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Early Change in Patient-Reported Health During Lung Cancer Chemotherapy Predicts Clinical Outcomes Beyond Those Predicted by Baseline Report: Results From Eastern Cooperative Oncology Group Study 5592

David T. Eton, Diane L. Fairclough, David Cella, Susan E. Yount, Philip Bonomi, David H. Johnson

From Evanston Northwestern Healthcare and Northwestern University, Evanston, and Rush-Presbyterian St. Luke’s Medical Center, Chicago, IL; University of Colorado Health Sciences Center, Denver, CO; and Vanderbilt University, Nashville, TN.

Address reprint requests to David T. Eton, PhD, 1001 University Place, Suite 100, Evanston, IL 60201; email: d-eton{at}northwestern.edu.

Purpose: To determine the ability of longitudinal patient-reported health (PRH) scores to enhance prediction of clinical outcomes beyond baseline scores.

Patients and Methods: In 573 advanced non–small-cell lung cancer patients enrolled in a phase III clinical trial, we used baseline and 6-week follow-up PRH scores to predict best response to treatment, disease progression, and survival. Using regression analyses, we tested the predictive ability of the five subscales of the Functional Assessment of Cancer Therapy–Lung (physical, functional, social/family, emotional well-being, and the lung cancer subscale) as well as the trial outcome index (TOI) aggregate score.

Results: After clinical factors were controlled for, baseline physical well-being (PWB) and TOI scores predicted all three clinical outcomes. A higher baseline PWB score was associated with a better response to treatment (odds ratio, 1.09; P < .001) and lower risk of death (risk ratio, 0.95; P < .001). Higher baseline TOI score was associated with a lower risk of disease progression (risk ratio, 0.98; P < .001). These two baseline predictors (PWB and TOI) were then used along with 6-week change scores to classify patients into four groups: low baseline-declined, low baseline-improved, high baseline-declined, and high baseline-improved. Patients with low baseline-declined PWB scores showed the worst responses to treatment and survived the shortest duration. Patients with low baseline-declined TOI scores had the shortest time to progression.

Conclusion: The physical aspects of baseline PRH and PRH change during chemotherapy are significant predictors of clinical outcomes in lung cancer. This has implications for patient stratification in clinical trials and may aid decision-making in clinical practice.

Supported in part by Public Health Service grants from the National Cancer Institute, National Institutes of Health, and the Department of Health and Human Services (CA23318, CA66636, CA21115, CA17145, and CA49957).

The contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute.

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