Health-Related Quality of Life in Early Stage Lung Cancer: A SEER-MHOS Analysis

Abstract

Treatment of early stage lung cancer currently includes surgery or SBRT. While data have been conflicting, both modalities provide similar outcomes. SEER-Medicare Health Outcomes Survey (MHOS) database is a linkage dataset between the Center for Medicare-Medicaid Service administered MHOS and SEER registry, that provides valid, reliable data to assess quality of life. Here, we compare differences in health-related quality of life (HRQOL) responses in early stage lung cancer patients treated in the SBRT era (post-2004) between those who received surgery vs. RT for the first time. Patients from the SEER-MHOS linkage database were eligible if they had a diagnosis of Stage I-II lung cancer treated by surgery alone (SURG) or radiotherapy alone (RT), were diagnosed in 2004-2013, had no other cancer diagnosis, and completed a post-diagnosis survey. Patients who received no treatment or both RT and SURG were excluded. If a patient filled out more than one survey after diagnosis, the survey completed closest to the date of diagnosis was used. The HRQOL outcomes of interest were the Veteran RAND (VR)-12 item health survey, captured by physical component summary (PCS) and mental component summary (MCS) scores. Survey responses likely to be affected by treatment to the lung were additionally analyzed. Chi-square test, t-test, and ordinal logistic regression was used to compare categorical, continuous, and ordinal variables. Multivariate models controlling for age, sex, race, ADLs, number of comorbidities, and BMI, were run to compare MHOS responses by treatment group. 490 patients met eligibility criteria with 86 (17.6%) receiving RT and 404 (82.4%) receiving SURG. Median age was 75.9 (range 65 - 93). 258 (52.6%) were men, 350 (71.4%) were white, and 128 (26.1%) had more than 4 co-morbidities. Median time from cancer diagnosis to survey completion was 35.7 (range <1 – 96) months. Patients who received RT were older (p=0.002), reported more difficulty with at least 1 ADL (p=0.004), were more likely to have BMI >35 (p=0.001), and had shorter time from cancer diagnosis to survey completion (p<0.001) compared to those who received SURG. On multivariate analysis, patients who received RT had lower PCS scores (p=0.014), more difficulty climbing a flight of stairs (p=0.004), and more shortness of breath when sitting (p<0.001), walking one block (p=0.007), and going up a flight of stairs (p=0.03) compared to those who received SURG. SEER-MHOS database provides useful information for patient-reported outcomes in patients receiving definitive therapy for early stage lung cancer. Compared to SURG, patients older than 65 who received RT had lower PSC scores and more difficulty with SOB, secondary to poorer performance status at baseline vs. treatment effects. Limitations include low number of patients receiving RT, lack of information of the type of RT or SURG received, and lack of direct comparison between individual patients pre- and post-diagnosis.