Quality-of-Life Data Provide Valuable Insights in Lung Cancer Patients

Benjamin Movsas, MD

As part of our coverage of the 2017 Multidisciplinary Thoracic Cancers Symposium, we spoke with Benjamin Movsas, MD, chair of radiation oncology at Henry Ford Cancer Institute in Detroit. Dr. Movsas gave a presentation at the meeting on how measuring quality of life in patients with lung cancer can be used to help guide treatment and inform outcomes.

 -Interviewed by Ian Ingram 

Cancer Network: Could you give us an overview of the presentation you gave at this symposium?

Dr. Movsas: My presentation was really about the critical role of quality of life in lung cancer. Recent studies have shown that by obtaining quality of life from patients we can learn things that we wouldn’t have known about without it. For example, in the NRG/RTOG 0617 study, which randomized patients with stage III lung cancer to different doses of radiation (74 Gy vs 60 Gy) along with chemotherapy, we found out that the higher dose of radiation unfortunately turned out to have a worse outcome than the standard radiation dose. This was quite perplexing. Why was this the case?

When we looked at the side effects of treatment, they weren’t all that different (except for more short-term swallowing symptoms in the higher-dose arm, as expected), but when we turned to the patients and asked them via quality-of-life validated instruments what was going on, this became much clearer, because the quality of life was actually much more negatively affected in the higher-dose radiotherapy arm than it was in the standard-dose arm. Suddenly, the unexpected results started to make more sense.

Cancer Network: What information does quality of life provide that we aren’t currently getting from other assessments?

Dr. Movsas: I think the key message is that without asking the patients directly what their experience is, we as physicians and other healthcare providers, can’t assume that we really understand. There’s clearly a disconnect between what we think is going on and what is really going on. So by asking the patients and getting their story directly, so to speak, we can then make much more fine-tuned recommendations.

For example, in the NRG/RTOG 0617 study, the doctors could either use standard 3D radiotherapy or the more sophisticated intensity-modulated radiation therapy (IMRT). If you just look at outcomes like survival, it would be very difficult to sort out differences between these two technologies (which were not randomized in this study). But in a secondary analysis of the trial, what was fascinating was when we looked at quality of life with the validated Functional Assessment of Cancer Therapy–Lung Cancer Subscale, the data suggested that a full year after treatment, the patients who received the more sophisticated IMRT had dramatically better quality of life than the patients who received the more standard 3D radiation. I think this is partly because the quality-of-life information is so much more sensitive than outcomes like toxicity scoring. And it’s coming directly from the patients so it really gives us a much broader perspective.

Cancer Network: How has the thinking with regard to examining quality of life in cancer patients changed over the years?

Dr. Movsas: We’ve been studying quality of life now for some time, probably several decades, and the good news is that it has become much more accepted, especially in cancer trials, to include quality of life-and that’s very important. I think where the field has to go, though, is we have to move beyond research. We need to move quality of life directly into our clinics. Just like we use blood pressure, temperature, or other signs like performance status-which we gather routinely in the clinic and based upon these factors make different recommendations and go down different pathways-we should use quality of life as another key parameter. We now have abbreviated, validated, quality-of-life instruments. They can be done electronically; they can be done on the web. Let’s offer it to our patients so they can share this critical information with us more readily, more easily, and we can actually use this critical information to help them. I believe this is something that really can happen.

It’s fascinating that in several of our studies, the quality of life that the patients told us on these validated instruments, before treatment, was a stronger predictor for their survival 5 years later than the any of the classic predictors like stage or performance status-the parameters that we use in the clinic all the time, and yet quality of life was more important than these factors. So it behooves us to use this quality-of-life information so we can better help our patients in terms of what treatments would be most effective in different situations.