Incorporating a Holistic Patient Perspective When Assessing the Value of Non-Small Cell Lung Cancer (NSCLC) Therapies

OBJECTIVES: Conventional NSCLC value assessments prioritize clinical benefit (survival, time to progression, tumor response, symptomatic improvement), potentially undervaluing treatments that could deliver other important benefits to patients, caregivers, and society, driving innovation. We sought to identify patient/caregiver-relevant value elements to support incorporation of broader value sources alongside clinical considerations.

METHODS: We searched Ovid for patient- and society-relevant outcomes in adults with NSCLC (i.e., non-interventional studies) applying a predefined algorithm supplemented by international medical and advocacy organizations’ websites. Relevant studies (utilizing a prespecified topic list) were used to construct value themes and subcategories that were further explored in structured interviews with patients with advanced NSCLC and advocates (from Canada, Germany, USA). Ad-hoc literature searches explored additional value elements and subcategories.

RESULTS: From 2,902 articles initially identified, 338 underwent full-text review with prioritization (high [n=63], medium [n=21], low [excluded due to availability of more recent evidence]). Ad-hoc searches added 20 publications, with 100 studies ultimately included. Evidence was grouped by value element and subtheme, including subthemes identified by patients/advocates: 1) Hope (from patient perspective): ~1/3 of patients with NSCLC experience depression and anxiety due to relapse risk, placing significant value on hope for cure or no disease progression. 2) Economics: impacts on patients’ employment and finances (~1/6 of patients with lung cancer permanently leave the workforce), societal costs, and productivity losses. 3) Caregiver impact: physical, mental, and emotional effects on caregivers, who on average were found to devote 16 hours/week over 51.5 weeks. 4) Equity: access to diagnostics, experts, and treatments; for example, a shortage of 2,258 US oncologists is projected for 2025. 5) Patient engagement in research, potentially benefiting future patients.

CONCLUSIONS: People with NSCLC value hope, economic considerations, caregiver impact, equity, and patient-driven research. Harmonizing patient/caregiver values with conventional value assessment measures (eg, clinical benefit, cost) could benefit patients, caregivers, society, and healthcare systems.