How do preferences for treatment change after patients with lung cancer start chemotherapy?
METHODS: To address aims 1 and 2 of the study, we conducted a quantitative study utilizing an observational longitudinal open cohort of patients with advanced-stage non-small cell lung cancer (NSCLC). Data sources included the patient's medical record and patient interviews before, during, and...
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| Format: | eBook |
| Language: | English |
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[Washington, D.C.]
Patient-Centered Outcomes Research Institute (PCORI)
[2020], 2020
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| Series: | Final research report
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| Online Access: | |
| Collection: | National Center for Biotechnology Information - Collection details see MPG.ReNa |
| Summary: | METHODS: To address aims 1 and 2 of the study, we conducted a quantitative study utilizing an observational longitudinal open cohort of patients with advanced-stage non-small cell lung cancer (NSCLC). Data sources included the patient's medical record and patient interviews before, during, and after chemotherapy. The interviewer asked about the patient's definition of treatment success and preferences for addressing chemotherapy side effects. We used univariate and multivariate regression methods to analyze the findings. To address exploratory aim 3, we conducted a pre-post randomized intervention study with oncologists from the participating cancer centers. All participating oncologists, regardless of study arm assignment, were provided with a case scenario patient who reported least-desired side effects that were common to all lung cancer chemotherapy drugs. BACKGROUND: Lung cancer in the United States accounts for 14% of cancer diagnoses and 28% of cancer deaths annually. Because there is no cure for advanced-stage lung cancer, the main treatment goal is to prolong survival. Chemotherapy regimens produce different side effects. Identifying individual patients' preferences related to side effects could result in patient-centered choices, leading to better treatment outcomes. We found no previous studies or tools for assessing and utilizing patient chemotherapy preferences in clinical settings. OBJECTIVES: Study aims were to determine (1) patients' definition of treatment success and whether individual preferences, characteristics, and treatment experiences affect their definition of treatment success; (2) how preferences among adverse effects relate to choice of chemotherapy regimen; and (3) whether oncologists are likely to change their chemotherapy treatment strategy when provided with information related to patient preferences. LIMITATIONS: Our study results are limited to patients with advanced NSCLC and drawn from a predominantly White patient population from the US Midwest and Florida. Generalizability is limited to similar populations and to a research setting using similar patient scenarios Aim 2: At first interview, shortness of breathing (29%), bleeding (21%), fatigue (12%), and dizziness (11%) were the most commonly reported chemotherapy side effects that patients most hoped to avoid.3. Aim 3: All oncologists (13 of 13) who were randomized to a case scenario patient whose least-desired side effects occurred with only 1 drug chose a different drug than in the first round, in which the case scenario patient's least-desired side effects were common to all lung cancer chemotherapy drugs. In the control group, the second case scenario was similar to the first round, and 5 of the 8 oncologists switched treatments. This result suggests that oncologists do pay attention to patients' preferences for side effects of chemotherapy. CONCLUSIONS: Patients' definitions of treatment success are dynamic, and changed during treatment, making it imperative to ensure effective patient-provider communication throughout the clinical care continuum. Following this, oncologists were randomized to an intervention arm (in which the least-desired side effects occurred only with 1 lung cancer chemotherapy drug) or to a control arm (in which the least-desired side effects were common to all lung cancer chemotherapy drugs). RESULTS: 1. Aim 1: Most (156 of 235 [83%]) of the cohort at the baseline interview defined treatment success as good quality of life and reaching an important personal goal with or without survival, and only 12% considered "survival alone" as treatment success (N = 235). Overall, 47% of patients changed their definition of treatment success as they moved through chemotherapy. A bivariate analysis showed patients whose annual income was less than $45 000 were twice as likely to change their treatment success definition compared with patients whose reported income was $45 000 or more (odds ratio, 2.33; 95% CI, 1.11-4.9; P = .0245).2. |
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| Physical Description: | 1 PDF file (127, 42 pages) illustrations |