Rebecca M Schwartz1,2,3, Naomi Alpert2, Kenneth Rosenzweig4, Raja Flores3,5, Emanuela Taioli2,3,5. 1. Department of Occupational Medicine, Epidemiology and Prevention, Zucker School of Medicine at Hofstra/Northwell, Great Neck, NY 11021, USA. 2. Institute for Translational Epidemiology and Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA. 3. Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA. 4. Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA. 5. Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA.
Abstract
BACKGROUND: Although surgical resection is considered the standard of care for early-stage non-small cell lung cancer, radiotherapy [stereotactic body radiation therapy (SBRT)] has been proposed as a minimally invasive treatment alternative. Studies have not examined differences in quality of life (QoL) between surgery and radiotherapy, despite important implications for patient and provider decision making. METHODS: The Surveillance, Epidemiology, and End Results Medicare Health Outcomes Survey (1998-2014) was used to assess changes in physical QoL score [Physical Component Summary (PCS)] and mental health QoL score [Mental Component Summary (MCS)] from baseline (prior to cancer diagnosis) to follow-up after treatment with surgery only or radiotherapy only. QoL was measured using the 36-item Short Form Health Survey (SF-36) until 2006, when it was replaced by the Veterans RAND 12-Item Health Survey (VR-12). RESULTS: Data from 184 patients (28 SBRT, 156 surgery) was included. There was a significant decline in PCS score from baseline to follow-up (surgery: -4.81; 95% CI: -6.31, -3.30; P<0.0001; SBRT: -5.6; 95% CI: -9.96, -1.24; P=0.0137). Similarly, MCS scores declined for both groups although the change was significant for surgery patients only (surgery: -2.96; 95% CI: -4.55, -1.37; P=0.0003; SBRT: -1.86; 95% CI: -5.4, 1.68; P=0.2902). Surgical patients had higher baseline PCS (P=0.0061) and MCS (P=0.0056) than SBRT patients. There was no significant difference in the change over time between the two treatment options for PCS or MCS. CONCLUSIONS: Although both treatments negatively impact QoL, the impact of SBRT on QoL may be comparable to surgery and therefore SBRT should be given consideration as an alternative treatment, especially when surgery is not an option.
BACKGROUND: Although surgical resection is considered the standard of care for early-stage non-small cell lung cancer, radiotherapy [stereotactic body radiation therapy (SBRT)] has been proposed as a minimally invasive treatment alternative. Studies have not examined differences in quality of life (QoL) between surgery and radiotherapy, despite important implications for patient and provider decision making. METHODS: The Surveillance, Epidemiology, and End Results Medicare Health Outcomes Survey (1998-2014) was used to assess changes in physical QoL score [Physical Component Summary (PCS)] and mental health QoL score [Mental Component Summary (MCS)] from baseline (prior to cancer diagnosis) to follow-up after treatment with surgery only or radiotherapy only. QoL was measured using the 36-item Short Form Health Survey (SF-36) until 2006, when it was replaced by the Veterans RAND 12-Item Health Survey (VR-12). RESULTS: Data from 184 patients (28 SBRT, 156 surgery) was included. There was a significant decline in PCS score from baseline to follow-up (surgery: -4.81; 95% CI: -6.31, -3.30; P<0.0001; SBRT: -5.6; 95% CI: -9.96, -1.24; P=0.0137). Similarly, MCS scores declined for both groups although the change was significant for surgery patients only (surgery: -2.96; 95% CI: -4.55, -1.37; P=0.0003; SBRT: -1.86; 95% CI: -5.4, 1.68; P=0.2902). Surgical patients had higher baseline PCS (P=0.0061) and MCS (P=0.0056) than SBRT patients. There was no significant difference in the change over time between the two treatment options for PCS or MCS. CONCLUSIONS: Although both treatments negatively impact QoL, the impact of SBRT on QoL may be comparable to surgery and therefore SBRT should be given consideration as an alternative treatment, especially when surgery is not an option.
Entities:
Keywords:
Cancer treatment; comparative effectiveness; mental health; physical health
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