Kea Turner1, Naomi C Brownstein2, Zachary Thompson3, Issam El Naqa4, Yi Luo5, Heather S L Jim6, Dana E Rollison7, Rachel Howard8, Desmond Zeng9, Stephen A Rosenberg10, Bradford Perez11, Andreas Saltos12, Laura B Oswald13, Brian D Gonzalez14, Jessica Y Islam15, Amir Alishahi Tabriz16, Wenbin Zhang17, Thomas J Dilling18. 1. Department of Health Outcomes and Behavior, Moffitt Cancer Center, USA. Electronic address: kea.turner@moffitt.org. 2. Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, USA. Electronic address: Naomi.Brownstein@moffitt.org. 3. Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, USA. Electronic address: Zachary.Thompson@moffitt.org. 4. Department of Machine Learning, Moffitt Cancer Center, USA. Electronic address: Issam.ElNaqa@moffitt.org. 5. Department of Machine Learning, Moffitt Cancer Center, USA. Electronic address: Yi.Luo@moffitt.org. 6. Department of Health Outcomes and Behavior, Moffitt Cancer Center, USA. Electronic address: Heather.Jim@moffitt.org. 7. Department of Cancer Epidemiology, Moffitt Cancer Center, USA. Electronic address: Dana.Rollison@moffitt.org. 8. Department of Health Informatics, Moffitt Cancer Center, USA. Electronic address: Rachel.Howard@moffitt.org. 9. Morsani College of Medicine, University of South Florida, USA. Electronic address: zengd@usf.edu. 10. Department of Radiation Oncology, Moffitt Cancer Center, USA; Department of Thoracic Oncology, Moffitt Cancer Center, USA. Electronic address: Stephen.Rosenberg@moffitt.org. 11. Department of Radiation Oncology, Moffitt Cancer Center, USA; Department of Thoracic Oncology, Moffitt Cancer Center, USA. Electronic address: Bradford.Perez@moffitt.org. 12. Department of Thoracic Oncology, Moffitt Cancer Center, USA. Electronic address: Andreas.Saltos@moffitt.org. 13. Department of Health Outcomes and Behavior, Moffitt Cancer Center, USA. Electronic address: Laura.Oswald@moffitt.org. 14. Department of Health Outcomes and Behavior, Moffitt Cancer Center, USA. Electronic address: Brian.Gonzalez@moffitt.org. 15. Department of Cancer Epidemiology, Moffitt Cancer Center, USA. Electronic address: Jessica.Islam@moffitt.org. 16. Department of Health Outcomes and Behavior, Moffitt Cancer Center, USA. Electronic address: Amir.Alishahi@moffitt.org. 17. Department of Machine Learning, Gates Hillman Center, Carnegie Mellon University, USA. Electronic address: wenbinzhang@cmu.edu. 18. Department of Radiation Oncology, Moffitt Cancer Center, USA; Department of Thoracic Oncology, Moffitt Cancer Center, USA. Electronic address: Thomas.Dilling@moffitt.org.
Abstract
BACKGROUND AND PURPOSE: The study objective was to determine whether longitudinal changes in patient-reported outcomes (PROs) were associated with survival among early-stage, non-small cell lung cancer (NSCLC) patients undergoing stereotactic body radiation therapy (SBRT). MATERIALS AND METHODS: Data were obtained from January 2015 through March 2020. We ran a joint probability model to assess the relationship between time-to-death, and longitudinal PRO measurements. PROs were measured through the Edmonton Symptom Assessment Scale (ESAS). We controlled for other covariates likely to affect symptom burden and survival including stage, tumor diameter, comorbidities, gender, race/ethnicity, relationship status, age, and smoking status. RESULTS: The sample included 510 early-stage NSCLC patients undergoing SBRT. The median age was 73.8 (range: 46.3-94.6). The survival component of the joint model demonstrates that longitudinal changes in ESAS scores are significantly associated with worse survival (HR: 1.04; 95% CI: 1.02-1.05). This finding suggests a one-unit increase in ESAS score increased probability of death by 4%. Other factors significantly associated with worse survival included older age (HR: 1.04; 95% CI: 1.03-1.05), larger tumor diameter (HR: 1.21; 95% CI: 1.01-1.46), male gender (HR: 1.87; 95% CI: 1.36-2.57), and current smoking status (HR: 2.39; 95% CI: 1.25-4.56). CONCLUSION: PROs are increasingly being collected as a part of routine care delivery to improve symptom management. Healthcare systems can integrate these data with other real-world data to predict patient outcomes, such as survival. Capturing longitudinal PROs-in addition to PROs at diagnosis-may add prognostic value for estimating survival among early-stage NSCLC patients undergoing SBRT.
