) - et al.
Reliability and validity of the Functional Assessment of Cancer Therapy-Lung (FACT-L) quality of life instrument
Lung Cancer (Amsterdam Netherlands)
(1995) The Functional Assessment of Cancer Therapy-Lung and Lung Cancer Subscale assess quality of life and meaningful symptom improvement in lung cancer
Semin. Oncol.
(2004)- et al.
Quality of life in lung cancer: the validity and cross-cultural applicability of the Functional Assessment Of Cancer Therapy-Lung scale
Hematol. Oncol. Clin. North Am.
(2005) - et al.
Quality of life assessment in individuals with lung cancer: testing the Lung Cancer Symptom Scale (LCSS)
Eur. J. Cancer (Oxf. Engl. 1990)
(1993) - et al.
Incorporating the patient's perspective into drug development and communication: an ad hoc task force report of the Patient-Reported Outcomes (PRO) Harmonization Group meeting at the Food and Drug Administration, February 16, 2001
Value Health: J. Int. Soc. Pharmacoecon. Outcomes Res.
(2003) - et al.
Importance of quality of life in patients with non-small-cell lung cancer
Clin. Lung Cancer
(2009) - et al.
A standardised, generic, validated approach to stratify the magnitude of clinical benefit that can be anticipated from anti-cancer therapies: the European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS)
Ann. Oncol.
(2015)
Derivation of utility values from European Organization for Research and Treatment of Cancer Quality of Life-Core 30 questionnaire values in lung cancer
J. Thorac. Oncol.
Overview of the SF-36 health survey and the international quality of life assessment (IQOLA) project
J. Clin. Epidemiol.
Validation of EORTC QLQ-LC43 for Chinese patients with lung cancer
Lung Cancer (Amsterdam Netherlands)
Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012
Int. J. Cancer
Lung cancer statistics
Adv. Exp. Med. Biol.
International lung cancer trends by histologic type: male:female differences diminishing and adenocarcinoma rates rising
Int. J. Cancer
Is late diagnosis of lung cancer inevitable? Interview study of patients' recollections of symptoms before diagnosis
Thorax
Health-related quality of life questionnaires in lung cancer trials: a systematic literature review
Health Econ. Rev.
Guidance for Industry: Patient-reported Outcome Measures: Use in Medical Product Development to Support Labeling Claims
Health-related quality of life in small-cell lung cancer: a systematic review on reporting of methods and clinical issues in randomised controlled trials
Lancet Oncol.
The past, present, and future of patient-reported outcomes in oncology
Am. Soc. Clin. Oncol. Educ. Book
Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement
BMJ Clin. Res.
The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology
J. Natl. Cancer Inst.
The EORTC QLQ-LC13: a modular supplement to the EORTC Core Quality of Life Questionnaire (QLQ-C30) for use in lung cancer clinical trials. EORTC Study Group on Quality of Life
Eur.J. Cancer (Oxf. Engl.)
E.L.C.G., the, Use of the lung cancer-specific Quality of Life Questionnaire EORTC QLQ-LC13 in clinical trials: A systematic review of the literature 20 years after its development
Cancer
Health-related quality of life in non-small-cell lung cancer: an update of a systematic review on methodologic issues in randomized controlled trials
J. Clin. Oncol.
The Functional Assessment of Cancer Therapy scale: development and validation of the general measure
J. Clin. Oncol.
Development of specific instruments for subjective evaluation of patients with lung cancer: comparison of observer assessment with patient generated visual analogue scales (VAS)
Proc. Am. Soc. Clin. Oncol.
Measurement of quality of life in patients with lung cancer in multicenter trials of new therapies. Psychometric assessment of the Lung Cancer Symptom Scale
Cancer
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