Abstract
ObjectivesCancer diagnoses at later stages are associated with a decrease in health-related quality of life (HRQOL). Health state utility values (HSUVs) reflect preference-based HRQOL and can vary based on cancer type, stage, treatment, and disease progression. Detecting and treating cancer at earlier stages may lead to improved HRQOL, which is important for value assessments. We describe published HSUVs by cancer type and stage.MethodsA systematic review was conducted using Embase, MEDLINE®, EconLit, and gray literature to identify studies published from January 1999 to September 2019 that reported HSUVs by cancer type and stage. Disutility values were calculated from differences in reported HSUVs across cancer stages.ResultsFrom 13,872 publications, 27 were eligible for evidence synthesis. The most frequent cancer types were breast (n = 9), lung (n = 5), colorectal (n = 4), and cervical cancer (n = 3). Mean HSUVs decreased with increased cancer stage, with consistently lower values seen in stage IV or later-stage cancer across studies (e.g., − 0.74, − 0.44, and − 0.51 for breast, colorectal, and cervical cancer, respectively). Disutility values were highest between later-stage (metastatic or stage IV) cancers compared to earlier-stage (localized or stage I–III) cancers.ConclusionsThis study provides a summary of HSUVs across different cancer types and stages that can inform economic evaluations. Despite the large variation in HSUVs overall, a consistent decline in HSUVs can be seen in the later stages, including stage IV. These findings indicate substantial impairment on individuals’ quality of life and suggest value in early detection and intervention.
Highlights
Cancer is the second leading cause of death globally and led to an estimated 9.6 million deaths in 2018 [1, 2]
Tumor size, lymph node involvement, and presence or absence of metastasis are used to define the stage of cancer, with stage 0 indicating tumors that have not spread to other sites, stages I–III indicating localized tumors ranging in size and lymph node involvement, and stage IV indicating distant metastasis [4]
While most subgroup analyses in this study showed a consistent trend of decreasing Health state utility values (HSUVs) with later stages, treatment-based subgroups defined as patients receiving chemotherapy, platinum surgery with chemotherapy, and platinum chemotherapy showed a trend for slight increases in HSUVs at stage IV vs stage III [45]
Summary
Cancer is the second leading cause of death globally and led to an estimated 9.6 million deaths in 2018 [1, 2]. Approximately 1 in 6 deaths is due to cancer [2]. Cancer is a heterogeneous disease which can affect different parts of the body and can spread to other organs. Tumor size, lymph node involvement, and presence or absence of metastasis are used to define the stage of cancer, with stage 0 indicating tumors that have not spread to other sites (i.e., in situ), stages I–III indicating localized tumors ranging in size and lymph node involvement, and stage IV indicating distant metastasis [4]
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