Abstract
BACKGROUND: Understanding the symptom burden experienced by patients with cancer can enable appropriate supportive care. Our aim was to describe patient-reported outcomes (PROs) for patients with metastatic NSCLC initiating first-line (1L) systemic therapy under usual care at a large academic center. METHODS: Patients eligible for this prospective observational study were ≥ 18 years old when initiating 1L systemic therapy for stage IV NSCLC from January 1, 2017 to December 31, 2020. Patients completed two PRO questionnaires before 1L therapy initiation (baseline) and every ~6 weeks at imaging visits thereafter: the MD Anderson Symptom Inventory for lung cancer (MDASI-LC) and EuroQol EQ-5D-5L. Study follow-up ended on June 30, 2021. RESULTS: The 609 eligible patients (median age, 63 years; range, 24-87; 51% men) received 1L chemotherapy plus immunotherapy (38%), targeted therapy (29%), chemotherapy (19%), or immunotherapy (13%). The five most severe MDASI-LC symptoms among all assessments were fatigue, pain, shortness of breath, disturbed sleep, and dry mouth; 17%-32% of assessments were rated as moderate or severe. Of all assessments, 39% recorded moderate to severe symptom interference with physical aspects of daily life, and 22% reported moderate to severe interference with affective aspects. Symptom and interference subscale scores generally declined from baseline to 102 weeks overall and for the four 1L regimens. CONCLUSION: Our findings confirm previous findings that patients with a new diagnosis of metastatic NSCLC experience a moderate symptom burden. More research is needed to identify predictors and causes of this symptom burden so that it can be effectively addressed.