OBJECTIVES

This study aimed to estimate the dynamic changes of utility values for all subtypes of lung cancer. The changes after different kinds of treatment and their major determinants were explored.

METHODS

From 2011 to 2017, all lung cancer patients who visited a medical center were invited to fill out the EuroQol five-dimension (EQ-5D) and World Health Organization Quality of Life-Brief (WHOQOL-BREF) questionnaires at each clinic visit. Utility values of QoL after diagnosis and treatment were depicted using a kernel smoothing method and their major determinants were repeatedly assessed for constructing a linear mixed model and cross-validated with domain scores of WHOQOL-BREF.

RESULTS

A total of 1,715 patients were enrolled, with 6,762 QoL measurements. Utility values were lower in old-aged, small-cell, and advanced-stage subjects. Patients receiving second- and third-line targeted therapy experienced a higher mean utility (progression-free: 0.89 and 0.84, progression: 0.85 and 0.79, respectively) than those under chemotherapy (progression-free: 0.83 and 0.82, progression: 0.72 and 0.71, respectively). After adjustments with mixed effects models, we found performance status, disease progression, tumor metastasis, line of treatment and targeted therapy were major determinants of utility values. There was convergent validity between utility and scores of physical and psychological domains.

CONCLUSIONS : Targeted therapy provided higher utility values than those of chemotherapy in treated patients. Adding psychometric QoL measurements for lung cancer survivors would improve the care of such patients.