Radiotherapy-induced toxicity may negatively impact health-related quality of life (HRQoL). This report investigates the impact of curative-intent radiotherapy on HRQoL and toxicity in early stage and locally-advanced non-small cell lung cancer patients treated with radiotherapy or chemo-radiotherapy enrolled in the observational prospective REQUITE study.
HRQoL was assessed using the European Organisation for Research and Treatment of Cancer QLQ-C30 questionnaire up to 2 years post radiotherapy. Eleven toxicities were scored by clinicians using the Common Terminology Criteria for Adverse Events (CTCAE) version 4. Toxicity scores were calculated by subtracting baseline values. Mixed model analyses were applied to determine statistical significance (p ≤ 0.01). Meaningful clinical important differences (MCID) were determined for changes in HRQoL. Analysis was performed on the overall data, different radiotherapy techniques, multimodality treatments and disease stages.
Data of 510 patients were analysed. There was no significant change in HRQoL or its domains, except for deterioration in cognitive functioning (p = 0.01). Radiotherapy technique had no significant impact on HRQoL. The addition of chemotherapy was significantly associated with HRQoL over time (p <.001). Overall toxicity did not significantly change over time. Acute toxicities of radiation-dermatitis (p =.003), dysphagia (p =.002) and esophagitis (p <.001) peaked at 3 months and decreased thereafter. Pneumonitis initially deteriorated but improved significantly after 12 months (p =.011). A proportion of patients experienced meaningful clinically important improvements and deteriorations in overall HRQoL and its domains. In some patients, pre-treatment symptoms improved gradually.
While overall HRQoL and toxicity did not change over time, some patients improved, whereas others experienced acute radiotherapy-induced toxicities and deteriorated HRQoL, especially physical and cognitive functioning. Patient characteristics, more so than radiotherapy technique and treatment modality, impact post-radiotherapy toxicity and HRQoL outcomes. This stresses the importance of considering the potential impact of radiotherapy on individuals’ HRQoL, symptoms and toxicity in treatment decision-making.
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Lotte Van der Weijst
Miguel E Aguado-Barrera
David Azria
Patrick Berkovic
Pierre Boisselier
Erik Briers
Renée Bultijnck
Patricia Calvo-Crespo
Jenny Chang-Claude
Ananya Choudhury
Gilles Defraene
Sylvian Demontois
Alison M Dunning
Rebecca M Elliott
Dawn Ennis
Corinne Faivre-Finn
Marzia Franceschini
Sara Gutiérrez-Enríquez
Carsten Herskind
Daniel S Higginson
Sarah L Kerns
Kerstie Johnson
Meritxell Mollà
Maarten Lambrecht
Mónica Ramos
Tiziana Rancati
Andreas Rimner
Barry S Rosenstein
Dirk De Ruysscher
Ahmed Salem
Claudia Sangalli
Petra Seibold
Paloma Sosa-Fajardo
Elena Sperk
Hilary Stobart
Holly Summersgill
Veerle Surmont
Paul Symonds
Begoña Taboada-Lorenzo
Christopher J Talbot
Riccardo Valdagni
Ana Vega
Liv Veldeman
Marlon R Veldwijk
Tim Ward
Adam Webb
Catharine M L West
Yolande Lievens
References
PubMed