Abstract
Approximately 27% of North American cancer deaths are attributable to cancer of the lung. Many lung cancers are found at an advanced stage, rendering the tumours inoperable and the patients palliative. Common symptoms associated with palliative lung cancer include cough, hemoptysis, and dyspnea, all of which can significantly debilitate and diminish quality of life (QOL). In studies of the effects of cancer therapies, the frequent evaluative endpoints are survival and local control; however, it is imperative that clinical trials with palliative patients also have a QOL focus when a cure is unattainable. We conducted a literature review to investigate the use of QOL instrument tools in trials studying QOL or symptom palliation of primary lung cancer or lung metastases through the use of radiotherapy. We identified forty-three studies: nineteen used a QOL tool, and twenty-four examined symptom palliation without the use of a QOL instrument. The European Organization for Research and Treatment of Cancer (eortc) QLQ-C30 survey was the most commonly used QOL questionnaire (in thirteen of twenty trials). Of those thirteen studies, eight also incorporated the lung-specific QOL survey eortc QLQ-LC13 (or the eortc QLQ-LC17). A second lung-specific survey, the Functional Assessment of Cancer Therapy-Lung (fact-L) was used in only two of the twenty trials. In total, only ten of forty-three trials (23%) used a lung-specific QOL tool, suggesting that QOL was of low priority as an endpoint and that measures created for lung cancer patients are underused. We encourage investigators in future trials to include specific QOL instruments such as the eortc QLQ-LC13 or the fact-L for studies in palliative thoracic radiotherapy because those instruments provide a measure of QOL specific to patients with lung cancer or lung metastases.
Highlights
Lung cancer is a rising epidemic and remains the leading cause of cancer death in both men and women in Canada 1
Morbidity from lung cancer or lung metastases often presents as troublesome thoracic symptoms such as hemoptysis, cough, chest pain, and dyspnea
We identified a total of forty-three trials that evaluated, in at least one study arm, the use of palliative radiotherapy to the thorax, and that assessed qol or symptom palliation as a primary or secondary endpoint
Summary
Lung cancer is a rising epidemic and remains the leading cause of cancer death in both men and women in Canada 1. 500 Canadians are diagnosed with and 400 Canadians die of lung cancer every week 1. Such high morbidity and mortality in patients with primary lung cancer emphasizes the need for palliative treatment intent. Palliative radiotherapy has been effective in ameliorating these symptoms 2–4 and improves or preserves the quality of life (qol) remaining in approximately one third of affected patients 5. Clinical trials in patients with lung cancer have focused on traditional endpoints such as overall survival, disease-free survival, or local control 6. Given the relatively poor prognosis of patients with locally advanced lung cancer or lung metastases, the inclusion of qol as a primary endpoint of treatment becomes increasingly important. Studying qol is relevant in the field of palliative radiotherapy because of known treatment-related side effects and toxicities
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