title: The impact of brain metastasis on quality of life, resource utilization and survival in patients with non-small-cell lung cancer.
abstract: This systematic review aims to improve understanding of the burden of disease associated with brain metastases from non-small-cell lung cancer (NSCLC) in terms of survival, quality of life (QoL) and economic impact. PubMed/MEDLINE, Cochrane collaboration and EMBASE databases were searched for articles published in English from 2000 to 2014. Of 3288 abstracts retrieved, 3156 were eliminated without a full-text review. Of the 132 articles that received a full-text review, a final set of 93 articles was included in an initial literature analysis. In order to homogenize the patient populations evaluated, we included entries that were either entirely composed of NSCLC patients or that had >50% of NSCLC patients in the total study population. From the studies identified in this systematic review, median OS and PFS varied based on the type of treatment received, although whole-brain radiotherapy (WBRT) was associated with the shortest OS and PFS durations. Regimens incorporating targeted therapy in molecularly selected patients were associated with the longest OS and PFS durations. QoL findings varied among studies, generally WBRT resulted in stable or worsening QoL scores rather than improvements. Healthcare costs were increased following diagnosis of brain metastases regardless of treatment. The findings from this review highlight the need for more effective treatments of brain metastases from NSCLC that improve survival function, QoL and potentially decrease costs.
authors.affiliation: Department of Oncology, CHUV, 1011 Lausanne, Switzerland. Electronic address: Solange.peters@chuv.ch.
authors.forename: Solange
authors.initials: S
authors.lastname: Peters
authors.affiliation: Global Pricing and Market Access, F. Hoffmann-La Roche Ltd, Building 74, CH4070 Basel, Switzerland. Electronic address: christin.bexelius@roche.com.
authors.forename: Christin
authors.initials: C
authors.lastname: Bexelius
authors.affiliation: Global Pricing and Market Access, F. Hoffmann-La Roche Ltd, Building 74, CH4070 Basel, Switzerland. Electronic address: veronica.munk@roche.com.
authors.forename: Veronica
authors.initials: V
authors.lastname: Munk
authors.affiliation: Princess Margaret Hospital/University Health Network, 610 University Avenue, Toronto M5G 2M9, Canada. Electronic address: Natasha.leighl@uhn.ca.
authors.forename: Natasha
authors.initials: N
authors.lastname: Leighl
mesh_terms: D001932:Brain Neoplasms / Q000191:economics / Q000401:mortality / Q000523:psychology / Q000532:radiotherapy / Q000556:secondary; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000628:therapy; D059248:Chemoradiotherapy / Q000191:economics / Q000379:methods / Q000523:psychology; D003362:Cost-Benefit Analysis; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D016019:Survival Analysis
keywords: Brain metastases; Cost; Non-small-cell lung cancer; Quality of life