Assessment of quality of life of patients with non-small cell lung cancer receiving immunotherapy versus those receiving chemotherapy

Abstract

Introduction: Non-small cell lung cancer (NSCLC) is accompanied by a range of symptoms and is associated with a poor prognosis and significantly reduced quality of life. Immunotherapy has significantly improved overall survival compared to chemotherapy.
Aim: The assessment of the effect of immunotherapy versus chemotherapy on the quality of life in patients with NSCLC.
Material and Method: A critical review of research articles was made, using the electronic databases Pubmed, Cochrane and HEAL-Link, and the Google Scholar, in order to find Randomized Controlled Trials (RCTs), in English language, published between 2017 and 2022, involving adult patients. The search was made using the terms «immunotherapy», «chemotherapy», «Non-Small Cell Lung Cancer», «quality of life» in all possible combinations. During the initial search, 128 articles were found and after applying the review criteria, 9 RCTs were included.
Results: The difference in mean change of EORTC QLQ-C30 score was in favour of immunotherapy (2.7 to 7.8 points, p < 0.05), with the exception of one study, which showed no difference between groups. On the LCSS scale, across studies, the difference in mean change ranged between -4.4 and -9.2 points (p < 0.05), in favour of the immunotherapy group. Regarding the EQ-5D scale, the difference in mean change was in favour of immunotherapy (2.1 to 7.2 points, p < 0.05), without the results being statistically significant in two studies. From all the studies, it appears that in the immunotherapy group, compared to chemotherapy, there was a statistically significant improvement in the main symptoms. Greater improvement was seen in alopecia (-15.9 to -4.5 points), peripheral neuropathy (-12.9 to -8.4 points), appetite loss (-11.9 to -7.5 points), dyspnoea (-11.7 to -7.0 points) and cough (-10.7 to -3.4 points) (p < 0.05 for all symptoms).
Conclusion: In patients with NSCLC, immunotherapy is associated with maintenance or greater improvement of quality of life compared to classical chemotherapy. In addition to overall survival, the assessment of quality of life should be considered a determining factor for the selection of appropriate treatment in cancer patients.