Longitudinal patient-reported outcomes and survival among early-stage non-small cell lung cancer patients receiving stereotactic body radiotherapy

Abstract

Background and purposeThe study objective was to determine whether longitudinal changes in patient-reported outcomes (PROs) were associated with survival among early-stage, non-small cell lung cancer (NSCLC) patients undergoing stereotactic body radiation therapy (SBRT). Materials and methodsData were obtained from January 2015 through March 2020. We ran a joint probability model to assess the relationship between time-to-death, and longitudinal PRO measurements. PROs were measured through the Edmonton Symptom Assessment Scale (ESAS). We controlled for other covariates likely to affect symptom burden and survival including stage, tumor diameter, comorbidities, gender, race/ethnicity, relationship status, age, and smoking status. ResultsThe sample included 510 early-stage NSCLC patients undergoing SBRT. The median age was 73.8 (range: 46.3–94.6). The survival component of the joint model demonstrates that longitudinal changes in ESAS scores are significantly associated with worse survival (HR: 1.04; 95% CI: 1.02–1.05). This finding suggests a one-unit increase in ESAS score increased probability of death by 4%. Other factors significantly associated with worse survival included older age (HR: 1.04; 95% CI: 1.03–1.05), larger tumor diameter (HR: 1.21; 95% CI: 1.01–1.46), male gender (HR: 1.87; 95% CI: 1.36–2.57), and current smoking status (HR: 2.39; 95% CI: 1.25–4.56). ConclusionPROs are increasingly being collected as a part of routine care delivery to improve symptom management. Healthcare systems can integrate these data with other real-world data to predict patient outcomes, such as survival. Capturing longitudinal PROs—in addition to PROs at diagnosis—may add prognostic value for estimating survival among early-stage NSCLC patients undergoing SBRT.