title: Health-related quality of life after first-line anti-cancer treatments for advanced non-small cell lung cancer in clinical practice.
abstract: This study attempted to compare changes in the Quality-of-Life (QoL) scores after three different first-line anti-cancer treatments for advanced non-small cell lung cancer (NSCLC) in a real-world clinical setting.
  
  
  
  From May 2011 to December 2013, we prospectively measured the QoL scores of patients with locally advanced or metastatic NSCLC using the World Health Organization Quality-of-Life-Brief (WHOQOL-BREF) questionnaire. Each QoL measurement was matched by age and sex with one healthy referent from the National Health Interview Survey. Dynamic changes in patients' QoL scores and major determinants were repeatedly assessed by construction of a mixed-effects model to adjust for possible confounders.
  
  
  
  A total of 336 patients with 577 QoL measurements related to first-line anti-cancer treatments were enrolled. Performance status was the most important predictor of QoL scores in all domains after controlling for potential confounders. With age- and sex-matched healthy subjects as the reference, patients treated with gemcitabine + platinum showed significantly lower scores in multiple physical and psychological domain items in the WHOQOL-BREF. However, pemetrexed + platinum and gefitinib/erlotinib affected patients' QoL scores in 'energy/fatigue' and 'daily activities' with smaller magnitudes, and the scores appeared to improve after 3-4 months of treatment.
  
  
  
  Patients receiving gemcitabine + platinum as first-line anti-cancer treatment for advanced NSCLC experienced relatively poor QoL scores throughout treatment course. Studies to develop a real-time computerized system automatically updating the mixed-effects model for QoL to facilitate participatory clinical decision making by physicians, patients, and their families merit further research.
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, Tainan, 704, Taiwan.|Department of Public Health, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, Tainan, 704, Taiwan.
authors.forename: Szu-Chun
authors.initials: SC
authors.lastname: Yang
authors.affiliation: Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, Tainan, 704, Taiwan.
authors.forename: Wu-Wei
authors.initials: WW
authors.lastname: Lai
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, Tainan, 704, Taiwan.
authors.forename: Tzuen-Ren
authors.initials: TR
authors.lastname: Hsiue
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, Tainan, 704, Taiwan.
authors.forename: Wu-Chou
authors.initials: WC
authors.lastname: Su
authors.affiliation: Department of Environmental Health, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA.
authors.forename: Cheng-Kuan
authors.initials: CK
authors.lastname: Lin
authors.affiliation: Institute of Statistical Science, Academia Sinica, 128 Academia Road Section 2, Taipei, 115, Taiwan.
authors.forename: Jing-Shiang
authors.initials: JS
authors.lastname: Hwang
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, Tainan, 704, Taiwan. jdwang121@gmail.com.|Department of Public Health, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, Tainan, 704, Taiwan. jdwang121@gmail.com.|Department of Occupational and Environmental Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng Li Road, Tainan, 704, Taiwan. jdwang121@gmail.com.
authors.forename: Jung-Der
authors.initials: JD
authors.lastname: Wang
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy*; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000069347:Erlotinib Hydrochloride / Q000008:administration & dosage; D005260:Female; D000077156:Gefitinib; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D000068437:Pemetrexed / Q000008:administration & dosage; D010984:Platinum / Q000008:administration & dosage; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D011799:Quinazolines / Q000627:therapeutic use; D018434:Sickness Impact Profile; D011795:Surveys and Questionnaires; D014944:World Health Organization; D000093542:Gemcitabine
chemical_list: D000970:Antineoplastic Agents; D011799:Quinazolines; D000068437:Pemetrexed; D003841:Deoxycytidine; D010984:Platinum; D000069347:Erlotinib Hydrochloride; D000077156:Gefitinib; D000093542:Gemcitabine
keywords: Dynamic changes; Healthy reference; Lung cancer treatment; Quality of life; Repeated measurements