BACKGROUND AND PURPOSE: The study objective was to determine whether longitudinal changes in patient-reported outcomes (PROs) were associated with survival among early-stage, non-small cell lung cancer (NSCLC) patients undergoing stereotactic body radiation therapy (SBRT). MATERIALS AND METHODS: Data were obtained from January 2015 through March 2020. We ran a joint probability model to assess the relationship between time-to-death, and longitudinal PRO measurements. PROs were measured through the Edmonton Symptom Assessment Scale (ESAS). We controlled for other covariates likely to affect symptom burden and survival including stage, tumor diameter, comorbidities, gender, race/ethnicity, relationship status, age, and smoking status. RESULTS: The sample included 510 early-stage NSCLC patients undergoing SBRT. The median age was 73.8 (range: 46.3-94.6). The survival component of the joint model demonstrates that longitudinal changes in ESAS scores are significantly associated with worse survival (HR: 1.04; 95% CI: 1.02-1.05). This finding suggests a one-unit increase in ESAS score increased probability of death by 4%. Other factors significantly associated with worse survival included older age (HR: 1.04; 95% CI: 1.03-1.05), larger tumor diameter (HR: 1.21; 95% CI: 1.01-1.46), male gender (HR: 1.87; 95% CI: 1.36-2.57), and current smoking status (HR: 2.39; 95% CI: 1.25-4.56). CONCLUSION: PROs are increasingly being collected as a part of routine care delivery to improve symptom management. Healthcare systems can integrate these data with other real-world data to predict patient outcomes, such as survival. Capturing longitudinal PROs-in addition to PROs at diagnosis-may add prognostic value for estimating survival among early-stage NSCLC patients undergoing SBRT.
Authors: Chantal Quinten; Francesca Martinelli; Corneel Coens; Mirjam A G Sprangers; Jolie Ringash; Carolyn Gotay; Kristin Bjordal; Eva Greimel; Bryce B Reeve; John Maringwa; Divine E Ediebah; Efstathios Zikos; Madeleine T King; David Osoba; Martin J Taphoorn; Henning Flechtner; Joseph Schmucker-Von Koch; Joachim Weis; Andrew Bottomley Journal: Cancer Date: 2013-10-11 Impact factor: 6.860
Authors: David Hui; Renata dos Santos; Suresh Reddy; Maria Salete de Angelis Nascimento; Donna S Zhukovsky; Carlos Eduardo Paiva; Shalini Dalal; Everaldo Donizeti Costa; Paul Walker; Heloisa Helena Scapulatempo; Rony Dev; Camila Souza Crovador; Maxine De La Cruz; Eduardo Bruera Journal: Palliat Med Date: 2015-04-16 Impact factor: 4.762
Authors: Camilla Zimmermann; Debika Burman; Matthew Follwell; Kristina Wakimoto; Dori Seccareccia; John Bryson; Lisa W Le; Gary Rodin Journal: Am J Hosp Palliat Care Date: 2009-09-25 Impact factor: 2.500
Authors: Nancy L Keating; Mary Beth Landrum; Selwyn O Rogers; Susan K Baum; Beth A Virnig; Haiden A Huskamp; Craig C Earle; Katherine L Kahn Journal: Cancer Date: 2010-02-15 Impact factor: 6.860