Characterizing health related quality of life among individuals living with non-small cell lung in the United States: Findings from the Cancer Experience Registry.

Abstract

11154 Background: Lung cancer is the second most common cancer and the leading cause of cancer-related deaths. Non-small cell lung cancer (NSCLC), which comprises ~85% of cases, is aggressive, often diagnosed late, and associated with significant symptom burden, and poor health-related quality of life (HRQoL) overall, as well as poor prognosis. However, the factors contributing to variation in HRQoL among NSCLC patients are poorly understood. This study aims to assess the role metastatic status and treatment history play in HRQoL. Methods: We conducted a retrospective analysis of Cancer Support Community’s Cancer Experience Registry (CER) survey data collected between Feb 2015 – Nov 2023. The sample included 279 U.S. adults with NSCLC. HRQoL, specifically physical and psychological symptom burden and function, was assessed using the 7 domains of PROMIS29v2.0: anxiety, depression, pain, fatigue, sleep disturbance, physical function, and social function. Preliminary analyses (not shown here) found that non-metastatic patients were more likely to report higher pain, fatigue, and physical and social impairments compared to metastatic patients. We hypothesized that treatment history could partially explain this outcome: 62% of nonmetastatic patients reported history of surgery vs. 31% of metastatic patients. Thus, an interaction term (metastatic status x surgery) was created for further analysis in backward elimination linear regression models. Results: Participants were 68% women and 88% Non-Hispanic White, with a mean age of 64 (SD=10 years). The mean time since initial diagnosis was 5 years (SD=7). 16% were nonmetastatic with no history of surgery and 27% with a history of surgery; 39% were metastatic with no surgery and 18% with surgery. After adjusting for sociodemographic and clinical variables, treatment history showed associations with HRQoL, though findings were inconsistent in most groups. Those who were nonmetastatic without surgery reported more sleep disturbance (b = 3.58), those with clinical trial history reported less anxiety (b = -3.61), and those with immunotherapy reported less depression (b = -2.55). Metastatic individuals without surgery reported less pain (b = -3.75) and fatigue (b = -3.06) and better physical (b = 3.67) and social functioning (b = 4.19). Metastatic surgery group was not significant for any domains. Conclusions: Results underscore the complex factors that contribute to HRQoL in those with NSCLC. The findings emphasize the importance of a holistic, value-based care approach, considering not just survival but also patients' preferences and quality of life. A full understanding of treatment side effects and their implications for HRQoL is essential to aligning care with patient preferences. Future research should investigate how treatment history impacts HRQoL outcomes.